Large Fees and How to Get Them: A book for the private use of physicians

by Albert V. Harmon

In the eyes of the Almighty all human lives are of the same value, and it would be cruelly unjust to attempt to appraise them on a commercial basis. But this should not prevent a physician from grading his fees in proportion to the ability of his patients to pay them. What might seem like a large amount to a wage earner, would be a mere trifle to one in more affluent circumstances. The lives of both are equally dear to them, and both are willing to pay the doctor according to their respective ability.

Custom, the mother of much folly, is the only excuse for adhering to the old, antiquated system. A physician who is called out of bed on a stormy night to answer an emergency call from the home of a coal heaver would not be justified in asking more than the minimum fee. But why should he perform exactly the same service at exactly the same charge for one who is able and willing to pay ten times as much, or even more? It is not sensible, it is not fair.

“But it would be a violation of the code of ethics,” some one may say. Bah! The code of ethics be —— but that’s another story which will be told later on in this volume. The plan suggested, however, is not a violation of the code of ethics. There is nothing unethical in a physician regulating his fees to please himself, provided no injustice is done, and none of his patients is oppressed in this respect. There are certain physicians in the large cities who will not respond to a call for less than $25. There are others who perform the same services for $2. Yet both kinds are strictly ethical and are recognized by the medical authorities as such.

The reason for this wide difference is that the $25 men have used business tact in the practice of their profession, and elevated themselves to a position where, by reason of their prominence, they are justified in naming whatever fees they think they can get. And these fees are almost invariably cash.

On the other hand the $2 men are timid in a business way; they hide their light under a bushel as it were, and consequently lack widespread reputation. Their fees remain at $2 because they don’t ask any more, and their ledgers are laden with unpaid accounts.

There is no reason why a physician should not collect his bills with just as much promptness as a merchant. It is usually his own fault that they go unpaid. Statements should be sent out regularly on the first of each month, and if there is no remittance by the 15th, it can be found inconvenient to make any further calls. This, of course, is allowing that the patients are able to pay. Where real inability to meet the bill exists it becomes a matter for the physician to settle with his own conscience.

Our medical schools are full of young men who are wasting their time and doing the world at large an absolute injustice by studying medicine. They are doomed to failure before they are well started because Nature has not endowed them with necessary qualifications for successful practitioners. Their instructors realize it, but the tuition fees are needed for the support of the schools, and year after year big crops of alleged “doctors” are turned out. It might be unfair to refer to them as incompetent, and yet this is what many of them really are. Most of them know medicine theoretically and know it well, but lack the vital essentials of success.

It would be a simple matter of justice to these young men if some plan could be devised for weeding out those who are manifestly unfitted for the practice of medicine before they have wasted their time and money on medical instruction. So long as such a plan is lacking it becomes the duty of the individual to assume this responsibility himself. The mere desire to become a physician should not satisfy the aspirant for medical lore. He should question himself closely as to his fitness. His character may be the best, his ability to acquire the necessary knowledge unlimited, but unless Nature has equipped him as previously outlined, the most he can hope to attain in the medical profession is mediocrity so far as actually helping the sick, and obtaining prestige and wealth are concerned.

There are men, it is true, of high standing in the profession, who do not possess these qualifications, but they are few in number and, as a rule, are consulting, rather than practicing physicians. Other doctors call upon them for advice because of their recognized skill and learning. They give this advice wisely and well, but in the sick room would fall far short of obtaining the same results which other men, more favored by Nature, obtain by acting upon the advice they give.

Time was when the word “physician,” conveyed the idea of a man with a beard. The two were intimately connected in the public mind. In many parts of the country, especially in remote districts where modern ideas and knowledge of the germ theory have not penetrated, this relationship still exists. In such places a full beard is an efficient badge of the doctor’s calling, and is essential in establishing his professional identity among the people.