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Professional Courtesy

Every so often there is an article hippocrates-bust.jpg in a newspaper written by someone complaining about “rich doctors” giving professional courtesy (not charging each other or their families for medical care), and blaming that in part for the escalating costs of medicine in this country. Don’t you just hate when the misinformed have a platform from which to blather incessantly?

And then recently I had a discussion with a non-physician “professional” who complained about this practice. So I felt compelled to explain to him

that it is not some perk bestowed upon members of a secret fraternity, but rather a long-standing sign of mutual respect between doctors. According to an article in Missouri Medicine (1998), professional courtesy “is a tradition that dates back to Hippocrates. The practice served to build bonds between physicians and to reduce the incentive for physicians to treat their own families.”

Now it is important to check with the insurance carriers in your area and make sure that you are in compliance with their contracts – you don’t want to be in a situation where you are arbitrarily no-charging a specific group and charging everybody else without exceptions. However, most physicians will certainly have had cases where they did not charge a patient – perhaps someone who was in a financial bind and was given a pass – so would probably not be out of compliance.

The other thing you need to avoid is even the slightest perception that the professional courtesy discount is a quid pro quo: make sure that no physicians are discounted solely in return for referrals. Although the Medicare Carrier Manual (MCM) Section 14028 does have guidelines for “protected” discounts to patients, it does not specifically address the issue of professional courtesy between physicians.

The American Medical Association does offer its own recommendations but these have become a bit namby-pamby in this age of cover-your-a** legal advice. The AMA now states that there are several reasons why physicians should discontinue this practice including

  1. physicians and their families have insurance and don’t need the special treatment
  2. it puts a “financial strain” on the physician giving the discount
  3. many physician practice organizations forbid it (see above)
  4. it inordinately affects some specialties more than others – psychiatry, pediatrics

In our case, the county medical society has a contractual obligation with the Blue Cross carrier for physicians to give each other professional courtesy. Why? Because there have been several studies showing that physicians and their families are higher over-utilizers of health care relative to the general population. I know, it’s kind of hard to believe. But this sort of arrangement is supposed to discourage the medical community and their families from seeking medical treatment for the most trivial problems.

If you’ll excuse me now, I have a bit of a headache and I think I will go and get an MRI…

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