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Flashback in Medical Economics

25 years ago: February 1977

Doctors exchanging homes at vacation time? Nothing unusual; some had been doing it for years. But family physicians Thomas D. Weaver and James F. Ivey Jr. took the idea a big step further: They exchanged not just their homes but their practices, as well.

The two had worked comfortably as partners for a year in Clermont, FL, west of Orlando, until Ivey decided to move to Alaska and practice solo in Palmer, a small town near Anchorage. As it happened, Weaver loved Alaska, too; he’d spent vacations there, searching in vain for a doctor who would swap practices with him for a few weeks a year.

Weaver visited Ivey after the latter had settled in Palmer, and their exchange agreement took shape: At the beginning of August, the Weaver family–doctor, wife, and four daughters–drove (yes, drove) from Florida to Alaska, where Ivey introduced the Florida FP to his staff and patients. The Weavers moved into the Iveys’ home, and Weaver saw patients in his former partner’s office–in between hunting and fishing excursions.

Meanwhile, Ivey took his family back to Florida, where they lived in the Weaver residence while Ivey carried out his part of the two-way locum tenens arrangement. Recreation for the Iveys included using the Weavers’ boats to cruise the local lakes.

In a Medical Economics article, Weaver described his family’s "northern exposure." Highlights: Camping along the Alaska Highway . . . picking wild blueberries and raspberries that seemed to grow everywhere . . . hunting game amid splendid scenery and fishing for salmon in a stream near the medical office. One not-so-great experience was Palmer’s biggest flood in 40 years, which occurred a few days after the Weavers arrived. Fortunately, most of the buildings in town, including Ivey’s home and office, were on high ground.

"It really took the boredom out of the old salt mine!" the Florida FP wrote of his Alaska exodus. The two doctors’ exchange was a success across the board, he reflected–and their financial arrangement would have raised no eyebrows at the IRS. "No money changed hands," Weaver explained. "Jim and I just swapped services."

Would there be a next time? As a matter of fact, Weaver wrote, they’d already worked out a new twist: He would go to Alaska in the summer and work with Ivey during tourist season there. In return, Ivey would come to Clermont in the winter to help Weaver while Florida’s tourist season was at its peak.

50 years ago: February 1952

The mediation committee of the Wayne County Medical Society, which had resolved more than 200 fee disputes between Detroit-area doctors and unhappy patients, shared its experience and insights with this magazine.

Statistics showed that the committee members had been remarkably evenhanded. In 45 percent of the cases that came before the committee, the doctor’s bill was upheld. But in 40 percent, the doctor was persuaded to lower his charge or cancel it entirely. The remaining 15 percent of cases ended when the patient withdrew the complaint or the matter was referred to the medical society’s ethics council.

The mediation committee made its availability known to Wayne County residents by periodically releasing reports about its activities to newspapers. Whenever an article appeared, the group’s executive secretary said, it triggered phone calls from patients who felt they’d been overcharged.

The committee noted that many of the complaints had two characteristics in common:

• The patient’s protest came not when the bill was delivered, but months later–after it had been turned over to a collection agency.

• The complaint letter contained a veiled threat that overcharging by doctors could pave the way for socialized medicine.

In each case, the mediators based their decision on three factors: the service the doctor had rendered, the responsibility he had assumed in delivering that service, and the patient’s ability to pay. If committee members felt the fee should be lowered–and the doctor agreed–a letter advised the patient to contact the physician and discuss the adjustment. On the other hand, when the committee considered the complaint unfounded, it sent the patient a letter explaining in detail why the fee was justified.

"About half the time," said the physician who headed the mediation committee, "an explanation of the fee is all that’s needed. It would be better if the physician himself had explained things to the patient to begin with. But too many doctors mistakenly assume that patients know the score on such things as consultants’ fees or billing for work done by assistants."

75 years ago: February 1927

H. Sheridan Baketel, the physician who was also the first editor of Medical Economics, had his hackles up. Today we’d call his condition "road rage," and from his description of the onset, it was justified.

"The other day I was motoring along a prominent New Jersey boulevard," our former leader wrote, "thinking pleasant thoughts and holding a grudge against no man. Suddenly from out of a blind street, there yelped a flea-bitten flivver. As I cut sharply to the left, the driver added insult to near-injury by derisively twiddling his fingers at the end of his nose."

At the sight of that, Baketel’s good mood had instantly turned sour. "Mayhem, even murder, was in my heart," he continued, "and for the rest of my trip, a veritable Mr. Hyde sat at my steering wheel. There is nothing like automobile driving to bring out the uglier side of our natures."

That’s the worst mental state for a doctor to be in while he’s on the way to the sickbeds of his patients, Baketel warned. "I motor nearly 35 miles a day to and from my office and home," he said. "It was my expectation that some of my solid thinking would be carried on during these morning and afternoon rides. Instead, I find myself growling inwardly when an over-cautious driver holds me back, snarling at the jaywalker who picks the middle of my path to hold a siesta, and positively bellowing curses at the trucks that go lumbering within an inch or two of my fender.

"Once in traffic, I am no longer a mild-mannered Episcopal vestryman," Baketel confessed. "A dozen times during the trip I perform a mental assault and battery upon some motormaniac."

His recommended therapy for a doctor-driver’s dark thoughts: "Drive serenely through it all, repeating over and over, ‘Love thy neighbor (grrrr),’ ‘Love thy neighbor (grrrr).’ Try this on your next call. A ‘traffic temper’ is the hardest of tempers to control, but control it we must."

—James D. Hendricks
Executive Editor

James Hendricks. Flashback in Medical Economics.

Medical Economics

2002;4.