I got the feeling, especially after the lawsuit was filed, that the
doctors at New England Baptist Hospital believed they were above the law. Perhaps one
of the reasons they feel this way is that they make so much more money than the average
physician. In addition to having access to an exclusive patient population that includes
very few uninsured people or Medicare patients, the surgeons at the Baptist have the
ability to reject patients because they don't like their form of insurance. Because the
Baptist is chartered as a private referral hospital, doctors are free, under
most circumstances, to discard any patient who can't pay what they want. This has led to
some remarkable income levels for the surgeons there. Here's one example:
Dr. Alan Curtis, who was my shoulder doctor before the accident that
brought me to the Baptist, seemed like a good guy. But he was very hard to reach on the
phone, and unless it was a grave emergency, it was difficult even for established patients
to get in to see him sooner then six weeks from when you called his office.
Once you got an appointment, there was often a two or three-hour wait to
see him from the time the appointment was scheduled. Frequently, the women who ran the
office at ProSports Orthopedics would lie when I called them to ask how far behind
Dr. Curtis was running, and I would arrive an hour after my scheduled appointment time,
as instructed, and discover that there was still a two-hour wait to come. If he was too
busy to answer my calls promptly, they would lie to me and tell me he was
out of the office, and I would discover later, by talking to other patients
at D.O.T.S., the physical therapy clinic that acted as a subcontractor for the physicians
at ProSports, that he had, in fact, been there all along. And its not like I was calling
him frequently. In the just under two years that I was his patient, I think I called
his office needing to speak with him three or four times total. Thats an average of
once every six months. Regardless of Dr. Curtis blowing me off, I was always
pleasant and friendly to the staff at his offices; it's been a principle of mine for
years never to hold wage-earning women responsible for delays or problems that generally
originate with their wealthy employers.
After a few visits, I caught on to what was happening and began scheduling
my follow-up appointments for 9 a.m., the first appointment in the morning.
I would arrive right on time, and discover as many as six other people in the waiting
room. Once I asked the receptionist when their appointments were, and she replied that
Dr. Curtis was fitting them in before his morning appointments. But he
often didn't start seeing them until 9 a.m., or later, which meant that my 9 o'clock
appointment would take place at 10:30 a.m., or later. My time with Dr. Curtis, when I
was finally able to see him, rarely exceeded three or four minutes, even though I had a
somewhat complicated shoulder problem that required a lot of managing. Alan Curtis
never even sat down to talk to his patients, but stood, file folder in hand, right next
to the open door of the examining room, ready to dash off to the next person right away.
During the first year or so, I thought that all of this waiting, having
my phone calls blown off, and having little access to advice from Dr. Curtis, even though
I had paid him thousands of dollars for surgery and office visits, had to do with his
popularity as a physician. But one day, as I was reaching hour number three of the wait
to see him, I took an envelope out of my handbag and began calculating an estimate of
how much money he was making, and a quite different picture began to emerge.
It came to me as I did the math that Alan Curtis wasn't a busy guy trying
to help the largest number of people he could, but rather a businessman maximizing his
income. And, suddenly, lots of the bizarre stuff I had experienced as his patient fell
into place and began to make sense. Let's have a look at my back-of-the-envelope
calculations of his income stream.
The physical therapists at D.O.T.S. and his staff told me that
Alan Curtis' work week looked like this:
Monday: Administrative work at the Baptist -- teaching and training.
He also returned phone calls on this day to selected patients, as I discovered later.
My impression, as I looked at the people who were accorded this privilege, was that
they comprised a group of the younger, most attractive, most athletic patients.
Although I was in very nice shape myself at this time, and was working full-time as
a personal trainer, apparently I didn't fall into this category. The once or twice I
called in to the ProSports offices on a Monday, I was told that Dr. Curtis
was not in and could not call you back until tomorrow.
Tuesday: Seeing patients at his office. Technically, he was scheduled
to see people from 9 AM until 4 PM, but as I have mentioned, he often fitted in
half-a-dozen extra people in the morning, and the same in the afternoon. My
impression was that his staff scheduled six people an hour, with a 1-hour break for
lunch that often did not occur. Let's estimate six patients an hour times six hours
per day, plus six extra patients in the morning and six in the afternoon. That's 36
scheduled patients, plus 12 more fitted in, for a total of 48.
Wednesday: First of two days a week to do surgery. The nurses told me
that Dr. Curtis operated on three or four patients on each surgery day, depending on
how complex the surgeries were, and how long they took. Surgeries were booked at least
eight weeks in advance.
Thursday: Same as Tuesday. 48 patients processed through the office.
Heaven forfend if you were, as I was, a Wednesday surgery patient who had a post-surgical
problem. Thursday was Alan Curtis' last day during the week to see patients in his
office, and my experience was that his staff was certainly not about to interrupt his
working day to ask him to answer a question or solve a problem, even for someone he
had operated on the previous day.
After all, we had just seen him the day before, which was more
than the patients who were sitting in the waiting room could say. They hadn't seen him
for six weeks. Whatever post-surgical problem it was, we, should have thought of
it yesterday.... I suppose that would have been between the time when the
anesthesia wore off and when the staff moved you out of the day surgery center.
Friday: Same as Wednesday. Three or four surgeries, depending on their
Alan Curtis kept to this schedule whenever he was working. I was told
by the physical therapists at D.O.T.S. that he took two entire months off every year,
February and August, and also took some time, though not a lot, at Christmas, and
occasionally a week off here or there.
Now that we are a little more familiar with Dr. Curtis' schedule,
let's start doing the math. These are all back-of-the-envelope calculations, but they
are illuminating nonetheless.
With two months, and, let's say, another two weeks off per year,
I estimate that he worked a total of 42 weeks a year on the schedule you see above.
He charged me $60 a throw for those 3-minute office visits. He had
office hours two days a week, seeing approximately 48 patients per day, at, let's say,
what he charged me, $60 per visit. That's 48 times $60 times two days a week,
or $5,760 per week in income derived from office visits alone. Multiply this by
42 weeks a year, and you get $241,920 in income per year just from office visits.
And don't forget the co-payments most people are making.
Mine was $10 per visit. Let's say that 30 of Dr. Curtis' patients per
day have a $10 co-payment. That's $600 a week, or $25,200 per year, in cash, paid
directly to him. To put it another way, Alan Curtis was making the same income from his
office co-payments that many Americans get from a full-time job. Rounding, we have
$242,000 per year so far.
Now let's look at the surgery days. Alan Curtis billed my insurance
company $5,700 for my shoulder surgery, which was a not-very-technical arthroscopic
procedure including a subacromial decompression, a clean-out, breaking adhesions from an
adhesive capsulitis, and cleaning some scar tissue off my rotator cuff. Because my
insurance company had a deal going with ProSports, he was ultimately paid $1,800,
plus several hundred dollars in associated fees as well. Let's call it between a third
and a half of what he billed us, or $2,365. Now, remember, some of his patients are
paying a little less, but doctors at the Baptist see very few poor, uninsured, or
Medicare patients, and his WorldPath patients are paying the full $5,700.
(See The WorldPath Connection.)
Mine was a medium-length surgery for him, which occupied about an hour
and a half. It took longer than a routine subacromial decompression or biceps tear
repair, but was faster than a total shoulder reconstruction, or the surgical do-overs
that he often performed on patients who had had other, less-skilled surgeons do their
initial procedures. Let's call mine average in length and expense. Since he performed
between three and four of these per day, two days a week, let's call this seven surgeries
a week on average, at $2,365 a throw. That's seven times $2,365 times 42, or $695,310
per year for performing surgeries.
I also believe that he gets paid for the administrative and teaching
work he does at the hospital on Mondays. Since he is giving up close to $350,000 in
income he could be receiving from performing surgeries that day, we have to assume that
the management of NEBH is compensating him. Let's put in a guess, based on what I
overheard at D.O.T.S., of approximately $100,000 a year. Now, he also has to pay for the
office space and staff he shared with three other doctors. On the other hand, they
Cox-and-Box-ed it so that they were each in the office on different days, fitting four
physicians into a modest office space with 3 small examining rooms and one large shared
office. But, since most people's income is stated as gross numbers, let's stick with
that for Dr. Curtis, too. After all, we don't say, My husband makes $55,000 a
year after taxes and expenses. People, even consultants and other self-employed
folks, express their income as gross figures.
Keep in mind that I did not feel at the time, nor do I think now, that
Alan Curtis is an avaricious man. It just seems to me that there's a connection between
the days-long waits for callbacks and the breathtakingly brief office visits I had, and
how much money he made. And remember that Dr. Curtis had an independent practice with
the other three doctors at ProSports, and does not have his hours or working conditions
specified to him by an HMO or by the hospital. He gets to choose.
Rounding down, we have $695,000 per year for performing surgery,
$242,000 for office visits, and an estimated $100,000 for his administrative and
teaching work at NEBH. That adds up to approximately $1,037,000 as Dr. Alan Curtis'
All of those hours I was sitting in the waiting room, and all of those
days I spent waiting for callbacks, I had assumed that Dr. Curtis was just another harried
physician. But after I ran the numbers, I began to see those long waits in a very
different light. Dr. Curtis was making over a million dollars a year! The average
general surgeon's income, as reported by the AMA in 1997, the year before my shoulder
surgery, was $225,000. And the average orthopedic surgeon's income was $200,000.
This means that Alan Curtis was most likely making more than four times the average
surgeon or orthopedist. I believe that most of the physicians at New England Baptist
Hospital are making similar multiples of an ordinary physician's income, because they can
cherry-pick from the most profitable patients, and because the system at the Baptist
is set up to maximize their income, rather than support some other goal, such as, for
example, serving the community. Dr. Curtis owned a nice house in tony, exclusive Weston,
Massachusetts' wealthiest town, as do many of the physicians at the Baptist,
and drove a late-model BMW sedan.
Imagine how different my life as a patient would have been if Alan Curtis
had chosen, for example, to see fewer patients in a week. Would he still have forgotten
that, in the week before my surgery, he had no X-rays of my shoulder? Would he have made
time to take a brief medical history from me, or even just an orthopedic history, and
discovered the low-grade inflammatory process that was keeping my shoulders from healing
on schedule, rather than blaming me for it? Dr. Schweitzer's* partner at Newton-Wellesley
figured it out right away when he took an orthopedic history from me after the accident.
What would my office visits have been like, and what would my callback times have been,
if he had limited his patients to four or five per hour, and set aside a few appointments
each week for emergencies?
The sad thing is that, even processing many fewer patients through his
office, he still would have had a full surgery schedule, and still been making close to
$700,000 a year from performing surgery alone. But instead of making around $250,000
a year from office visits, he would have been making less, say, $200,000. This would
still total close to a million dollars a year, and amount to four times more than most
orthopedists are making, not to mention 10 times more than my family practice doctor was
making. (This kind gentleman was forced to step in and manage my medications and try to
answer my questions when my calls to Dr. Curtis' office went unanswered for days at
a time.) My family practice doctor lives in Arlington, a Boston suburb of people of
mixed income levels, and drives a 7-year-old Subaru station wagon.
At the time I did all of these calculations, Alan Curtis' making all of
this money didn't bother me that much. When I actually got the chance to talk to him,
we got along fine. In fact, I was sort of impressed and fascinated at his ability to
work the system. I told myself, hey, it's a capitalist society, he's entitled to do
this for as long as he can get away with it. Many of the patients seemed content with
their three-minute office visits, and the long delays to have their phone calls returned.
And Alan Curtis is a talented surgeon, and has an air of fabulousness about him that is
very compelling. But I made my living using my body, and was becoming increasingly
unwilling to assist him in making that kind of dough when I couldn't even get my
phone calls returned, and eventually asked for a referral to another doctor
(See Fascinating Documents.)
But after the accident, and the way I was treated by the other
orthopedists at the Baptist, and the way Alan Curtis apparently violated my
confidentiality and then abandoned me, and especially after his C.Y.A. visit,
(See Aftermath and also
Abused at the Baptist: A Chronology -- Wednesday),
all of this extra money didn't seem so harmless after all. It seems to me that it is
one of the main factors driving the hospital's culture of amorality, avarice, and arrogance
that harmed me so much when I was a helpless multiple-trauma patient there.
Now, keep in mind that your orthopedist from a community hospital,
or even from a teaching hospital, especially younger orthopedists, are not
making anywhere near this kind of money. That's because they are doing fewer
surgeries than Alan Curtis, they are charging less for them, and a goodly proportion
of their patients are on Medicare, are uninsured, or are from HMO's. Your orthopedist
from a community hospital or a teaching hospital is probably making quite a bit less
than the average of $200,000. Most of the doctors at Newton-Wellesley, for example,
are driving Toyotas, Volvos and minivans. But this is not the case at the
New England Baptist Hospital.
When I was a multiple-trauma inpatient there, many of the older
doctors at the Baptist, especially the orthopedics staff, seemed very spoiled.
Certainly, screaming at and then abandoning a desperate multiple-trauma patient
(with insurance) who badly needs immediate surgery indicates a level of selfishness
and arrogance most doctors would never even consider. A number of them seemed utterly
outraged, for example, at the idea that they might be asked to work in the evening or
on a weekend. Looking closely at Dr. Alan Curtis's income, and at the probable income
of his partners at ProSports Orthopedics, one can start to see why -- these guys are
making way too much money.
Perhaps I should have known.
Now 'tis spring, and weeds are shallow-rooted;
Suffer them now, and they'll o'ergrow the garden.
William Shakespeare, King Henry VI