Dr. Andy

Reflections on medicine and biology among other things

Friday, May 05, 2006

Free Advice

As medicine increasingly becomes a business, will it's characteristic collegiality be eroded?

As a specialist, I am often asked for "curbsides" about patient I don't see and for which I don't get reimbursed. As one of my life's overall goals is helping sick kids (or keeping them well in the first place) and as a faculty memeber at an institution that promotes learing, I don't particularly mind this. Plus, there may be some indirect benefit in that docs who I give advise to are more likely to send me patients in the future. In fact, many who call for advice already refer a lot of patients my way. Plus, I see most pediatricians as overworked, (relatively) underpaid, and struggling to keep up with the constant flow of new information about how to treat every disease of childhood as well as what is and isn't recommended for well-child care. To the extent I can help, I'm happy to. Heck, I answer all the crazy and not-so-crazy emails I get from people who read this blog and want free medical advice

But a recent experience has me wondering if this kind of attitude won't change. A few months ago I got a call from a physician I didn't know and spoke with him for 10 minutes or so about chronic urticaria (hives). I even sent him a review article on the subject. Later I found out he operates a "concierge" practice in which he charges patients just to be in his practice. The fees are steep (>$1000 a year for younger kids, less for older) and I presume he makes a lot more than the average pediatrician. I found myself a bit mad that he'd felt free to take up my (uncompensated) time so he could pass the information on to parents (probably crediting it as coming from a specialist at my locally prestigious hospital) and justify his fees, which effectively exclude most children.

I'm still not sure exactly how I feel about this issue, and I still talk to whoever calls me, but if calls from concierge docs became more frequent, I'd consider tryng to charge them for advice. My rationale would be they've made their practice into businesses first and foremost, why shouldn't that same principle apply to them?


At 7:23 PM, Blogger healthpsych said...

I think your colleague is a little cheeky, IMHO. I've never come across the 'concierge' practice. I hope I never do, I hate that idea. Perhaps he should put you on retainer for advice? :)

It's great that you are so generous with your time and knowledge. I hope you won't let this experience put you off.

At 7:59 PM, Anonymous jb said...

If he calls you again, or if you get similar calls from others, give him a minute of your time at most, then tell him that you will be happy to see the kid in your office. That way you will get the advantage of a patient who can benefit from your knowledge, be able to pay you, and show mom/dad that the concierge practice is overpriced and does not deliver. You don't owe him anything more. The calls I get from primary care docs with whom I work always start with a brief apaology for taking up my time, get to the point quickly, and half the time at least end up with an office visit (I'm a surgeon).

At 12:32 AM, Anonymous Kim said...

Yeah, and I bet the parents think their pediatrician is sosmart for knowing all the stuff that he does.

I bet you didn't even get credit for the information.

It's just wrong.

At 7:03 AM, Blogger Flea said...


I understand your point of view. Mine, as a non-concierge flea, is that collegiality is such a prized and disappearing commodity in our business, that I hope you continue to do curb-sides to whomever. So he's a jerk? You be the bigger guy.

If you haven't seen this already, please see this.



At 7:52 PM, Anonymous Anonymous said...

This will run counter to the other posts here, but you should charge him for information like that. Here is why--the (relatively) underpaid pediatricians call you for your help and you volunteer or give away your knowledge for free to make their difficult job easier.

Concierge boy likely makes more money than you do and is using you as a tool to aid in customer satisfaction so he can continue to make more money than you do.

In reality, it will be impossible to sort out who is an HMO/medicaid pediatrician and who is a fat daddy concierge physician, but you have already found one!

As a primary care doctor (internist) I thank you for helping out my brethren in pediatrics. As far as my curbsiding goes (and what I think is appropriate) my ratio of curbsides to referrals is about 1:20 with most of my curbside questions turning into referrals anyway.

At 9:14 PM, Blogger ollie said...

at times like this I am glad that I am a liberal arts facutly memeber and therefore talk to other collegues who don't make squat. :-)

Typcially, if someone bounces an idea off of me and makes good with it, I get a "thanks also to X who I had a helpful conversation with" or something like that.

At 7:49 PM, Blogger ollie said...

whoops, I meant "doesn't make squat".

That is why I don't get paid very much; my speling an gramar no gud. :-)

At 6:49 PM, Blogger Nurse Practitioners Save Lives said...

That definitely was rude of him to use the information that you gave freely and then get to charge his patients for it. Besides, it makes him look like he knows more than he does. Cheers from The Nurse Practitioner's Place and Nurse Practitioner News

At 5:33 AM, Anonymous Anonymous said...

It depends on your philosophy of life. Are you trying to make money out of illness or are you trying to help people?

Well we all have to make a living somehow. But what is your priority?

Reading some of you posts makes me think you are in the second category.

When you give your help freely to someone who charges, you help him make a living and you help his patient who will presumily have the benefit of your advice. So you help two people.

I think you should try to work out what this guy might be able offer you in return besides money.

At least you can feel good about helping him and his patients.

At 6:40 PM, Anonymous Anonymous said...

great article..thanks for keeping me informed.
mortgage girl

At 10:07 PM, Blogger Shazam! said...

I have a friend who started a concierge practice so that she could spend MORE time with her patients. She doesn't take insurance, and her patients pay a flat rate for the year with no added charges (not sure how she does labs & imaging). She provides necessary diagnoses & codes & the patients can submit to their primary insurance if they want. She has no trouble getting patients/clients. Sure it's a business, but she created her business because in the traditional model, she had no time to spend with her patients. Maybe she charges more, but the patients also get more.

And why wouldn't she still consult specialists if needed?

And you don't really know waht the other fellow did with the information, you are makingg assumptions in your post.

I don't think concierge practice is evil at all. it makes teh whole medical arena more tolerable for patient and physician, so more power to them both.

At 10:51 PM, Blogger Michael said...

Hello, I went in for surgery and they gave me 160 mg of Oxycontin every 2 hours for 6 hours. Is this right? They said I stopped breathing and had to be on the cart.

At 10:51 PM, Blogger Michael said...

Blogger Michael said...

Hello, I went in for surgery and they gave me 160 mg of Oxycontin every 2 hours for 6 hours. Is this right? They said I stopped breathing and had to be on the cart.

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