To the patients who resent greedy doctors

Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are.  Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.
-Johnathan Blaze

It is generally agreed upon that the more one values a good or service, the more he or she is willing to pay for it.  Most will agree that shoes are important.  They keep your feet from bleeding and hurting when you walk on the street.  People seem happy to pay anywhere between $20 to $150 for them.   Some will clamor to pay without complaint as much as $315 for sneakers that mimic those of their favorite basketball hero, or $865 for designer Manolo Blahnik “BB” Snakeskin Pumps.  Many place great value on a youthful physical appearance and sex appeal and will gladly pay up to $15,000 cash for a new pair of breasts with little if any sense of resentment for the doctor providing the service and metering the charge.  Having a car, most of us will agree is very important, and therefore paying around $30,000 is pretty average.  Though it seems that many are outraged at a Plastic Surgeon charging $12,000 to repair a fingertip, most people consider their limbs and appendages important, and being able to use them of significant value.  Therefore, it follows that a total cost of approximately $40,000 for a hip replacement tends be generally well accepted and frequently paid by insurance companies along with the physician portion of $1,505 (CMS CPT 27130.)

So how much is your life worth to you?  Clearly it is worth more than a pair of shoes.  Are we still in agreement?  Certainly you would be more than happy to pay $20 to $150 to have it saved, if you or your insurance company had the finances.  Is a human being’s life in total worth more than the $15,000 pair of augmented breasts on the human being?  I’m sure most would agree it is.  I’m sure as a society we must pay more than this for a human life saved, correct?  I’m sure we all similarly agree that the entire value of a human life saved is greater than the value of a “spare replacement part” such as a $40,000 hip.  We must certainly and gladly pay those who save our lives at least as much as we pay for sneakers, designer shoes, our cars or a spare hip, correct?

No.  We don’t.  It’s not even close.

In the field of emergency medicine, there are only a few situations where the physician can truly walk in a room and walk out a few minutes later absolutely certain he saved a life.  One is an emergency intubation (making a non-breathing person breath again) and another is cardioversion/defibrillation (restart a non-beating heart.)  It doesn’t always happen every day, but it is what emergency physicians and other critical care providers are paid to do.  To be an emergency physician is a paid position.  It is not a volunteer position.  It stands to reason that emergency physicians would be paid at least as much as for a life saved as for the aforementioned goods and services, correct?  Let’s break down what a true life-saver gets paid to save an entire life, not just the hip, the breasts, the fingertip or the shoes.

What an emergency physician actually gets paid to save a life:

  1. Emergency intubation: $112  (CMS payment for CPT 31500) or,
  2. Cardioversion/Defibrillation: $131  (CMS payment for CPT 92960)

Even if one combines cardioversion with a $226 charge for critical care services provided (CMS CPT 99291) the total charge is still only $357. Therefore, according to the United States Center for Medicare and Medicaid Services, your life is worth $357, or at least that’s what they’re willing to pay emergency and critical care physicians to save it.  This doesn’t factor in the number of people who are still uninsured and unable to pay anything.  In other countries the payments are even less, or are lumped into a salary that if broken down service by service doesn’t come close to even this amount.  Any outrageous bill from such an emergency department visit is and only can be from the hospital itself.  Zero of the portion of the hospital charges go to the emergency physician.  Zero.  This is a fact.  So, to paraphrase the above commenter, is $357 a “ridiculous amount of money for a simple routine procedure?”

I am not an economist, nor a philosopher, but this all seems to follow a theory of sorts, that I have observed.  There may be an official theory of economics of which I am unaware that explains this.  This may or may not be an original thought or observation (economists: if not, please place source in comments section and I will cite it.)

The extent to which the value of a service to an individual approaches infinity (such as a human life saved), is the extent to which a person expects it to be provided to them for free.  Any charge for this infinitely valuable service will not be considered a very fortunate undercharge.  Instead, the extent to which there is any charge at all for the infinitely valuable service, is the extent to which the receiver of the service will harbor undue resentment toward whomever profited any amount from providing it.

It is for this reason that an emergency physician that asks to be paid $40,000 for giving someone a new chance at life is considered greedy and contemptible, yet the hospital and orthopedic surgeon that ask for the same payment for a spare hip are not.

It is for this reason that the emergency physician that expects to be paid $15,000 for a life saved is wrong, yet the plastic surgeon is right to charge, and is happily paid by his “customers” $15,000 for a beauty enhancement service.

It is the same reason, Manolo Blahnik is a “life-saver” for trading beautiful shoes for the fee of $865, but an emergency physician is expected to feel fortunate to be paid hundreds of dollars less than this for a life saved.

I am not suggesting that emergency physicians (in the United States) aren’t paid well, because they are.  I am also not suggesting that orthopedic surgeons, plastic surgeons, shoe designers or anyone deserves less than that which they rightly earn.  Also, I am by no means implying that emergency physicians are, or should be, motivated by primarily by money, nor that those with life threatening emergencies should have their lives held hostage and be price gouged.  I am not even suggesting that for life saving services emergency physicians should be paid a fee equivalent to performing a hip replacement, breast implant operation or a pair of luxury shoes.

I am suggesting, however, that if they were, they would certainly deserve every penny.  My main assertion is that if people and society are not going to pay life-savers that which a life saved is worth, or even what they gladly pay for a new hip, pair of breasts or luxury shoes, that at a minimum they hold emergency physicians, nurses, EMTs and other emergency service workers in the highest regard.

Some patients give great thanks when treated for true emergencies in the emergency department.  However, many others, for some reason, rather than showing great appreciation or at a minimum rewarding the providers of such infinitely valuable and life-saving services with compensation comparable to that of products and services of definitively much less valuable ones, often times the payment is instead the toxic and misguided negativity of those such as the commenter above.  It is very unfortunate.

Clearly, the economics of our healthcare system are warped and distorted in countless ways, and far and away those who profit the most are the insurance companies and hospital mega-corporations, not the emergency physicians, nurses and other providers.  However, to point the finger of blame at those who are on the front lines of the trauma and chaos, with the highest burden of burnout, who also get paid a small fraction of the payment of other medical services for the service of saving a life, seems to me at best misguided, and at its worst sick and twisted.  How much longer they will choose to do so I am not sure, but thank God, the unappreciated heroes of the emergency departments of the world can make their way through the negativity, sleep deprivation, and stress to be there to save the lives of all of us, including even those who resent and condemn them the most.  To them, I say, thank you.

(Financial disclosure: In my current practice I do not bill the above mentioned procedure codes and would not benefit financially from any increase in reimbursements for these, or any other emergency procedures or services.)

“BirdStrike” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.

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