Physicians should switch to a billable hours system. Lawyers are now breaking the $1,000 per hour mark, while physicians are taking it hard with an impending 10% Medicare fee cut next year.
Here’s what a trial lawyer says about breaking the $1K per hour barrier:
“Frankly, it’s a little hard to think about anyone who doesn’t save lives being worth this much money,” says David Boies, one of the nation’s best-known trial lawyers, at the Armonk, N.Y., office of Boies, Schiller & Flexner LLP.
Related posts:
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- Malpractice defense lawyers: Do they lead physicians astray?
- Ann Coulter on doctors and lawyers
- My take: Primary care, treating lawyers, bitter at doctors
- Doctors and lawyers agree on a malpractice bill
- So much for prevention saving money
- Lawyers in the ER
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{ 36 comments }
what kind of legal work compares to the decisions and dexterity that a surgeon makes . what kind of decisions could warrant that kind of pay. even a family practicioner makes more medical decisions in an hour which demand a broad range of knowledge… what coudl a laywer possibly do for you ? be suave on the phone? well, if you really want that result and you have the $…. doctors clearly deserve higher salaries than lawyers. but the lawyers demand more.
What could a lawyer do that would justify $1000/hr? Well, if he could lobby effectively enough to have the Medicare cuts aborted, say, for 200 billed hours, would that be worthwhile?
Hourly rates at that level are for buying special influence, the access that a senior partner in a major firm would have among influential members of Congress and the administration or access to key people in foreign governments. If the welfare of your company or industry requires that kind of access, then that can be cheap money, depending on what is at stake.
You don’t pay someone $1000 per hour for cold calls, you pay them for their connections. Partners at that billable level often have a team of associates who do the grunt work, many of whom are very skilled attorneys themselves.
Exactly. I believe Boies represented Clinton at the impeachment trial.
I’m sure that O.J. Simpson paid his lawyers the big bucks and that’s the price of FREEDOM.
Boy, Kevin, if bashing all socialized medicine wasn’t enough to pigeon hole you, now you want to hold up lawyers as the model for reasonable billing practices! Priceless.
Lawyers are the people who charge clients for driving to court (at full hourly rate) and charge another client for consulting on the phone while driving.
I can’t wait untill hospitals try and make all of resident’s hours billable. Yeah, that will improve quality of care and reduce costs :-p
Double billing like that is illegal. If you know of a lawyer doing it, you should contact their local bar. They will be punished.
Hi, as a medical student I am generally well on the side of physicians in these inter-professional shouting matches, but I think that some of these comments are going a little too far.
It’s true that medical malpractice pits doctors against lawyers, but I don’t think that we can deny the crucial role that the law has in our society. Just in case you guys don’t realize it, lawyers are the law. There can be no law without them.
If the question is “what could a lawyer possibly do that would justify $1000/hr”, just think of an outcome that you would be willing to pay that much for an you’ll have your answer… Maybe arguing in front of the supreme court and changing the interpretation of our constitution, or maybe stopping somebody from rezoning your business, or keeping you off death row…
And I don’t think that it’s obvious that doctors deserve to make more money than lawyers. Maybe lawyers deserve to make more, they seem more miserable…
” . . . illegal. ” ROFLOL!
In any case, the billing practices of top attorneys may be an appropriate source of guidance for hyenas and vultures but are not a useful guide for ethical behavior by even ordinary attorneys serving ordinary people, much less a helping profession like medicine. They are talking about top of the food chain predators feeding off the greed and mendacity of 100 million dollar a year CEO’s of multibillion dollar corporations in deals worth hundreds of millions. For taking out the tonsils of Mrs Jones who makes 12.35 an hour at the beauty parlor, it is unconsciousable to even consider.
On the other hand, if one of those 900 dollar an hour guys come to see you, you have my blessing to practice reciprocity billing. If you do, don’t forget to bill for having lunch with the refering physician, add the food tab, and bill for sending the bill as well as filing and appealing any insurance claims.
In principle I support hourly billing by physicians and essentially do that in my psych practice. The practices of some lawyers of charging for a 15 minute phone call for a 2 minute call, for charging for “research” they have actually already done for similar cases, for inserting boiler plate into documents at a rate as if they had to generate denova, are in my opinion, simple theft and I would hope would never be emulated by our profession.
Why would anyone think that people wealthy enough to pay these fees would allow their lawyers to double bill them? Do you think multibillion dollar companies just let poor billing practices slide by?
Why should Mrs. Jones receive a reduced rate simply because she makes less? Unless of course you’re arguing she has a “right” to that treatment at a price you, or the govt. deem appropriate.
Ordinary legal disputes don’t typically require the services of someone with close ties to the Clintons, so isn’t the market doing its work?
If physicians did it that way, no doubt some would be able to differentiate themselves from the herd in a manner to justify those fees, just like star architects, lawyers, etc.
The person paying $1000/hour or more is likely to be somebody wealthy who is facing a very grave situation who wants “the best” Think O.J..
Now if that very same person walks into your office with a life-or-death situation, you will not be able to collect more than their “allowable”, even if you save their life. Medicine is much more egalitarian in this regard than other professions or businesses.
Simply because you signed a contract with their health insurer which already set your rate for the work doesn’t make you more egalitarian. You traded that set rate for getting access to all their insured and presumably getting you a steady income stream.
No different than an insurance defense attorney.
Oh please! You really do not have a choice.
Really?
http://medrants.com/index.php/archives/3315
“You traded that set rate for getting access to all their insured and presumably getting you a steady income stream.”
Balderdash. What I traded was the right to set my own rates and ceded my economic value to a quasi-monopoly which sets rates based on the federal Medicare monopoly and which reaps profits at my expense. I get no “exclusive” on their patients; all the docs in town are on the same plans. If you choose not to participate, your patients essentially have no choice but not to see you, as their health insurance is dictated by employer or government fiat. This is an antitrust matter plain and simple.
Balderdash is a fun game. If anyone wants to get together and play, I’m up for it.
” What I traded was the right to set my own rates and ceded my economic value to a quasi-monopoly which sets rates based on the federal Medicare monopoly and which reaps profits at my expense.”
Whether I agree or disagree with you, the key phrase in there is “I traded”. YOU made that choice. Have you since decided it’s a bad one? Perhaps. Others might think it’s a fine trade if they compared your standard of living to theirs.
But YOU made that choice. If you don’t like it, don’t make it again.
You say there aren’t other patients out there, but approx 15% of America is uninsured. Surely another at least 5% would pay you a premium for more access to your time, to be treated a little differently. So why not try it if you don’t like the last deal you cut?
Oh piffle! One does not “cut a deal” when the letter arrives unilaterally dictating the latest change of terms and reimbursement of a contract that perpetually renews without negotiation. What I would like to do is send a letter explaining my costs have risen X percent this year and as a result the terms of the contract will include a X% increase in reimbursement over the previous year’s rates. Of course I have no market power and cannot discuss my plans with other local physicians (that would be an antitrust violation). And to think some of the feds worry about Whole Foods acquiring Wild Oats or Sirius acquiring XM.
“Why would anyone think that people wealthy enough to pay these fees would allow their lawyers to double bill them? Do you think multibillion dollar companies just let poor billing practices slide by?”
Happens all the time. The driving to court and consulting with a different client on the phone is common enough and each charge is legitimate on its own and impossible to dispute unless by some miracle you happen to have access to time stamped logs of all of a lawyers billing activity and not just your case.
An even more common practice is rounding up. Legal billing increments are typically 1/10 of an hour. Some lawyers will dash off a bunch of cc’s to clients that take a minute or two each and bill for the minimum 6 minutes.
Because the pressure is on lawyers to produce un-godly amounts of billable time for the firm, the impetus is on them to find ways to bill hours. If they don’t have work, they’ll make it even if it means thinking about a case while on the can and then billing for it.
If Kevin thinks that hourly billing by doctors is a good idea then chances are he hasn’t thought the whole thing through.
“Of course I have no market power and cannot discuss my plans with other local physicians (that would be an antitrust violation).”
Why do you think this? What case out there makes it impossible for you to discuss opting out of these insurance contracts?
People are doing it all the time. Go to http://www.medrants.com for a discussion of a number of physicians doing it.
The only person keeping you from getting control of your practice is you.
Anon 10:34,
If you’re a physician I know you get paid by health insurers. Any lawyer who gets his work from and is paid by liability carriers is subject to the same scrutiny you are. As for working for large companies as outside counsel, all I can tell you is that you’re a fool if you think that someone can bill that loose very often and get away with it very long. Particularly if you want to keep them as a long term client.
The billable hour is certainly the way to go for physicians, IF you believe your lifestyle and your work product would be improved by not having the time constraints many of you are currently subjected to.
This month’s ABA Journal has an article on getting rid of the billable hour, by Scott Turow, more famous as a writer than as a lawyer. Link.
I bill by the hour as a neuropsychologist, not as a physician and it is a good system. I generally get reimbursed 50-60% by insurance, NF, or WC. The bottom line in all this is that you are only worth what someone is willing to pay you.
Dominic A. Carone, Ph.D.
Founder and Webmaster of MedFriendly.com and The MedFriendly blog.
I had a surgery that lasted just under 45 minutes. The cost was over 20,000.00 so I guess some Drs. do make far more than 1,000.00 per hr. Now if you want to think we should pay 1,000.00 to visit the PCP and have our BP taken you have lost your marbles.
You are the whinniest bunch of grown men ever born.
“As for working for large companies as outside counsel, all I can tell you is that you’re a fool if you think that someone can bill that loose very often and get away with it very long. Particularly if you want to keep them as a long term client.”
I speak not of me, nor even the mythical friend. No, I would think that flaunting one’s crimes in a forum is a stupid thing. However, attorneys contracted by insurance companies make less per hour than those fancy $900 litigators. That being so, they are actually under more pressure to find ways to bill clients to meet the firm’s minimum billing hours.
Fudged billing happens all the time. The fact that you doubt it is only evidence that that practice is successful, not that it doesn’t exist. You’d be amazed how many lawyers can bill more than 48 hours in the weekend before hours are due…
sure. fudgable bills. when i was an anesthesia resident. we would commonly round to the next 5 minute interval for billing. we were doing alot of time keeping for billing. we made sure that all the anesthesia time was billed. but i never knew how much that was reimbursed for. surely 5 minutes is probably 40-50 dollars..
to anonymous 12:01 am
Was the $20,000 cost of your surgery from the doctor’s bill alone? And if so, was it for cosmetic surgery? (which by the way is not covered by health insurance companies so you are going to be paying out of pocket) The total costs of surgery also includes hospital equipment costs, nursing costs, laboratory costs, etc.
Guys:
You are wasting your time with the anon (AKA CJD) who states “just stop taking private insurance/medicare/medicaid”. He doesn’t understand the business side of medicine and the virtual monopoly controlled by the “big three”. What he uses as examples are the few conceirge docs/elective procedure specialists that can do this. We in the biz know that accounts for a small minority of all patients. For what he suggests to work for most docs (not all CJD) would be a total change in the payer system from third party to direct from the patient with the third party going to the pt not the doc. Maybe not a bad idea, but in the real world this will never ever happen. From what I can tell, CJD appears to be some governmental beurocrat and entirely too much time on his hands during the work day.
You’re right. I’m an idiot with no concept of business. You guys should continue doing EXACTLY what you’re doing, entering into the same contracts that make you unhappy now, and things will change.
That’s how the world works. If only I’d seen it.
“The fact that you doubt it is only evidence that that practice is successful, not that it doesn’t exist. You’d be amazed how many lawyers can bill more than 48 hours in the weekend before hours are due…”
I’m amazed that someone who knows so much about illegal billing practices hasn’t turned more people into the bar.
“I’m amazed that someone who knows so much about illegal billing practices hasn’t turned more people into the bar.”
Yeah, that would work. It would be easier to hold back a river with my hands. Oh, and that small matter of finding a new job.
I could report a lawyer or two, but I’d never get the chance again and these lawyers are still doing their cases right, so their billing may be questionable–but that’s it, its “questionable,” plenty of room for the Bar to let them of the hook and sell me down the river.
That’s quite the high horse you are looking down on me from.
Thanks for making my point CJD
“Thanks for making my point CJD”
Who are you talking to Annon 7:11? If you wish to refer to another post you need to quote from it or cite the authors name or Anon posting time. Plus, you assume that it is obvious what earlier point you made that you seem to think Annon 12:34 made for you. It isn’t.
Bravo Anon 8:58 for the intelligence work. We need you at the NSA; who knows maybe we would have Bin Laden by now.
on reading this blog and its comments i cant possibly think where our profession as a doctor is heading. people come to us at a time wen they are at their lowest for not only treatment but also they trust their lives in our hands. i do think the situation currently in doctor patient relation is due to our measuring of our help in monetary gain. if i just wanted money i would have taken up any other profession as you rightly said even plumber earns more than us. i think in order to be a good doctor it is necessary to be a good human being and not just delve in money.
you may think wat does an intern know about the life of a practioner, well i think if you try to help the patient irrespective of their paying capability and see the joy on the faces of the people you heal you will see the difference. this is wat my teachers and my patients have taught me.
Here’s a Novel Idea.
Legalaid and Legalcare based on the same rate structure Medicaid and Medicare Doctors receive.
For all Americans not just seniors.
Few can afford the cost of legal counsel.
Dale DeLong
Houston, TX
I’d love to be one of those lawyers who charges $1000/hr. Not many can do that. The standard billable hour rate for attorneys is more like $250-$300. Economically, physicians as a whole fare far better than most lawyers. A lawyer can expect to make about $55,000/year the first five years out of law school. Those that make more than that have no life, and they still don’t make as much as doctors.
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