“I don’t want to have anything to do with the money part of medicine.”  “I just want to practice medicine and leave all of that money stuff to someone else.”  “I’m not any good  at the business stuff.”  “I just want to do what I know I’m good at and pick up my check at the end of the month.”  “Someone else can deal with the headache of my overhead, employees and malpractice.”  “If I talk to patients about money, they’ll think I’m greedy.  They’ll think that’s why I went in to medicine.”  “I just do the right thing, no matter what it costs. ” “Discussing costs makes it look like you are willing to cut corners.”  “I only practice the best medicine.  If people can’t afford it, that’s their problem.”  

If you are a physician reading this, you’ve heard physicians say some of these things, particularly the younger ones.  If you are not a physician reading this, I am going to help you understand what doctors who say these things really mean and what it means for you.

The statements above are quite simply a cop out.  In this day and age, in particular, financial abandoning of the patient, leaving them easy prey for the hospital wolves and others, is simply unethical, however difficult it may be for some physicians to read this. “Not for profit” hospitals are busy buying physician practices so that they will develop this mentality, one which serves to make these corporate giants even richer.  

“They charged me $8300 for that scorpion anti-venom! I didn’t know it was going to be that much and am not sure how I’m going to pay for it.”  “Doctor, why would you send me to a hospital that charges $730 for a drug that an outpatient surgery center like the Surgery Center of Oklahoma won’t charge me for at all?”  “I wish someone had told me what my options were so I’d have an idea how much all of this was going to cost.”  “That antibiotic you prescribed for me was $650.  I would have liked to know about other options.”  

What doctors who treat their patients as if money is no object and pretend to be disinterested in the financial part of health care, really mean by abandoning their patients is this:  ”you’re on your own.”  ”I’ve done my part, and now I’m out of here.”  ”Good luck.”  This, of course, is exactly what the hospital-employed doctor is thinking.  He has a salary and a practice whether you come back or not.  He has an income whether he sends you to a horrible hospital-employed colleague or not.  He really could not care less whether you are bankrupted by the hospital wolves.  He is likely bonused by bankrupting you and very likely punished for any move on his part to curtail patient costs.  The automatic ordering of tests and referrals by the electronic medical records systems used by many corporate hospitals as a method of controlling their doctor employees, serves to run up the cost of care for anyone that comes in contact with it.

This is what I call “churning.”  This maximization of profit seeking from patients who have insurance, particularly if they’ve not yet reached their lifetime limit, is commonplace now.  Divorce lawyers are famous for “churning,” that is, conspiring to stir up trouble during a difficult divorce, so both sides benefit from the ensuing litigation.  Corporate hospitals, are also into this game, ordering unnecessary lab and nutrition consultations and the like.  Making this sort of robbery routine is easy now with electronic medical records systems, the physician orders for these money squeezing games no longer necessary, just part of the default program.  

“Doctor, my husband died in a car accident two days after my surgery at your surgery center.”  “I simply don’t know how I am going to pay you.”  Owning and operating a facility gives the doctors the ability to control the quality of care in that facility and gives complete control over the financial exposure of the patients.  Facility ownership brings another level of accountability to the patient, a financial accountability.  The doctor can no longer say, “if the hospital is bankrupting you, that’s none of my affair.  You’ll have to talk with them.”  On the contrary, no physician can simultaneously bankrupt a patient while claiming to be their advocate!  Physician ownership of facilities allows for the operation of a true “not for profit” enterprise, one where on a case by case basis, patient circumstances can be considered and no facility profit can be dictated if this is appropriate.  Physician ownership was the rule until the 1960’s with the appearance of the community hospitals.  Many times these facilities took the place of those owned and operated by local physicians.  Thus was born the extreme profit seeking and greedy corporate hospitals, the most gigantic profit seekers in health care today.  Beginning to see why physician-owned hospitals were outlawed by Obamacare while the adoption of the electronic medical record systems was mandated?  

Let your physician know that you want to talk about the financial aspects of your health care when you see them.  Don’t waste your time though if he/she works for a hospital.  They’re not working for you.

G. Keith Smith, M.D.