On Medical Fees

Baltimore Evening Sun/June 24, 1910

A Surgeon Of Long Ago

 In the late thirties of the last century there lived in the town of Athens, Ga. a skillful and enlightened surgeon name Crawford W. Long. Dr. Long’s service was in great demand all over the South, and he spent most of his time travelling from town to town performing operations. He did his work well and he saved many a poor unfortunate from death, but he always felt that there was something lacking in his art, for that was before the day of anesthetics, and the operating room was still a place of barbarous agonies. Why shouldn’t it be possible to find some benign drug that would render patients unconscious, and so make it possible to relieve them without torturing them? Dr. Long pondered the problem as he went his rounds, and finally, in 1841, he hit upon the drug that he was seeking. It was sulphuric ether.

But he was a cautious and modest man, and it was some time before he ventured to test his discovery in practice. First of all, he tried the effect of ether upon animals, then upon himself, and then upon other healthy persons. It was not until March, 1842, that he felt himself ready to use it in his actual work.

A man named James Venable, a Georgian like himself, was the first patient to enjoy its unspeakable blessings. Venable had a couple of bad tumors on his neck and came to Dr. Long to have them removed. The latter explained to him the effects of ether, but also pointed out to him the risks attending its use. Venable decided to take those risks, and so on March 20, 1841, he inhaled Dr. Long’s ether and one of his tumors was cut out. From first to last he felt not a single twinge of pain. Three weeks later he inhaled ether again, and the second tumor was removed. A month more and he was completely well.

Dr. Long’s Modest Bill

The rest of the story belongs to medical history. Dr. Long revealed his discovery to the other surgeons of his town, and in a short while all of them were using ether in their operations. The news spread to the North, and after awhile other surgeons began to claim the discovery. The honor of having made it is commonly accorded today to a Bostonian, but that is another story. The matter which concerns us here is the bill sent to Venable by Dr. Long. It was found years afterward among the good doctor’s papers. Here it is:

 

Mr. James Venable to Dr. C. W. Long

March 30

Excising tumor    2.00

Sulphuric ether      .25

June 6,

Excising tumor    2.00

Sulphuric ether      .25

                                       _______

                                    4.50

Imagine it! Four dollars and half for two operations! The removal of a tumor from the neck, let it be remembered, is no small enterprise. It ranks as minor surgery, true enough, but it requires the best sort of skill. What is the market price of such skill today? The answer depends entirely upon the means of the patient and the reputation (which is not necessarily synonymous with skill) of the surgeon. If the patient is poor and the surgeon young and eager to try his hand, the cost of hacking out a surface tumor will probably run from $5 to $25. But if the patient is well-to-do and the surgeon a fashionable star, the latter’s bill may call for $50, or $100, or even $1,000.

Outrageous Hospital Costs

 The cost of surgical operations, in other words, has vastly increased during the past two generations, and that cost shows a tendency to increase still further. The popular surgeon, the prima donna of the operating room, has become a plutocrat. According to an article in the National Magazine, from which Dr. Long’s bill is taken, “surgery has advanced into the realm of high finance.” Only the pauper can now afford to go to hospital. The man of fair means and self-respect, who desires to pay his way, is stripped of most of his savings the moment he gets into the surgeon’s hands. The rental of hospital rooms has long since gone beyond absurdity, and medical and surgical fees seem to be mounting daily. A typhoid patient who desires good attention must pay from $60 to $100 a week for it throughout the 6, 10 or 20 weeks of his illness. And a surgical patient, in hospital for a month, is extremely lucky if his bill is less than $500.

The fee card of the Medical and Chirurgical Faculty of Maryland shows how vastly fees have advanced in this town of hospitals, with its swarms of doctors. Twenty years ago the customary charge for a house visit was $1, for an office visit 50 cents and for a consultation visit $5. But today, as the card shows (it was revised in 1907), every member of the faculty is expected by his colleagues (apparently for the honor and good of all) to charge no less than $2 for each house visit and the same for each office visit.

And that $2 is merely the official minimum! Without laying himself open to trial before the faculty for unprofessional extortion, the practitioner may charge $20 for his first house visit and $3 for every subsequent visit!

The minimum for consultation visits is still $5, but as everyone knows, the more eminent consultants of Baltimore are not to be seduced from their offices for any such fee. Dr. Osler, when he was in practice here, charged $10 for advice, and, considering the vast skill of the man and the enormous demands upon his time, it seemed reasonable enough. But of late the orthodox fee for the higher sort of counsel has gone up to $23. The result is that the average patient must do without that higher counsel or go into debt.

But let the fee table of the learned physicians and surgeons tell its own story. Here it is, in full, “as ordered by the Council of the Faculty”:

MEDICAL AND SURGICAL ATTENTION

First visit in any case of sickness    $2 to $20

Each subsequent visit    2 to 5

First consultation visit    5 to 100

Each subsequent consultation visit    5 to 100

Single visit and advice in special cases, where the physician is not the

regular attendant    5 to 25

Distant visits, for every mile over two miles in addition to the usual charge, night visits double    1 to 5

Night visits, between 10 PM and 7 AM    5 to 10

Detention with patient all night    10 to 100

In case of several patients in one family, charge the visit to the others each one-half the amount charged to the first     2 to 10

Advice at physician’s office, night double    2 to 10

Advice anywhere except at office    2 to 10

Advice by telephone    2 to 10

 

SURGICAL OPERATIONS

Minor    5 to 100

Major    100 to 10,000

Obstetrical attention    20 to 1,000

The Income of A Rockefeller

There is something grimly fascinating about this price list. Note the quoted fee for major operations–$100  to $10,000. Imagine a surgeon performing ten operations a day at $10,000 apiece. His annual income, even supposing him to spend all day Sunday in bed and two months of each summer on his steam yacht, would be $6,000,000. And even at $100 an operation he would earn in 365 days, $73,000, or but $2,000 less than the President of the United States.

If it true enough, of course, that the great majority of physicians and surgeons collect no such fees. Nine tenths of the general practitioners of Baltimore, in all probability, still charge but $1 each for house visits—and are lucky if they get the money. But the fee table of the Faculty, if it lacks the force and effect of law, at least shows how the ambitions of the medical gentlemen are mounting. The maximum fees fairly touch the sky. They make it possible for a member of the Faculty, if the chance offers, to demand fees that would make a Swiss hotelkeeper hide his head in shame, and still escape trial by his peers for grossly and indecently oppressing his patients.

 

(Source: Iowa State University, Parks Library Media Center, Microfilm Collection)