Medicine is a business

While I get a chuckle out of Dr Ladouceur’s rose-coloured view of the business of medicine¹ (and make no mistake, it is most definitely a business), his public condescension toward colleagues seems to be ongoing,^2,3 so I feel I must respond.

First, to his point about charging for missed appointments, in my experience most physicians advertise these penalties but rarely enforce them. If I missed a dentist appointment, I would be charged; if I wasn’t home to open the door for the plumber, I would be charged; and a doctor’s office is no different, in that it is time wasted for the business. If I had a patient who missed multiple appointments without a reasonable explanation, I would not hesitate to ask them for compensation for my time.

To be clear, I run a business trying to maximize profits, and yet I care deeply about each and every patient I see and I work my hardest to do right by them. What Dr Ladouceur seems to miss is that these goals are not mutually exclusive. Just like most every other business, there is a market rate for my services. In recent years, government fee schedules have not kept up with the market rate for these services, and certainly have not kept up with changes in technology and innovative service delivery models, and so in talking with my colleagues, we feel increasing pressure to fill this gap by billing for services that previously went uncompensated. My own professional interest is in innovation in service delivery in family medicine (for example, how many patients in Canada can freely send an e-mail or text to their physicians?), and as fee-schedule changes are inherently conservative, this type of innovation will necessarily come from user fees, with the hope of being included on the fee schedule once proven. My patients are free to shop around for a family physician, and all fees are published up front and before service delivery. I refuse to be made to feel guilty for asking to be compensated appropriately for my services.

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