letters | when medical bills result in sticker shock

Specialist’s fee ought to prompt a double-take

The article “A hospital fee, minus just one thing: a hospital” (Page A1, Jan. 27), which highlighted the excessive costs associated with hospital-owned office practices, was thorough and long overdue. However, as a physician who cares for senior patients, I was struck by the way both the reporter and apparently the patient seemed content with the fee of “just” $354 for a dermatologist to squirt liquid nitrogen on three small growths.

My patients, most of whom are over 85, come with a concerned child — someone who wants to speak about his or her parent before and after the visit — as well as a list of multiple problems and an even longer list of medications. This requires considerable time and intellectual energy even for routine visits. Our office can bill, at best, about $100 for such a visit, and Medicare pays considerably less.

We have a crisis in our medical workforce. Primary care shortages are only getting worse, and our health care system will suffer drastically if we don’t correct it. We can’t expect students to want careers in primary care as long as they can see that you can bill $354 for a short visit to apply liquid nitrogen and nobody seems concerned. Until we considerably narrow the gap between primary and specialist physician income we can expect ever increasingly costly health care with little if any increase in quality.

Dr. Robert L. Dickman

Newton Centre

The writer is a board-certified geriatrician and was the founding chairman of family medicine at TUFTS UNIVersity School of Medicine.