MedCity Influencers

Lawyers say the darnedest things

Dr. Wesby Fisher wonders: “If each of us had to pick an hourly wage like lawyers, what would we charge if we take all of our expenses and vagaries of our current system into account? Given all of the overhead to health care today, would we have the ability to justify our hourly wage to our patients?”

Dr. Westby G. Fisher is a board certified internist, cardiologist, and cardiac electrophysiologist at NorthShore University HealthSystem in Evanston, Ill., who writes regularly at Dr. Wes.

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Last night, I overheard a senior lawyer speaking with my wife, a psychologist: “The first thing a lawyer does is discuss how much their services will cost their client. You know, in all my years of going to the doctor, I never once felt I needed to ask how much he cost.”

I couldn’t resist joining in and said, “Well, that’s because most know what to tell you, since for any given person, the doctor does not negotiate his own fee, it is negotiated for him by third parties.” He nodded acknowledgement.

But this got me thinking. What would we ask as salary for our services priced by the hour? Could we have this conversation with our patients after the dust had settled after an acute illness? If we factor in office expenses, the price of malpractice, account for our level of training and experience, and consider the price point of our attorney colleagues, what hourly wage would we accept? Would we be able to have this conversation, or have our policies and expectations made such a discussion too politically incorrect to broach with our patients?

I have heard others in private practice discuss this topic before while working in Cincinnati. One doctor mentioned to me that he had to bill at least $200 per hour just to cover their office expenses (receptionist, billing staff, office manager, benefits, vacation, utilities, rent, taxes, etc).

Certainly there are many geographic differences in the cost of living and practicing medicine in America. Also, different price-points might be acceptable for an primary care doctor or a specialist and worse, the amount we bill no longer pairs with the amount we can collect. But if each of us had to pick an hourly wage like lawyers, what would we charge if we take all of our expenses and vagaries of our current system into account? Given all of the overhead to health care today, would we have the ability to justify our hourly wage to our patients?

Given that it’s likely to far exceed $200 per hour, I suspect none of us could have that conversation any more.

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005. He writes regularly at Dr. Wes. DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.

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