I received a question from a friend who is in FP (family practice) about referrals.
“The specialist is offering me a referral fee, should I accept it?”
My answer is no. And so is the AMA’s.
“Council on Ethical and Judicial Affairs of the American Medical Association (AMA)—Clinics, laboratories, hospitals, or other healthcare facilities that compensate physicians for referral of patients are engaged in fee splitting, which is unethical. . . . Offering or accepting payment for referring patients to research studies (finder’s fees) is also unethical.”
My understanding is, even if making a referral costs you time in ways of preparing a summary, discussing the referral or calling referring physicians, it’s not outside the scope of duties as a GP or FP. You’re the PCP, its part of your job description.
There are arguments on both sides of the fence. Check out this peer reviewed paper on “Paying Fees to Referring Physicians.” The article goes on to say that if you are taking fees you should tell the patient.
That in itself is a problem, because the patient is then left wondering if he’s getting referred to Dr. X for the fee?
What do I do? I usually pass on referral fees to my patient. I refer to some of the best specialists in Mumbai. As a rule I refer to doctors I’ve worked with or doctors with a solid reputation in their field. I can tell you from personal experience that these specialists are the best human beings on the planet.
Case in point, I was once referring a patient to Dr. Soonawalla in Kemp’s Corner, Mumbai. I picked the phone with trembling fingers, the script I prepared with the case history was shaking in my hands. When he finally picked up the phone, he quietly listened to me narrate the case. His answer was, “Do you want me to come to your clinic and examine or is he able to come to mine?”
It blew me away.
His first concern was the patient. We didn’t talk fees. The patient’s need came first. I never met him in person, because eventually the patient went to see him. For a very popular specialist in South Mumbai, he seemed to have his priorities right. Patient first.
As far as other referrals go, if the specialist does offer a fee, I usually pass it on to patients. So my patients can get a 10% discount or earlier appointments in exchange for the fee. No benefit is passed on to me. My patients benefit out of the referral completely. It also eliminates any niggling worry the patient may have, that I’m making a profit out of the referral. Quite contrary, but that’s what it is.
What do you think of “referral fees?”
American Medical Association. Health and Ethics Policies of the AMA, www.ama-assn. org/ad-com/polfind/Hlth-Ethics.doc, accessed January 8, 2009.
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