About those US fees . . .
CMAJ 1997;156:761
In response to: N.E. Levan
Re: "MD crosses great divide when moving between practices in Canada, US," CMAJ 1996;155:1599-1600 [full text / en bref]
I can categorically and unequivocally state that the fees paid in New York State for the 2 items in question are, contrary to Levan's inference, in no way exaggerated. I enclose a copy of a statement from an insurance company for a patient who underwent removal of a dysplastic nevus from the face. [CMAJ has this statement on file. -- Ed.] The total payment was US$375, $250 for the surgery and the rest for preoperative and postoperative visits. The equivalent fee in Ontario would be Can$86.70 (before clawback).
In the 11 years I have been practising in upstate New York I have never been paid less than US$2500 by a private insurer for a bilateral breast-reduction operation once permission for the procedure has been granted. Approval is based on patients' complaints of upper-back and shoulder pain and disturbed posture. If the procedure is considered a reduction mammoplasty rather than a simple breast reduction, the fee can be as high as US$4000.
Another example: carpal-tunnel release in Ontario pays Can$144 (before discount), whereas the going rate in New York is US$550, exclusive of visits. Because of the different values of the 2 currencies, the discrepancy is even greater than it appears.
My point is to emphasize what an incredible bargain the Ontario Ministry of Health is getting from its physicians. It is their unselfishness and devotion that have kept the system working all these years, and they are certainly justified in their long-overdue voicing of concern about the financial shortchanging they and the health care system have experienced, especially in the past decade.
Levan is correct in stating that managed care is growing in popularity in the US. In my case, however, this has been a boon, because I have signed up with several of these insurers and my patient clientele has increased as a result. Finally, because of geographic risk differences, my malpractice insurance is roughly equivalent to that in Canada (US$13 200 vs. Can$16 020).
Practising medicine today is not nearly as agreeable as it once was, but in the US the physicianpatient bond still exists. In Canada, health ministry prerogatives often take precedence over the patients's best interests. In any event, that has been my career experience.
Robert W. Harris, MD
Massena, NY
A detailed comparison of physician fees in the US and Canada is found in the Pulse column, page 960. -- Ed.
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