About those US fees . . .
CMAJ 1997;156:761
See response from: R.W. Harris
In a recent article by Charlotte Gray ("MD crosses great divide when moving between practices in Canada, US," CMAJ 1996;155:1599-1600 [full text / en bref]), plastic surgeon Dr. Robert Harris compares medical practice in Canada and the US. The only complaints he describes are purely economic: higher overhead costs and insufficient compensation in Canada.
That US overhead is lower is at best improbable, especially given the very high malpractice fees in New York. As for compensation, the 2 conditions he cited (breast reduction and mole removal) are not compensable by either Medicare or private insurance unless there are medical, rather than cosmetic, indications.
Harris said he is paid "several hundred dollars" for "a simple mole removal." This is both unlikely and outrageous. Most private insurers pay the same or slightly more than the Medicare "allowed" schedule. The 1997 Medicare "allowed fee" for excision of a benign mole between 0.6 cm and 1.1 cm is $79.42 if it is on the face and $64.05 if it is on the trunk, arm or leg. Harris also claimed that he "earns between $2500 and $4000" for a breast reduction. The Medicare fee is $1260.13.
I have recently been privileged to observe the practices of fellow dermatologists in Calgary. They too have complaints and discuss improvements they would like to see in your health care system. But neither they nor their patients would abandon its principles, as spelled out in the Canada Health Act.
I do not doubt that the incomes of many orthopedists and cardiovascular surgeons is higher in the US, but this is changing. US physicians are losing their professional autonomy -- and, yes, income to boot -- to the managed-care industry. Managed care promises, inter alia, protection from the exorbitant charges of "entrepreneurial types" (Gray's well-chosen term). Instead of inviting the managed-care fox into their medical hen house, my Canadian colleagues should instead mend the defects within their system.
Norman E. Levan, MD
Emeritus Professor of Medicine
University of Southern California
Bakersfield, Calif.
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