The Richmond palladium and sun-telegram. [volume] (Richmond, Ind.) 1907-1939, 1913-10-04
Fee Splitting

business of fee splitting. Whenever a scandal
GUS practice is revealed among physicians, it is
too often presumed that all are involved. But
this is an error. While it seems that much fee
splitting has been practiced there is no doubt
only few have been guilty. The doctors in the
great majority of cases have kept their skirts
free.
There are some means of dividing fees that
are above reproach ethicaly though they may
be unwise as policy, but the practice so drasti-
caly dealt with at the recent state medical asso-
citation is that wherein surgeon will secretly
contract with practitioner to pay percentage
of all fees charged for cases referred by the
practitioner.
Twenty-Five years ago there few spec
ialists. What little surgery was done was per-
formed by the general, old time family physi-
clan. AS the healing art progressed men began
to specialize and develop themselves as experts
in narrow divisions of the work
When these specialists first began to be called
in by the family doctor the latter would present
bill to cover entire expenses of the case and
out of that himself pay the operator. This was
innocent enough and deserved no condemnation.
But specialism has grown to such proportions
the surgeon has been more and more drawn apart
from the general practitioner. His speciality has
OooAiASoo
and he makes his scale of charges.
AS the number of surgeons increased, compe-
tition began to tighten up and each specialist
found it increasingly difficult to hold his own.
This threw out a temptation to INSCRIPTIONS
men to invent means of securing trade other
than skill and reputation. Fee splitting was such
an invention.
By means of it given surgeon is able almost
to monopoize the surgical work of community
He offers larger percentage than his competi-
tors can will offer and makes it to the inter-
est of the general practitioners to refer all his
cases to him.
This temptation is strongest to the least COM
petent surgeon because he is least able to meet
the stress of competition. Because he can't win
business from rival by fair means, he chooses
foul
Where number of practitioners strike bar
gain with specialist they prepare reputation
for him which will attract an increasing number
of cases from other surgeons. The more reputa-
ton a surgeon has the more weight does his
word of recommendation carry. Because of this,
unsuccessful or incompetent practitioners, eager
to secure business will work the hardest for
him in order to receive the benefits of his rec
ommendation and his divisions. A practitioner
will praise an incompetent surgeon because he
divides fees, while the surgeon will boost for an
incompetent practitioner because he refers cases.
Thus the practice works both directions to en-
courage incompetency and to depress the skilful
men and lift the unskilfu
It is easy to see how much the unsuspecting
public will suffer in the long run from such a
state of affairs.
When practitioner stands to receive large
fee from an operation over and above his own
charges for attendance he is tempted at times to
refer for operation when operation is
necessary. Per contra, when practitioner calls
in a surgeon for consultation the surgeon is
afraid to turn the case down as operable for fear
of offending practitioner who sends him so
much business.
Another result is that surgical fees are
raised unnecessarily in the long run. When a
fee splitting surgeon monopolizes a local bust
ness his reputation enables him to lift prices He
is tempted to do in order to make up in his
own purse the amount paid practitioners in
division.
Again, the practice will sometimes place a
surgeon at the mercy of INSCRIPTIONS practi-
TONER If the latter turns in bill to the patient
covering total expenses of given case, he will
turn over to the surgeon only portion of amount
paid by patient for the surgeons work.
Not only is the business of fee division dis
honorable and dangerous, it is fraudulent The
practitioner who receives division is securing
money under false pretenses. He charges the
patient for his own work and then in addition re-
100 Ut ATNrS improvements an