Charging $5 per visit is easy if you’re independently wealthy

Charging $5 per visit is easy if youre independently wealthy

Recently there was a news story about Dr. Russell Dohner, of Illinois. He charges all patients a flat fee of $5 per visit. He doesn’t take insurance.

This led to several online threads featuring comments such as “Finally! A doctor who cares!”

Apparently, this means that doctors like me, who charge more than practically nothing, are evil and don’t care.

I respect Dr. Dohner, and am not putting him down. I think highly of what he does. I actually like what I do, and if I were independently wealthy and could see patients for free, I probably would.

It isn’t until almost the end that the article notes Dr. Dohner is supported by his family’s farming business, and NOT his medical practice. By that time most readers have moved on to the football scores and “Dancing with the Stars” results, and therefore are left with the impression that any doctor can do this for $5 a head.

Bullshit.

I do care.

But that doesn’t mean I don’t have my own responsibilities: like office rent. And paying Annie and Mary. And a mortgage. A wife. 3 kids. If I can’t support those things, then I’m not going to be able to keep my office open to care for people.

Regardless of what people may think, just because I charge for my services doesn’t mean I don’t care.

I care enough to call in your seizure medication to a pharmacy at 2:00 a.m. because you’re out of pills, even though you knew you needed a refill for at least a week.

I care enough to call you from my family vacation to go over your MRI results, because I didn’t think they should wait until I got home, or that you should get bad news from a covering doctor who doesn’t know you.

I care enough to come in early and see you at 7:00 a.m. because you can’t get time off work, but really do need to be seen.

I care enough to spend time arguing with some pinhead at your insurance company about why you need an MRI, when they don’t think you do.

I care enough to rush in to the hospital to see you on my weekend off, rather than let a hospitalist who doesn’t know you from Adam try to figure this out.

I care enough to call a drug rep and beg for samples of your medication because you lost your job and can’t afford it.

I care enough not to order unnecessary EMG’s and EEG’s on you, even though doing them would improve my revenue.

I care enough to face worsening reimbursements and rising expenses every day, when many colleagues have given up and gone into another field.

I care enough to try and give you hope, even when I’m not sure there is any.

I care enough to help you find another neurologist who will take good care of you, because your crappy insurance won’t let you see me anymore.

I care enough to step out of my kid’s music recital and take your call, because I know you’re scared.

I care enough to take the time and explain why the drug you saw advertised on TV isn’t a good idea in your case, rather than just writing a script to shut you up.

I care enough to stay in a job that has deprived me a of decent night’s sleep, family time, and likely shortened my overall lifespan, in spite of the fact that my financial goal nowadays is just to break even.

I care enough to refer you to a neurological subspecialist who can take better care of you than I can, even though in doing so I’ll lose you as a patient.

I care enough to call your spouse at 9:00 p.m. to reassure them that you’ll be all right.

I care enough not to force you to have a test you can’t afford, even though you can sue me for malpractice if I miss something.

I care enough not to dismiss you from my practice, in spite of your insanely annoying personality, because I know that you really do need my help.

I care enough to still be doing this job, even though every day a little bit of my idealism dies.

I care enough to be a doctor. I hope I always will.

“Doctor Grumpy” is a neurologist who blogs at Doctor Grumpy in the House.

Image credit: Shutterstock.com

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  • http://www.facebook.com/alison.m.galvan Alison Manders Galvan

    Couldn’t agree more. So tired of having to explain to patients why we can’t give free care.

  • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

    If you are very productive family doctor, you can see about 30 patients a day I figure without sacrificing quality (with an EMR). At $5 a patient, that’s $150 a day, $750 a week or about $37,500 a year with 2 weeks of vacation. That doesn’t cover the rent for my office space (and my rent is cheap)

    • Suzi Q 38

      You probably don’t have your office in a 60 year old building in a small, rural town in Illinois. The good doctor has admitted that he does not take a salary. He doesn’t need to. The family farm provides his shelter and pays for his food. He probably grows or barters a lot of his food. He sounds very, very, frugal.

  • http://womanfoodshinyobjects.wordpress.com/ Brian Stephens MD

    What?? we are supposed to make a living?!?!?

    society is trying to make civil servants out of us, but they sure as heck still want to be able to sue us.

    I say fine.

    make a civil servant out of me, but then pay for all my expenses and office, give me legal immunity, and give me a nice cushy government benefits package, pay, and pension like the rest of the government.

    or

    get the heck out of my business and finances and let free market do it’s thing.

    the problem in health care is that we sit on the fence.
    we have Free market expenses but Socialized income.

    A terrible way to do anything.
    I really am fine either way, just please can we stop pretending to do both!!

    • NormRx

      “make a civil servant out of me”
      Some doctors have already made that decision, they call it working for the VA, You might have a difficult time getting a job there if you are fluent in English.

      • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

        I haven’t found that to be true at all.

      • Suzi Q 38

        In California, It is helpful of you speak several languages..English and Spanish being the most important.

      • http://www.facebook.com/people/David-Richardson/664914139 David Richardson

        It used to be you could get such a job easily. The VA had lots of openings. Today in California they are very hard to come by. Even working for the LA County jail system has become a desirable alternative to private practice! Imagine that – doctors so fed up with dealing with insurance, increasing overhead, and patients who still think well all own yachts and vacation homes that working with criminals is preferable to private practice.

    • Suzi Q 38

      This doctor has let the “free market” do it’s thing.
      He has carved out a simple life for himself and served a lot of people in return.

    • northfeedlot

      I don’t have any answers, but agree with your free market approach. My grandson recently needed to go to the pediatrician for an ear infection. Having dealt with these many times in the past, I made the appointment telling them he had an ear infection and needed the antibiotics. Five minutes with the doctor and we were on our way to pick up his Rx. A day and a half on the medication he began complaining of itching “all over” and I called the doctor’s office, wondering if this could be a side effect. I was told he would need to be seen. Another five minutes with a doctor determined that nothing was wrong and to use lotion. The bill for a total of 10 minutes? (literally 10 minutes) $848.00.

  • John Henry

    I would be curious to see how this supposed altruistic doc, seeing patients for $5.00 a visit, buries the losses in his medical practice. Is he employing any help? Does he pay rent, or is the farm paying for that,too? Does he keep abreast of his field (and not the farm field)? Does he take call for his practice or at $5, does the phone send the message to go to the ER? Is there a phone?

    • azmd

      The article is quite interesting. Income from his practice “is hardly enough to pay the nurses.” His wife left him shortly after he decided to stay in this small town in Illinois to practice and he has never remarried. He “has never taken a true vacation” and is “always on call.” Judging from the 2000 admiring comments that the article garnered, this is how people wish that all doctors lived. I think that’s what happens when we allow a professional culture to develop in which we present ourselves to the world as superhuman.

      As for finances, he is supported by income from his family farm and attended college on the GI bill, so I suppose you could say he has had a couple of advantages in the financial arena that most doctors today don’t have.

      • Suzi Q 38

        Agreed. He has a unique set of circumstances.

        Not unattainable for a few doctors, but not likely.

        Sadly, his wife left early on and he never remarried or had children. That right there is a huge savings. IF she had been married for longer, she would have been able to get alimony for a long period of time.

        If they had children, there would have been childcare (if he was left with them), clothing, food, etc. for the children.

        He would have also sent them to college. Children are expensive.

        Student loans?? Not the medical school loans of today. He probably paid them off early or they were forgiven because he served our country.

        He didn’t give in to feeling so poor during medical school that he ran out and bought or built a huge house with a huge mortgage to match. He either inherited his house and farm or was frugal and bought a modest house…it is definitely paid off at the age of 80 something. No million dollar mortgage for him. He probably drives his cars until the wheels fall off. No BMW or expensive cars with payments. He pays cash.

        European and Asian trips? He probably hasn’t gone anywhere and doesn’t care to. That saves a lot of money. His vacations are probably spent at the office or the farm.

        After he paid off his house (if he ever had a mortgage), he continued to pay off the building where he sees his patients.

        That was probably paid off in the late 60′s.

        Clothing?? No fancy Armani suits and shoes for him, he has no woman to impress and is figuratively “married” to the people he serves. Similar to a person that is a priest or a nun.

        A Mother Teresa of sorts for this small town in Illinois.

        Now he just needs to pay for his nurses, as he makes enough money for his food and shelter from his farm.

        The nurses are older (both in their 80′s), so he has not replaced them with younger, more demanding employees.

        He has gotten older with his staff and his patients. He probably has had few health issues himself.

        He hasn’t had to buy a new computer, scanner, or printer…he skipped all of that.

        I knew a doctor that had her practice in a wealthy Los Angeles zip code that lived simply. She loved to work with the poor in another side of town (Los Angeles), and her office had a fancy zip code, but it was a small one story building. she owned it. I think she said she got the downpayment for her office from a suitor that begged her to get married, but she politely declined…2 or 3 times. He was crazy about her, but she did not want to be someone’s wife. She wanted to be a physician more.She did not even go the the hair stylist or drive a fancy car.

        She never married. The suitor married about 3 times, and in between marriages, he always came to her and asked her to please reconsider.

        She told me and many others: “Who would marry me? It just wouldn’t work. I love practicing medicine more than anything. I spend way too much time doing so. I don’t want to be conflicted as to who is more important…I can’t stop my work to be “barefoot and pregnant…” most men would not put up with what I have to do, so I have decided to stay single.” Not her exact words, but very similar as she spoke to me about 25 or 30 years ago.

        Some days, she would work for the poor in Los Angeles. She was not afraid to go to the at risk areas of the city.
        Other days, she served movies stars, as they could pay any fee that she charged. She did not charge $5.00, but she did not overcharge, either.

        This doctor in Illinois that charges only $5.00 has made several life choices that has allowed him to have the freedom to do as he wishes. Someone like this has true financial freedom, so he does what he wants. Incredible.

        Not all of us chooses to live this way. We all have different circumstances, possibly a family (worth every dollar!), mortgages, vacations, cars, student loans, etc.

        I think he is an interesting “study.”

    • http://www.facebook.com/people/Michael-Rack/100001703895437 Michael Rack

      This doctor and his staff are in their 80′s. He has dedicated his life to medicine and his town. Give him a break.

      • John Henry

        Look, if this doc wants to do what he is doing and charge next to nothing for his work because he can, great. But let’s not pretend that this is anything more than an altruistic oddity possible only for someone with an outside source of income and a modest lifestyle in a place where things do not cost very much. Pretending someone “cares” because he charges peanuts is soft-headed and irrational, as if to imply that someone who charges a reasonable and necessary amount that is more cares, what, more about making money than taking care of patients? Cheap does not necessarily have anything to do with good, and as most know, at some level does affect quality. This good old doc’s care isn’t cheap either, it is subsidized, it is only cheap to the patients.

        • Suzi Q 38

          It works for the doctor and his patients, though.
          They all appear to be happy.

      • Suzi Q 38

        I agree. We should be admiring him.

    • Suzi Q 38

      Maybe he has no time to answer the phone. His 80 something year old nurses answer it whenever they can get to it. He probably sees patients all day long, at that price.
      I don’t think he has time to take new classes or subscribes to publications such as Up To Date because he doesn’t have a computer.

      His patients don’t care, they just know that he works for them.
      They obviously are happy with him and appreciative of his medical care. He has been known to stay at the hospital with ill patients…in some cases, driving them to the hospital himself, in his personal car.

      He takes care of “business” in the manner that he thinks is best.

      Interesting.

    • Suzi Q 38

      You can probably go see him…take a “road trip,” pay the $5.00 and see how good he still is.

  • Chris Livingston

    2 takeaways from the first article. What could providers charge if they didn’t have to deal with insurance? Secondly if regulations were removed could providers diversify their income streams by charging for nurse visits for low acuity calls, or creating a subscription service for patients to be a part of the practice. The move should be away from insurance and regulation but as long as the government is bent on insuring us all reimbursements will go down, premiums up, and the best and brightest will choose professions outside of medicine where they can earn more.

    • Suzi Q 38

      True. I am not sure what will happen in the future.
      Maybe this is concierge medicine. People just are paying the $5.00 cash. For the right doctor, I might pay the $40.00 cash and use my HMO insurance for emergencies.
      This of the freedom of no paperwork with regard to getting reimbursed. No letters of denial.
      BTW, if my insurance company denies payment to any of my doctors, I call and do what I can to make sure that they are paid. I have threatened to take them to small claims court. They usually pay eventually. If they didn’t I would just pay the doctor what he would have been paid by my insurance.
      I don’t know what the answer is if you want to be a doctor and love practicing medicine. Things change.

      Teachers used to have it easy, but no more….I can list a litany of professions that no longer pay what it used to.

  • SBornfeld

    Wow, you ARE Dr. Grumpy!

  • Rob Burnside

    I was a paid firefighter for twenty years, and was able to support a small family, but whenever our union negotiated improvements in salary, benefits, and working conditions and city taxes went up, I felt a little guilty. After retiring with a pension, I offered my firefighting services for free as a volunteer in a neighboring town, and felt good about that. Perhaps volunteering at some point is a solution for physicians who would like to charge less but can’t.

  • Richard Watt

    Five dollars might have worked, say a hundred years ago. I find my current doctors very caring and helpful. And of course they need to make a living too, and given what they do, they deserve a good living.

  • http://www.facebook.com/evennow Deborah Loretto

    Dr Dohner delivered both of my cousins who are now in their mid-forties. My aunt, their mother, taught 4th grade in Rushville, IL (where Dr Dohner’s office is) for 30+ years, never made more than $30k/yr, and still lives in Rushville. It is a town of approx 4,000 people, they have one, 26 bed hospital, a Dairy Queen, and a Subway. It is located in central IL and it is a poor, farming community. I spent many, many holidays and vacations in Rushville. Dr Dohner does what he does because these are poor people, most without health insurance, and living on fixed incomes. Please don’t judge… and trust me, NO ONE in Rushville, IL is independently wealthy.

    • Suzi Q 38

      Deborah, Thank you for writing to us.
      You have answered some of my questions, rather than me just guessing about how he could afford to do this.
      I am not judging him. I am “celebrating” what he has done and is still doing.
      I am amazed, but like to believe that there are still good people that do what they can for others.
      Dr. Dohner is a fine example.
      He could be retired, sitting home alone at his home.
      Instead, he is out there with people, helping them in the best way he knows how. Why not charge $5.00? This way, he can continue to pay his two employees. Maybe he should start charging $10.00.
      What do volunteers charge?

  • f. lusu

    i checked my claims statement for the last visit to my family dr .
    my small copay plus the insurance co. payment to him added up to a grand total of $70-for 10 minutes of his time. i don’t understand how he pays his bills. he is the best dr i’ve ever had and his time is worth so much more money than he is getting now, so i would be extremely uncomfortable paying any dr. $5 no matter what the circumstances. i think about how much med school takes out of any young dr .first they are used as free labor at the hospital before they graduate, and then are ‘paid’ so little as an intern that they barely get by. then it’s too much stress,too little sleep,etc.
    the public has no clue that the ‘job’ a dr does takes such a heavy toll.

    • Suzi Q 38

      I used to see the statements, too.
      I used to think that $45.00 from my insurance company for the office visit was just not enough.
      I can see why certain doctors that have developed steady work have given up on certain insurance companies.

      Maybe they make up for it with other tests.

  • querywoman

    Dr Brian Stephens:

    Most injured patients sue because they need money for additional health care. Medical malpractice suits are VERY difficult to bring. In effect, the existence of a medical malpractice legal system simply results in higher malpractice insurance premiums. My understanding is that a doctor who wants to practice in a hospital must have malpractice insurance. No hospital work, no need!

    In the late 1980s, which was the heydey of fee-for-service, with the old deductible system and then 80% coverage of medical fees after that, I was frequently ill, undertreated, and dissatisfied and had to cough up more money on credit cards to see other doctors who wouldn’t accept insurance assignment.

    Then, when the small copayment system came into use, and for me it was at first a $5 copayment, it was less of a problem for me to see a new doc. But, the copayment system of PPO’s saves no money at all and costs everybody more. That’s easy to explain! When I am only paying $5, $10, or $25 out of my own pocket, then lots of docs feel free to order every test imaginable.

    So let’s just make you all civil servants, then if we patients shafted, we easily can go to another doc. Don’t pretend you don’t make mistakes – that’s part of the nature of medicine. Another big problem patients have with doctors is that so many won’t admit to their mistakes! A sincere apology would help so many times, or assistance in finding another way to get care for the problem which most state laws advocate anyway, like the Medical Practice Act in Texas. Instead of a medical doctor stomping his or her foot, etc., and telling the patient to get lost or get a shrink!

    I do advocate some legal responsibility for truly injuring a patient. Sure, normal criminal sanctions would still apply to a doctor who knowingly and intentionally injures a patient.

    Civil servants, and that includes the IRS for whom I have worked, all have complaint systems! You CAN go up channels to complain within the IRS.

    Hospitals receive tons of Medicare and Medicaid money already and are therefore legally required to follow government complaint procedures, but frequently don’t! Time the law applied to all of us! We also need a system way of settling complaints against doctors without access to the courts. State medical boards are currently worthless! The medical practice has proven it cannot police itself!

    If a medical doctor took out government-sponsored loans to attend school, and most US doctors do, then he or she has already benefited from our government system immensely. You have a responsibility to the public!

    Querywoman

  • http://www.twitter.com/alicearobertson Alice Robertson

    I think sometimes doctors are too defensive. This could have been really informative, but it just didn’t come off right…..although, well-taken. There is room for different approaches to helping people. It’s hard not to herald this charitable doctor, realizing not everyone can duplicate it.

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