Remuneration of Physicians JOHN L. IRWIN, Ph.C., M.D. Detroit Reprinted from The Journal of the Michigan State Medical Society Battle Creek, Mich. V. REMUNERATION OF PHYSICIANS JOHN L. IRWIN, Ph.C., M.D. Detroit ONE PHYSICIAN’S METHOD OF INCREASING HIS INCOME To the Editor : — I wish to contribute a statement to the subject of the remuneration of physicians: I have been in the general practice of medicine since 1890 in Detroit on the same lot on which I was born. For twenty years I trusted all applicants for medical aid with results approximately as follows: 2 per cent, would pay ihe promptly. 13 per cent, could pay me only “when I went after them.” 25 per cent, got out of paying me in every possible way. 60 per cent, did not pay me at- all. Jan. 1, 1910, I turned over a new leaf, and referred to other physicians all would-be patients who did not pay cash and had not approved credit. In 1910, the income from my practice was 98 per cent, greater than my average yearly income for the preceding twenty years and my expenses for 1910 were less than the average yearly expenses for the same period. Except for the fact that I gave my individual attention to my invalid mother for the three years prior to 1908, which cut into my practice considerably, I am unable to assign any other cause than this change of policy for the increase in income. Since Jan. 1, 1910, I have had more time for reading, refreshment and sleep; and my present plan is preferable to that of those physicians whose ambition is to have the “largest* practice” in a community at the cost of poor health or an early death. John L. Irwin, M.D., Detroit. Reprinted from The Journal of the American Medical Association March 4 , 1911, Vol. LVI , p. 687 Copyright, 1911 American Medical Association , 535 Dearhom Ave., Chicago HOURS. 1.30 TO 3.30 P. M. 7.00 TO 8.00 P. M. MORNINGS AND OTHER HOURS BY APPOINTMENT SUNDAYS AND HOLIDAYS 2.30 P, M ONLY Telephone Main 3349 230 THIRD AVENUE DETROIT. MICH. Professional Fee Bill of John L. Irwin, M. D. OFFICE CONSULTATION, EXAMINATION OR SPECIAL OFFICE SERVICE, $1.00 ToVlO.OO CASH. Ordinary visits $ 2.50 each ; night visits $5.oo each, detention extra charge. Ordinary office service, $ 1 . 50 . Ordinary confinement (including three (3) visits), Operations, difficult confinements, electrical tf IN COURT, UNUSUAL MEDICINE OR OPTICAL SUPPLIES, SPECIAL CHARGE. Office consultation to strangers, STRICT LY CASH. Accounts due whan service is rendered. The honest indigents free of charge. $25.00 EATM ENTS, VISITS IN CONTAGIOUS DISEASES, ATTENDANCE Special Notice from John L. Irwin, M. D. This account is rendered according to my professional fee bill. Items may be seen at office. A DISCOUNT OF IS OFFERED TO BUT MADE CONDITIONAL TO PROMPT SETTLEMENT. IF SATISFACTORY ARRANGEMENT IS NOT MADE BEFORE FOR SETTLEMENT, THE DISCOUNT IS NOT ALLOWED, AND DOES NOT APPLY ON ACCOUNTS PLACED FOR COLLECTION OR GARNISHMENT. Tt^t* REMUNERATION OF PHYSICIANS JOHN L. IRWIN, Ph.C., M.D. Detroit The twenty years’ practice mentioned in my article on this subject published in The Journal of the American Medical Association 1 was confined to no particular locality in Detroit, patients often living in extreme limits of the city, and repre- sented financially all classes. Those best able to pay too often were delinquents. There should be some practical remedy for the financial abuses in constant expo- sure to danger and % to death, of the physician — some practical way should be pointed out to close in on the army of deliberate grafters who shorten the phy- sician’s life, and medical men should refuse to be longer “done” by them. Josh Billings advises the young doctor to ignore the disease and treat the patient. Do not our “experienced” and “tactful” M.D.’s who keep up the “bluff” of a large office business — doing but little charging and in some instances causing the sick whom they visit to have one or more of the neighbors call at the office at a partic- ^.ular time to daily report progress — fol- «-> low such advice ? In this and in other ways, such as cases from their free clinics, do they supply their office with “stool pigeons,” and flim-flam the laity into thinking they have a large office business Lv and must necessarily be “able” physicians. * Ntt is told of one of our physicians, here, of years of practice, who is a j good “mixer and joiner,” that he regu- . r larly gives his many friends “auto-rides” during which he makes fifty or more \ “stops,” leaving the impression of having a “wonderful” practice; and of' another ^ surgeon who tells his acquaintances all ^ about his many and “great” operations. "ft fM i #> 1. March 4, 1911, lvi, 687. Nor is the average busy physician either fair to himself or to his patient. Instead of scheming to keep his office filled at any cost, he should aim to limit the number of his cases; and thereby give those w*ho do consult him value for the money which they pay him, and at the same time guard his own hours of refreshment and sleep. As physicians we know too well that the follies of youth are promissory notes which begin to fall due about thirty years after date. Just as true is it that an over- worked 'physician will too soon lose his health. Of the prominent Detroit physi- cians in active practice in 1900 more than 25 per cent, have since died. Medical practitioners are, as a class, more subject to illness than are their fellow men. The combined influence of anxieties which weigh on them in the amount and nature of their work, irregularity of meals and broken sleep, exposure to weather and infection — all these are sufficient to break the strongest constitution ; hence they should insist on being first to be paid for their services instead of last, as is too often the case at present. Is it too much to expect that the day may soon come when the very tff busy” man whether he be doctor or lawyer will be passed by for the good reason that he undertakes too much not to neglect those wdio have a right to receive value from him? It is but natural to expect to be neglected by any doctor or lawyer whom one employs who is doing too much work in each twenty-four hours. That the “ethical” physicians of repu- tation themselves are not entirely fair, take for example the matter of their inter- views in daily papers and of advertising. c 4 REMUNERATION — IRWIN We say that to buy space and advertise in a daily paper is unethical, and yet we allow and too often request newspaper reporters to be present at and take notes in our society meetings, annual clinics and conventions, and receive a free write-up in all the local newspapers — then, by mailing broadcast our reprints of papers read at said meetings we finish the "eth- ical graft.” Are we not less consistent here than he who pays his money to the newspaper for space and whom we desig- nate as a "quack” ? Let us then in all our work call a spade a spade, and apply the golden rule. There will then be fewer and better colleges, fewer and better physi- cians, and best of all, when we are paid for what we do, a chance to make an honest living from what at present is an over- "done” profession. In every large city there are already city physicians, free dispensaries, college and hospital clinics, for the poor, and it is an economical error for any physician to sacrifice himself in building up an unre- munerative practice. He has to neglect his own health and to forego the reading he should do to keep himself up-to-date; and he cannot give the attention to any of his patients that they deserve. Colleges are grinding out physicians faster than they are needed, or can make a living for themselves, as it is. The so-called "busy” doctors make slaves of themselves in most cases to keep up the "show” and are worn out too early in life. From the patients, even those who are able to pay and do not, the doctor only finally receives ingratitude. We must teach our patients that we get our living by our calling and that all must pay promptly except such honest in- digents as we ourselves select to treat free. We who believe with John S. Billings, M.D., that medicine is not a rigid system of rules and formulas, as it was in ancient Egypt — a fixed creed to which we are to subscribe and from which we must not vary; but a living, growing thing making use of every resource which the progress of science brings, testing all things and hold- ing fast to that which is good — we who believe this should not hesitate to require the just compensation for our labor which will be a fair return for our large finan- cial investment in years of college train- ing, study and experience. Oliver Wendell Holmes, M.D., said: “Could Youth but know what Age doth crave Many’s the penny Youth would save.” So with the wise physician : let him not by the poetry or imaginative flight of the "extremist” in medical ethics strive to die for the physical sins of the people, but rather to so regulate his financial affairs that when old age comes on him he will have, then, something with which to meet his needs more substantial than the so-called gratitude of the people whose physical and mental distress and heart- ache he relieved without money or price. I suggest that lists of "dead beats” or "deliberate grafters” and "delinquents” be filed with the secretary of every county medical society throughout the country; and that the said lists be revised every three months — same to become a book of reference for use of members. Let us have fewer patients and better fees; those who have not approved credit to pay cash at each house visit or' office consultation; statements on good accounts to be ren- dered monthly ; and payment required before the 10th of the month following. The American, state and county medi- cal societies should at once take up the subject and get a practical remedy, giv- ing our members some return for "annual dues” beyond scientific papers and discus- sions for the "good of humanity,” while too many of our members who depend wholly on their practice for a living are all but "starving to death.” 230 Third Avenue. A Sample Health Board Propaganda. Detroit, Mich., Feb. 28, 1903. To the Editor: — I accepted the appointment as a member of the Detroit Board of Health from Governor Pin- gree, Feb. 21, 1899, for the term ending Feb. 28, 1903. On March 15, 1899, certain thoughts of mine appeared in the Detroit Evening News concerning the workings of the Detroit Health Department, and the kind of man needed as health officer. These thoughts later became my convictions, and were contained in my fixed policy, and were, viz. : (a) Health officer to be a clinical physician with executive ability, and to have had personal experience diagnosing con- tagious diseases, including smallpox, scarlet fever and diph- theria. ( b ) Health officer to examine personally suspicious or doubtful cases reported to the department, and meet person- ally private physicians asking consultation thereon. ( c ) Health office to be operated on practical business prin- ciples, and without political coloring. ( d ) .Methods of health office to be up-to-date, but for every dollar of cost of maintenance the department to obtain full value in practical results — all unnecessary expense to be eliminated. (e) All health department work of a medical nature to be performed by the salaried physician employes of the city. (/) Health officer and all employes to give their entire time to the department. Under no circumstances should per- sons on regular salary be paid extra compensation. Spencer says : “Political life is healthy only in proportion as it is conscientious.” I have endeavored faithfully to en- force the above policy, as well as all health laws and ordin- ances applicable to Detroit, with what success the official records of the Detroit Board of Health will show. John L. Irwin, M.D. Reprinted from The Journal of the American Medical Association, March 7, 1903. . Condensed Biography OF DR. JOHN L. IRWIN. (Reprinted from Polk’s Medical Register and Directory of Noith America, 8th edition and Detroit News, Feb. 22, 1899.) 1. Born on site of residence, No. 230 Third Ave., Detroit, Michigan. 2. Graduate of Detroit public Cass school in 1875. 3. Graduate of Detroit public high school in 1878. 4. Assistant to Prof. A. B. Prescott in faculty of Univer- sity of Michigan, department of chemistry, Ann Arbor, in 1879 and 1880. 5. Graduate of the department of science, literature and arts, University of Michigan, Ann Arbor, degree of Ph. C., in 1880. 6. Manufacturing and consulting chemist for a chemical works, manufacturers of medicines and chemicals, at Cin- cinnati, Ohio, from 1880 to 1886. 7. Graduate of the department of medicine and surgery, University of Michigan, Ann Arbor, degree of M. D., in 1889. 8. Made hospital observations at New York City and Boston, and in Great Britain, Ireland and Continental Europe in 1889 and 1890. 9. Holds certificates for hospital courses and post- graduate study at the University of Vienna General Hos- pital, Vienna, Austria, in 1890. 10. President of the National Greek Letter Medical Fraternity “Nu Sigma Nu,” from 1893 to 1897. 11. Detroit city physician to Poor Commission during 1893 and 1894. 12. Instructor in general chemistry, physics, and toxi- cology Detroit College of Medicine from 1894 to 1900. 13. Physician in charge of department of diseases of children, Harper Hospital polyclinic, Detroit, from 1898 to 1900. 14. Health Commissioner of Detroit from February 1899, to March, 1903. 15. Member American Medical Association, Michigan State and Wayne County Medical Societies, Detroit Alumni Association of University of Michigan, Ohio State Pharmaceutical Association, Detroit High School Alumni Association and Corinthian Lodge, No. 241, F. & A. M. 16. Contributor to medical and chemical literature. 17. For private reasons declined an invitation from Governor H. S. Pingree to act as contract surgeon to one of the Michigan regiments during the Spanish-American war.