“I don’t care where you do the cases I refer to you.”  This is what an ear nose and throat partner of mine recently heard from a hospital-employed primary care doc.  “Just come on down to “our” hospital.  We need an ENT specialist here.  My partner had been honest and open when he told this primary care doctor that children and certain difficult adult patients would need to be operated on at the surgery center where he was a partner, rather than the hospital that employed this doctor.  “No problem!”  “We just want you down here running a clinic.”  

What followed was a bait and switch that is all too common.  What my partner did in response to the hospital is not common, and is why I am writing this.  An adult patient without insurance, but needing a sinus surgery came into this clinic.  He didn’t have any particular health issues that made my partner feel like he needed to bring him to our surgery center.  He just didn’t have any insurance.  He was going to have to pay for this out of his pocket.  My partner consulted the pricing page at our surgery center and told this patient how much it was going to cost.  Out of courtesy, he called the administration of the hospital where this clinic was located and asked them for a price for this uninsured patient.  ”$20,000” was the answer.  And that didn’t include the surgeon and anesthesia charges, unlike our answer (ours for his condition was $3795…for everything and everyone).  

After the surgery, my partner had a very different conversation with the primary care doctor.  ”Why the hell did you operate on Mr. Jones at The Surgery Center of Oklahoma?” “Because they had the best price by far and he was uninsured.”  “I don’t care.  You should have done that surgery here!”

Now the good part.  My partner walked away from that clinic and never went back.  Many physicians would have sucked it up and stayed and dealt with coercive and compromised fools like this, hoping to stay as busy as they could.  ”One of us has to be the advocate for patients, and as his primary care doc, that is supposed to be you.”  Having said this, the doctor employee didn’t know what to say, and my partner said nothing more.  He just left.

The extent to which the interests of patients have been compromised by the employment of physicians by hospitals is vast, I think.  This exchange represents just the surface of the problem.  Once again, patients should make sure that their doctor is working for them, not for someone else.

G. Keith Smith, M.D.