Do doctors take advantage of desperate couples with infertility loans?

Do doctors take advantage of desperate couples with infertility loans?

Somewhere near where you live, a couple will discover this week that they are infertile and that if they want biological children of their own, they are going to need in vitro fertilization (or IVF).  According to treatment protocol, the woman will need to take powerful medicines to ramp up her production of fertilizable eggs.  One monthly cycle of this treatment will run around $12,000.  But most couples require more than one cycle to achieve their goal of carrying a child to term.  In other words, this couple could easily be looking at a bill exceeding $30,000 or $40,000.

And did I mention that this money could all come out of their own pockets?  Because not all insurance companies pay for in vitro fertilization.

No worry though.  Their infertility physician informs them about a company he has worked with that specializes in infertility loans.  He even offers to have his office staff help the couple fill out the necessary paperwork.  Thanks to this assistance, the couple secures the loan and, with luck, will soon be rewarded with a healthy baby.

Free market medicine at its finest, yes?  A couple with “skin in the game” learns about their health costs in advance.  They are given accurate data about the likelihood that any given cycle of treatment will work.  They even work with a loan agency specifically geared to meet their financial needs.

Would it bother you if you learned that the infertility doctor received a referral fee from the loan agency?  Would you be upset to learn that this couple was charged an annual interest rate of 22%?

There are lots of reasons to worry that doctors and bankers are taking advantage of couples who are desperate to become pregnant.  For starters, those of us who work in behavioral economics recognize that emotions—“I’ve just got to have a baby!”—can stand in the way of rational decision making.  Even honest communication about the odds of treatment success—“You have a 10% chance of becoming pregnant in the first round of treatment”—get reinterpreted by couples whose unconscious psyches refuse to hear bad news: “He says 10%, but I know our odds are better than that!”  As I point out in Critical Decisions:

Good decision making is not merely a matter of comprehension.  Understanding doesn’t necessarily lead people toward making rational choices.  Decision making is often as much about feeling as it is about thinking.

In the case of couples’ struggling with fertility problems, all these emotions push them toward believing their odds of pregnancy will be greater than average.

Infertility loans are even more problematic when they are suggested to patients by physicians who doubly benefit from such loans.  The patients recognize that their physicians make money by providing them treatments.  This conflict of interest is inherent to fee for service medicine.  All else equal, a fertility specialist who treats 600 couples a year should make more money than one who treats 400.  This conflict of interest is a problem, as it can influence physicians both consciously and unconsciously, to offer more treatment than is medically necessary.  But there aren’t a whole lot of great alternatives to such conflicts.

In the case of these loans, however, some physicians are carrying an additional conflict of interest.  These doctors get kickbacks from loan companies when they refer clients.  Should that trouble us?

When I borrow money from an automobile dealer to purchase a car, I realize they are making money not only by selling me the car, but also by giving me the loan.  But in the case of fertility treatments, physicians are rarely up front with their patients about their financial interest in getting them to borrow money.  And I expect most patients have no idea that some doctors are working out these kinds of financial arrangements.  At a minimum, physicians need to be up front about this conflict of interest when it exists.

But even with such disclosure, the fertility case differs in another important way.  Physicians are trained to be patient advocates, training that despite its enormous costs is partially subsidized by public funds.  Physicians are sworn by oath to look out for their patients’ best interests.  They are endowed with specialized knowledge, and commensurate responsibility, with the understanding that patients will come to them in time of need knowing they can count on the doctors for good advice.

Let me be clear: I am not—repeat: not!—calling on the government to regulate the fertility loan market.  While I think we need sensible rules to help consumers understand their loans, not just fertility loans but other types of loans too, we don’t need special legislation to protect infertile couples from predatory doctors.

Instead, we need physicians to reflect upon their long established moral duties.  So fertility doctors, please: If you want to help your patients, if you plan to advocate for their best interests, don’t muck up the situation by becoming party to the profits made by loaning money to these same patients.

Don’t let your interest in the bottom line cause your morals to bottom out.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

Image credit: Shutterstock.com

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  • http://www.facebook.com/johnckeymd John Key

    It’s always open season on the physician…when other entities offer ease in financing it’s praised as “convenience” or perhaps “offering high value-added services”. As long as a quality service is provided, it should be “no harm, no foul”. Perhaps it is just a sign of our cynical times; even our President belives that physicians will lop off a leg or tonsils to make a quick buck.

  • lauramitchellrn

    As a former L&D nurse, I’ve cared for many of these patients and the thing that has always struck me is that the infertility industry (and make no mistake, it’s an industry) has a great potential for the exploitation of desperate people. I also watched “the rules” change. It used to be you had to be trying for two years to get pregnant, then it was changed to one year. A lot of insurance will cover the costs to find why you can’t get pregnant, but that’s it. Infertility, like cosmetic surgery, is a cash business. Another thing that bothered me was the attitude of the infertility specialists I’d met (and perhaps these were outliers): people pay us to get pregnant, we get them pregnant. They don’t tell the patient (or they minimize it) the potential consequences of implanting four embryos and all four embryos taking: gestational diabetes, pregnancy induced hypertension, pre-term labor, pre-term birth, etc.

    As an example, many years ago, I had a co-worker who was desperate (and I do mean desperate) to have a baby. She and her husband ended up with a 3rd mortgage and after five years, multiple doses of Clomid and Pergonal, and who knows how many hundreds of thousands of dollars, they finally had one child.

    • Suzi Q 38

      I think that people know this.
      Just as in any profession, there is the good and the bad.
      You could say this about plumbers, lawyers, or surgeons.
      This is what I know about doctors in general.
      To us this is serious and personal stuff.
      To them, it is another day of work.
      I am not sure it is avoidable.
      I will say this, though. The public is getting wiser.

  • katerinahurd

    Do you think that, in the name of good communication between the IVF specialist and the infertile couple, the dramatic psychological side effects of fertility drugs should be addressed by the IVF specialist? I strongly disagree that. IVF treatments should be be paid for by fee for service, because the desperate couple wishes to parent a single healthy baby. Do you think that the lack of regulation of IVF treatment and loans to finance them is the driving force for many infertile couples to seek IVF treatment outside of the United States? Lastly, what would be the role of the American Academy of Reproductive Medicine in ensuring that the infertile woman is not abused by her IVF specialist?