Two lawyers write an article in JAMA, saying that it’s the physician’s moral obligation to give free care. They seem immune to the financial pressures doctors face, and as lawyers, really are not in a place to lecture:
Ludwig and Nestle adopt a scolding tone to physicians that ask for immediate co-payments and attempt to collect on overdue bills. The authors site the AMA’s ethical opinion that urges ‘compassion and discretion in hardship cases.’
Every doctor I know gives some degree of charity care to patients, but in the end, it’s impossible do so if the bills aren’t paid:
The fact that it ignores the first rule of business, that if revenues don’t meet expenses the doors shut.
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{ 9 comments }
No margin, no mission.
One can not give free care if it can jeopardize the survival of the business.
Is it any wonder why the AMA suffers the exodus of membership by American doctors? These people must have brains borrowed from sheep.
Are these lawyers providing free “care” to anyone and everyone that walks in their door?
Hi, sorry to be an anon with a correction here–it should be “Hall and Schneider” taking the scolding tone. Ludwig and Nestle wrote the article about the food industry and obesity.
I would agree that we are obligated to give free care. Society spends a lot of resources educating us, and we are obligated to use that education in a way that benefits humanity. If that means giving free care, so be it.
The dirty little secret of medicine is that while most doctors complain about malpractice, managed care, and call, but the good ones would do this for free.
InteractMD.com
Interact MD:
“Society” doesn’t spend any more educating us than on anyone else. Apparently you do not value the hours of work you spent as a resident, which “society” bought from you very cheaply. And if you went to a medical school like mine, you also not only did plenty of service work without pay, you paid dearly for the privilege. And if you paid off loans like I did, they came at the same or higher interest rates as any other person’s educational loans. So I don’t buy your idea of “debt” to society. On those terms, I would rather deal with a real loan shark.
If you say we are obligated somehow, the obligation is universal, not particular to doctors. So university professors should have to teach students for free, and lawyers take clients for free and builders build homes for free. All of that, or none. Neither you–we–nor any other doctor is special.
Your last sentence is incomplete. Unless you are a trust-funder, and can do what you want without worry for money, you must earn your keep. Work, including call, including liability risk, including high administrative costs and frustrations with insurers are all things that require someone to deal with, and those persons, including yourself, should be paid fairly for the efforts.
Being a chump or working without pay is not what makes you “good”.
In fact it has nothing to do with good. In fact, you could do all that and be quite bad.
I wish I could read the original JAMA editorial, but apparently JAMA believes that while physicians should give away their services for free, JAMA should be able to charge to read their articles.
Total number of practicing physicians in the USA is pushing 800,000-900,000.
Number of AMA Members these days…..about 240,000. About a quarter to a third of that number is students and residents, getting sharply discounted or free membership.
Sheesh, I used to think the AMA was “only” a third or a quarter of physicians. I’m not sure if it’s even that many.
“Anonymous”: thanks for the response to my earlier post. You seem to imply that I am some sort of “trust fund” person, but I’m not. I came from a middle class family, fortunate to have the opportunity to get a good education. I paid for med school, and I’m still paying.
What I was trying to express, perhaps a little inarticulately, is that it’s really a privilege to be a doctor, a privilege that is a little similar to being a college professor or a lawyer, but also a little different from any other profession. Perhaps this isn’t the strongest argument for free doctoring, fine. Here’s the better one:
The other thing here is that I don’t know about you, but I really love being a doctor, and I suspect many other docs do too. I tend to think the good doctors love being a doc more than the bad ones, but I cannot cite you a reference for this.
So if you really love being a doctor, would you do it for free? Would you pay to do it? Maybe you wouldn’t, and maybe even I wouldn’t, much as I love it, but there are probably plenty of people out there who would. I can barely believe they pay me to do this all day, since to me it still feels like what I was paying THEM to ALLOW me to do as a medical student!
Hope that helps. Thanks for maintaining a modicum of civilty.
Dr. Rack, I agree that medical information should be free, and controlled by doctors, not publishers or the AMA. This is why I have created InteractMD.com, and I hope you will check it out.
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