Why professional courtesy is becoming obsolete

If you have been in practice for more than 10 years, you are probably familiar with the concept of professional courtesy where doctors treat their colleagues without charging them.  With reimbursement decreasing and overhead expenses rising, many physicians have started charging their colleagues when they provide their fellow colleagues with medical services.

What is the position of the AMA?  The AMA advises that physicians should be aware that forgiveness or waiver of copayments may violate the policies of some insurers, both public and private; other insurers may permit forgiveness or waiver if they are aware of the reasons for the forgiveness or waiver. Routine forgiveness or waiver of copayments may constitute fraud under state and federal law. Physicians should ensure that their policies on copayments are consistent with applicable law and with the requirements of their agreements with insurers.

Extensive research has failed to uncover any instance where a physician has been prosecuted by either the Office of Inspector General or the Department of Justice for fraud or abuse based on the extension of professional courtesy. Furthermore, the OIG is unlikely to initiate a fraud or abuse investigation related to the traditional act of professional courtesy.

I would like to share an approach of a colleague, Dr. Dabney Ewin, a surgeon in New Orleans who is world expert on medical hypnosis. Dr. Ewin said he often treats colleagues and asks them how the colleague manages treating fellow physicians.  Dr. Ewin said if a doctor treats his\her patients without charging them, then he would offer his services for free.  If a colleague charged their fellow colleagues a full fee, then he would charge his full hourly fee.  If the doctors discounted their services, he would discount his service by a similar percentage.  What a terrific model of adhering to the Golden Rule:  “Treat” others as you would like to be treated.  This approach was very tactful, very practical and certainly very fair.

Professional courtesy is possibly falling by the way side and is becoming obsolete.  Perhaps asking a colleague how he\she manages caring for their fellow colleagues might be a guideline for your professional fees when treating a physician or others in the healthcare profession.

Neil Baum is a urologist at Touro Infirmary and author of Marketing Your Clinical Practices: Ethically, Effectively, Economically. He can be reached at his self-titled site, Neil Baum, MDor on Facebook and Twitter.

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