Does ‘free’ healthcare devalue doctors?

“But it just took you a minute!” my patient yelled demonstrably while waving the form I had just completed in one hand and the invoice in the other.“Actually,” I replied, “It took years. Years of school, years of experience, and years of getting to know you.”He shook his head, muttered something, and stomped out of the office.I wondered whether he did that after paying his dentist. Or reading the bill at a restaurant. Or when he shops online. In these instances, the cost of the good or service is clear.But in healthcare, there is truly little understanding of cost.Although we have “public” healthcare, most costs of community care are paid by doctors. And while taxes and the cost of staff, equipment, and rent skyrocket, our reimbursement fees rarely keep up. Add to that the tired and false narrative of fat cat doctors—often propagated by short-sighted “experts” and reports—and patients' perceptions of our incomes and outflows are often jaded and false. Read: Dr. Eric Cadesky: Chart it: Every. Single. Time.After one patient haggled about a long form that I had completed on her behalf, I asked her what she thought I received for the 20-minute visit that included four complaints, several refills, two referral requests, and the insurance form.“$200,” she replied.I explained that it was about $10 after taxes and expenses.She never complained again.I am all for equitable access to care based on need, but increasingly I feel that our time as doctors is taken as an unlimited resource to be accessed at will. Patients want notes, pharmacies want refills, insurance companies want information, and dentists want clearance. Since a willingness to pay does not always accompany these requests, there is an unhealthy perception of our worth. We want to care for people where and when they need it, but I worry that the lack of out-of-pocket expense—or at least the understanding of the true cost—for each visit or treatment means that people do not fully appreciate the value of healthcare. And we as doctors often make the biggest financial investment and take on the most liability—commitments rarely seen and more rarely recognized.So, I will continue to let patients know the costs involved in their care. I will continue to bill the government for publicly funded care, and I will continue to invoice those who request uninsured services. Because while the ability to pay should never prevent access to needed care, “free” should never cheapen our value.Dr. Eric Cadesky is a full-service family physician in Vancouver and a past-president of Doctors of BC.

Does ‘free’ healthcare devalue doctors?

Register for free access or login.

Related Topics