Doctors Earn a Lot, Part 1

The average family doctor earns about $220,000 per year. My peak income came nowhere near, but I’m not complaining. When friends suggest that we earn a great deal, I agree that America pays doctors generously. 

There’s no need to defend myself. Among problems of our health system that upset Americans, the size of our incomes is well down the list. 

Other doctors insist that they’re underpaid, and I wish they’d shut up. Their excuses sound whiny. Every complaining doctor beats two dead horses.

The first is what I call the Oprah Winfrey defense.

“Oprah Winfrey (or Tom Hanks or the chairman of Disney) makes. . .  How many lives do they save?”

Similar excuses include:

“A plumber charges. . .”

And the traditional:

“Lawyers make three hundred dollars an hour, so. . .”

Doctors aren’t the only ones comparing themselves to lawyers, plumbers, and celebrities. Everyone does. Worse, almost everyone who uses this argument earns less than I do. People who feel underpaid for their own honest labor are unlikely to agree that doctors are in the same boat.

Number two, equally feeble, is the trash compactor defense.

       

 “The average American pays more for alcoholic beverages than. . .” 

       

“My last malpractice premium was. . .”

“The consumer price index proves that doctors incomes haven’t. . .”

       

“Ten years ago, Medicare paid ... for a cataract operation.  This year it paid a mere. . .”

The trash compactor is a machine that converts a hundred pounds of trash into a hundred pounds of trash. A physician using this defense doesn’t grow less prosperous.

My blogging book says that readers lose interest when posts are long, so I’ll stop here and finish next time when I explain why we deserve a high income.

The Five Actions of a Hotel Doctor

After the door opens and an exchange of greetings, my first action is to look down at the floor. If I see a pile of shoes, I remove mine. You may think this is a quaint foreign custom, but some Americans have adopted it. When you consider what people and animals deposit outside, it seems terribly unsanitary track it onto anyone’s rugs.

My second action, on entering the room, is to identify the patient. A doctor making a housecall is an exotic event even for Americans, so I often encounter a large, attentive audience.

My third is to brush off apologies as guests rush to clear a space for my bag, clipboard, and buttocks. Apparently no one reads or writes while traveling, so desk and chairs are piled with belongings.

My fourth action is to suggest that someone turn off the television. Time and again, a patient begins talking – and I can’t hear. Guests often seem startled at this request – and occasionally miffed. What’s the problem?.....

It’s surprising how many people around the world turn the TV on before breakfast and leave it on. It’s the background to their daily life.

My fifth, after listening to the patient and before the examination, is to announce that I will wash my hands. This produces more apologies as guests rush to tidy up the bathroom.

I hope this held your attention. You should realize that any competent blogger must write at least once a week, or his audience drifts off. Being a hotel doctor may be a great job, but it’s not always exciting.

It's Just a Stomach Virus

“I’m worried about sunstroke,” said a guest at Maison 140. Her husband was vomiting, and they had returned from a walking tour of Beverly Hills. The temperature was in the 90s.

Sunstroke is life-threatening, and it takes more than a hot afternoon walk in Los Angeles to bring it on. I’ve never made the diagnosis, but hotel guests worry about it.

“I think someone put something into my drink.”

You’d think no one outside of a B movie would say this, but I hear it perhaps once a year. It’s alarming to fall violently ill after a night on the town, and Los Angeles is an exotic locale to many travelers, so anything can happen.

“The sushi tasted funny…”

It’s common sense that food your stomach rejects must be noxious, but if you’ve been paying attention you know that using common sense to explain an illness is proof that you don’t know what’s going on.

Food poisoning is not rare, but the responsible toxins are tasteless. Also, infections such as Salmonella and hepatitis are not the result of spoilage but contamination of perfectly good food with feces.

It’s almost impossible to diagnose food poisoning unless more than one person is sick. Almost everyone blames an upset stomach on the previous meal, but it’s most likely a virus. Google “viral gastroenteritis.”

Being Awakened Twice

 "How quick can you be in Costa Mesa?” asked the dispatcher for Expressdoc, a housecall agency. The call had gotten me out of bed at 11 p.m.

“In about an hour.” 

“Can’t you make it earlier?”

“Costa Mesa is forty miles away. How sick is he?”

“He has back pain. He wants to go to an emergency room, but we said we could send a doctor. Let me see if he’ll wait.”

After fifteen minutes had passed, I phoned the agency.

“I’ve been trying to reach him, but it looks like he’s gone to the hospital. If he comes back, is it OK to call you?”

“No. If he comes back, tell him I’ll be happy to see him in the morning.”

I have no objection to being awakened to make a housecall, but I don’t want to be awakened twice. After breakfast, I phoned the guest. He hadn’t gone to the emergency room, but he was feeling better.

Nearing the End of the Road

I have never denied being America’s most successful hotel doctor. No one has made as many visits – over 18,000 -- or works at it exclusively. All others do it as a sideline.

Yet time is passing. I’m not the only Los Angeles hotel doctor collecting social security. A new generation is muscling in, displaying the energy of youth, fierce marketing skills, and a priceless absence of ethics. All are concierge doctors, building cash-only practices that serve patients willing to pay to have a physician at their beck and call.

Even in Los Angeles, such patients are a limited resource, so concierge doctors have cast an eye on hotels, a major source of cash-payers.

“I guess no one’s been sick,” is the lie I hear when an employee explains why her hotel isn’t calling. I’ve been hearing it lately.

Partly it’s because my field is consolidating. National housecall services are expanding, and almost all use me. This is no news to my competitors, but marketing to these services presents difficulties for a concierge doctor.

One obstacle is their spectacular fees: double, triple, or quadruple mine. This may strike you as terrible business practice, but it’s no problem with hotels. Hotels don’t care what a doctor charges unless guests complain. They rarely do.

In addition, when concierge doctors introduce themselves to a hotel employee, extol their virtues, and offer an amenity for every referral, they have a receptive audience. It’s illegal for a doctor to pay for a referral, but no one is complaining. 

On the bright side, concierge doctors are young and busy. Immediate 24-hour service is their mantra, but providing it is impossible for anyone with a practice and social life. My leisure activities are reading and writing.

The result is that concierge doctors ask my help regularly. They send me to their patients who are increasingly guests at my hotels and those of competitors. When I retire, it won’t be because business is declining. 

A Plug for a Book

Try to find The Hotel, A Week in the Life of the Plaza by Sonny Kleinfeld. Published in 1989, it’s long out of print, but you’ll love it. Kleinfeld is a journalist who spent a week in the famous New York hotel and wrote about twenty chapters describing every position from the doorman, desk clerk and laundry worker to the kitchen staff, concierge, security, bellhops, housekeeping, and management.

I was impressed at the difficulty of keeping such an institution running smoothly and satisfying demanding guests. If you want to know the hardest job in a hotel, there’s no contest. It’s the housekeeper’s. 

The book includes a chapter on the hotel doctor that kept me scratching my head. Mostly, he complains.

It infuriates him that guests wake him up at 1 a.m. with a bad cold. I’d be thrilled by a call from an exclusive Los Angeles hotel at any hour. Why was he upset? Did he volunteer for the job? Is he working for free? I have no problem seeing guests who aren’t very sick no matter what the hour.

I take for granted that doctors go into medicine because they want to help people, and unlike other helping professions (clergyman, fireman, social worker) we’re paid very well. Almost no one calls me during wee hours unless they feel bad. That may represent poor judgment, but who thinks clearly when they’re miserable?

A Weird Letter from My Doctor

I take good care of myself, but the best life-style only postpones the inevitable.

I was seeing a cardiologist at the Pacific Heart Institute in Santa Monica. He was excellent. I would be seeing him still but for a strange letter I received.

Insurance companies and Medicare have been reducing payments, the letter began, and more cuts are threatened. In response other cardiology groups were lowering the quality of their care. Pacific Heart Institute vowed to maintain its standards. But how to do that while continuing to accept insurance?

The solution, according to Pacific Heart Institute, was an “Enhanced Access Program.” An accompanying sign-up sheet listed three levels of benefits.

For an extra $500 a year I could choose the “SELECT” level. Among its features were priority in appointments, prompt notification of test results, waiver of miscellaneous office fees, a special internet portal, and a customized wallet card with my EKG tracing.

$1800 per year would bump me to “PREMIER” status: same day appointments, direct e-mail and phone access to my cardiologist, and a free vascular risk assessment (whatever that is…).

At $7,500 a year (that’s not a typo), the deluxe “CONCIERGE” level gives 24 hour access to my “personal” cardiologist, same day visits, same day tests, and a call from my personal cardiologist to discuss results.

I could check a fourth box that merely stated “I choose not to participate… No fee.” The doctor would continue to see me if I decided not to pay up. It didn’t say he would consider me a cheapskate, but why wouldn’t he?

Paying extra to get the doctor’s attention is routine where doctor incomes are low. It was the norm in the old Soviet Union and remains so in Russia, China, and Eastern Europe.

American doctors are the world’s richest, but they didn’t get that way by ignoring sources of income. If you follow the news, you know that cash-only or “concierge” practices are a growing niche. They’re so popular that professional organizations such as the AMA have set up ethical guidelines. This strikes me as similar to setting up ethical guidelines for operating a Mexican cancer clinic, but mine is a minority view.