Premeds are like bright-eyed stem cells. They walk into med school wanting to help people generically. Who and how to help are unknown… and how to collect is far from the radar. After 4 years they differentiate into specialties like pediatrics or surgery, and some into subspecialties like pediatric surgery. With graduation from residency, they’re set free to save lives, gather revenue and repay debts. Whether medicine is more science or more art, it’s most certainly business. Yet few doctors run the gauntlet with business training. I’m no exception.
I entered med school seeking a people-helping career sprinkled with intriguing science and meaningful human interactions. Emergency medicine offered these, plus no pager. It was also the perfect fit for a business buffoon like myself. I had no interest in setting fees, billing and collecting. “Work an hour and get paid an hour” was my mantra. Let someone else do the collecting. After a few thousand shifts, however, I’m changing.
It’s shocking to me to read that 60% of US bankruptcies are due to medical expenses. Where’s the compassion? And what role have I played in these? No clue. Even if a patient asks me how much their X-ray may cost, I truly don’t know and will struggle for hours to find out. In economics, this is the principal-agent problem.
“Principal” being the patient and “agent” being the doctor. The doctor ordering the tests doesn’t feel the pain of payment, especially after bills are received weeks after the care. They may also be swayed by medico-legal angst. “Fee for service” distorts even more.
Emergency medicine has been good to me and I wouldn’t click rewind. But I’m ready for this Pre-R experiment. Can I practice essentially kindness-based medicine? Is it possible to make a living with no set fees? Will patients in San Luis Obispo value one-on-one compassionate house calls, and pay enough for such a service to keep Pre-R alive? We’ll see.
It’s just hard to know who is financially strapped, so why not let satisfied patients themselves decide? I’ve met many doctors who work long hours, who then pay relief agencies and airlines to work in impoverished communities for free to practice the kindness-based medicine that they truly enjoy. Uniformly they return reenergized remembering their premed days. Can Pre-R be a hybrid?
In any case, if I come to you for a visit and we have a discussion about our fees, my answer will be something like this: I can’t tell who’s struggling more than most, and taking advantage of someone when they’re sick doesn’t feel right. If you like our care and want our service to continue, then help us to grow or pay it forward.