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

by Albert V. Harmon

Truly, a generous corporation, the public would argue. It not only looks after its sick and injured without charge to the unfortunate, but it gives them the benefit of the best medical and surgical talent obtainable. But the corporations did not do this from philanthropic motives. Not much. It was a matter of business.

Sickness and accident among a large force of employees costs money. The quicker it can be overcome the better off the company will be. But, the reputation for philanthropy once established, the corporations began to economize in their outlay for medical expenses. For this the doctors and surgeons were largely at fault themselves. The plum was too tempting and there was a keen competition for it, with the result that prices took a sharp tumble.

Physicians with a small practice who heard of other doctors getting $5,000 a year to look after the sick and injured employees of a corporation argued that they would like to do the work for $2,000. It would ensure living expenses, and what they could pick up on the side in regular practice would be profit. They didn’t know, until too late that the demands on their time would be such that they would have little opportunity for outside practice, and that the $2,000 they received from the corporation would cover their entire income. So they began bidding and wire-pulling against one another, and the corporations, wise unto their day and generation, took advantage of the unseemly competition.

In no one line of corporate endeavor is this competition more keen and noticeable than in life insurance. It is not so very long ago that the position of medical examiner for a good company was a respectable, lucrative position. What is it now? It is safe to say that there is hardly a company in the field to-day that pays a decent sum for its medical examinations. The doctor is the watchdog of the company’s treasury. He stands between it and great financial loss. He protects it against fraud. A slight error or the least degree of negligence on his part may cost the company thousands and thousands of dollars. The issuance of a policy is a very important business transaction. The doctor stands in the same relation to it as does the lawyer who examines the abstract in a real estate deal. Contrast the fee allowed the medical examiner in a case involving the issuance of a $100,000 life insurance policy and that received by the lawyer who examines the abstract in a real estate transfer involving $5,000, and my argument is complete. Some companies expect to secure all of an expert examiner’s time—and actually get it—for $2,000 to $3,000 a year. It might be well to contrast, also, the commission received by the agent who writes the policy, with the medical examiner’s fee.

In the case of our fraternal societies the examiner’s fees are pitifully low, so low that a busy man cannot do the work save at a great loss of time. There are some extenuating circumstances in the case of the co-operative societies. In the case of both old line and co-operative insurance, however, only the overcrowded and generally poverty-stricken condition of the medical profession can possibly explain the fact that good men are to be had so cheaply.

Railroad and manufacturing corporations have no difficulty in securing doctors to look after their interests at a rate so low as to reflect on the respectability of the profession at large. There are, for example, instances in which doctors are rendering for $300 a year services that should bring several thousand dollars at very ordinary fees. In addition to this direct cheapening of professional values, the company or corporation surgeon is expected to go on the stand as an expert and prevaricate in the interests of his employers. As a corollary, he is expected to testify against the interests of the poor fellow who, perhaps, as the result of the company’s wilful neglect, has only the wreck of a once vigorous manhood with which to oppose the company’s immense capital. And this the doctor does in an uncomfortable proportion of cases.

When the charge is made that he “prevaricates” it is correct. It would be pitiful, indeed, if the expert opinions rendered by some corporation doctors were the result of ignorance. The corporation expert does not always prevaricate. The truth may be the best card to play. He had better not let the corporation catch him telling the truth, however, when said truth is prejudicial to its interests. There is an ax, my brethren, an ax that is ever ready.

Speaking of corporation surgeons reminds me of the fact that practice in the neighborhood of our large factories is rather poor picking for everybody. There is plenty of work to be done, and there would be considerable income derived therefrom, but the corporation surgeon gets it all, and receives a mere pittance therefor. The corporation claims to employ a surgeon for humanity’s sake. This is pure hypocrisy—the doctor is employed for its own protection. Every doctor knows of cases in which, by the co-operation of the claim agent and the surgeon, an injured employee has been induced to sign away his manifest rights. He is usually denied the right to select his own surgeon. To the non-partisan medical observer, the bitter opposition of the average juryman to corporations is in no wise remarkable. It will be argued that there are plenty of honest corporation doctors. Grant you that, but it is hard to see how they hold their jobs.

Then there is a hurtful disposition to fraternize. In the good old days the regular profession ostracized him who consulted with that horrid bugaboo, the homeopath. It has come to pass that the regular lion has laid him down beside the homeopathic lamb. And when they rise again the mutton shall be no more, and the lion shall have waxed fat. The latter-day regular has gone farther, and hobnobbed, as on equal terms, with “osteopaths,” “Christian Scientists,” “faith healers,” and others of their ilk. Not so? Oh, yes it is. It is not long since the Physicians’ Club of Chicago invited representatives of these creeds to break bread with it, and formally discuss the merits and demerits of their theories as opposed to regular medicine. The affair was given great publicity in the newspapers, and the wise layman, reading thereof, laughed exceedingly merry and said, “What fools these doctors be.”

And, from a business, politic and social standpoint, were they really so very clever? The Physicians’ Club gave these people standing in the public eye, and by inviting them to a joint discussion, gave them professional recognition—a recognition they were not slow to use as a valuable advertisement. If a dinner invitation does not constitute social recognition, what does? This action of the Physicians’ Club did more to further the interests of these people than they themselves could have done in a year. Still, mistakes will happen, and the worst that can be said of the club is that it made a serious, impolitic and unbusiness-like blunder.