Monday, September 20, 2004

Patient, Can You Spare a Dime?

I found this recent Washington Post story about doctors asking patients for voluntary donations to help offset rising malpractice insurance costs.
Kenneth M. Greene wasn't sure how his 1,500 patients would react when he asked them for a $10 contribution to help pay his $11,000 malpractice insurance bill.

"The medical malpractice insurance crisis has come full force to Maryland," the 47-year-old Towson internist declared in a letter he sent last December. A "small donation . . . is necessary if we are to continue to keep our doors open."

Nine hundred miles away in North Palm Beach, Fla., family physician Ira G. Warshaw launched a similar plan. Warshaw asked his 3,000 patients to send him a check for $125 ($25 if they were under 25) to help defray his $30,000 insurance bill, which has quadrupled since 2002. If patients didn't send him money, Warshaw warned in a letter earlier this year, he might be forced to stop participating with Medicare and some health plans.

"I felt like I was drowning, really," said Warshaw, a solo practitioner who said he felt "some guilt" about his request but was also grappling with a $100,000 debt from a failed venture in group practice. He felt compelled to act, he said, after his income dipped below the national average for his specialty, roughly $140,000.

I am fortunate to have an annual malpractice premium of about $5500, but then again, I'm in California (where malpractice rates have generally held steady) plus this is my first year of solo practice. Malpractice rates are designed to rise as your practice grows.

I think this is a reasonable request for doctors to make, basically to ask patients to help pay for the cost of doing business, especially if insurance reimbursements aren't enough to cover the costs. There is no free lunch, after all. High malpractice judgements = higher malpractice premiums = higher operating expenses which get paid by whom? Insurance reimbursement rates are relatively fixed by the Medicare fee schedule, so doctors can't charge patient more for services. But the money's got to come from somewhere.

Let the doctor pay for it out of their own income, some say. After all, he/she is still making enough money. The public may see an annual salary of $100,000+ and consider that adequate compensation. On the other hand, a doctor who has spent 7 to 12 years of their life in post-graduate training, with huge debts from school loans, who has spent countless sleepless nights of being on call, and who now has a young family with growing children whom he/she can barely spend time with because of long working hours and patient responsibilities would probably consider this inadequate compensation.


As for my growing practice, I am fortunate to have more patients calling me in the past 2 weeks. I am nowhere near making a profit yet, but I am getting close to the number of patients I need to see to break even: 3 patients a day. Of course, it would help a lot once I start submitting medical bills regularly for reimbursement, won't it?