Please Send Cash

Originally published: June 30, 2010

This was a new one on me in the madcap world of getting hit up for money.

I recently received a plaintive letter, printed on paper as blue as the mood of its content. It was a cry for an immediate infusion of cash from an unexpected source. This new supplicant was not a needy person, a charity or a non-profit. The plea was not even from my political party or its eager relations. 

It was from my doctor.

She and her colleague/suitemate were requesting $25 from each of their patients, to – and I am paraphrasing here - keep their awesomeness going. The letter stated that the decline in Medicare reimbursements, the high cost of malpractice insurance, and the relentless free services they provide (authorizations, pharmacy calls, pesky primary care consultations), are reducing their income by more and more every month. With each passing year they are reimbursed less, making their jobs, one gathers, barely worth the bother of slipping into their white lab coats.

They called this a “suggested annual maintenance fee”, which would, they said, cover some of the many costs for which they are not reimbursed. Our $25 would enable them to continue such things as teaching at the nearby world-class hospital, enhancing their ongoing education to keep their expertise current, and continuing their selfless volunteerism. They were inviting us to share in the cost of our specialty needs because otherwise, they would be forced to nickel and dime us for each “subtlety”. This word interested me because I had never before seen the noun subtlety used so subtly.

Now, I have no intention of disclosing the name of this doctor. I will say she is a specialist in a legitimate field of medicine – not some scatterbrained offshoot having to do with crystals or colonic cleansings. Her specialty is not cosmetic or imaginary in nature, but is a real field of medical study, a ratified and recognizable ology. And, no, it’s not one of the embarrassing ones. I don’t name it because I don’t want her (or him - I might be intentionally misleading you) to read this, recognize my name, and then extract revenge upon me in either a legal or a physical manner. Who knows what might accidentally get written on my chart. Doctors have ways of making you wish you’d kept your mouth shut.

And yet some of my closest relatives are doctors. My brother, for example, has been an internist at a major healthcare organization for 30 years. He currently has 2,200 patients but has had as many as 3,400 at one time. All his patients have his email address. His life - like that of my specialist, apparently - isn’t easy. He is on call every other weekend and often works the night clinic. His raises are modest merit-based bonuses and cost of living for the most part. I wondered if he’d ever asked his patients – most of whom seem to find him awesome enough to remain his patients into their old age - to chip in a maintenance fee. He said no. I thought, does he know what an opportunity he’s missing?

I understand that private practice is different from health systems where doctors are salaried and can concentrate exclusively on patient care. Doctors in these systems have the luxury of leaving the accounting to others. My private practice doctor is at a disadvantage because she must be attentive to the financial side of things if she wants to stay in business. Then again, how private is a practice when its physicians need to make public their money woes, passing the hat ‘round the room to fill the coffers? I find myself torn between sympathy and indignation. 

In the letter, my doctor pointed out that she and her colleague are considered national experts in their field. I worried that if I didn’t pay them the $25, they would somehow lose this status. Then they would lose still more income, making me ultimately responsible for the disintegration of their mission – and the resulting loss of their awesomeness. 

Enclosed with the letter was an envelope, for my convenience. There was no stamp on it. There was, however, a line for patient name, address and phone. Just so they’d know who you were and where you lived. And if you anteed up or not.

Damn right I sent the money. What am I – stupid?