The High Cost of Specialists

Tuesday, January 28, 2014

doctors prepping for surgery doctors prepping for surgery (interplast/flickr)

New York Times reporter Elisabeth Rosenthal continues her series “Paying Till It Hurts,” on the high cost of health care in this country. Her latest article in the series is “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” which looks specifically at how expensive some dermatological procedures are, why they cost so much, and what patients can do about it.


Elisabeth Rosenthal

Comments [26]

Mandy laira from usa

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Feb. 08 2014 08:19 PM
William Fisk

Dr Rosenthal asserted that physicians have no obligation to inform patients of alternative therapeutic options. But informed consent is a legal requirement, and failing to inform patients of alternative therapies is a violation of that requirement.

Jan. 29 2014 01:44 AM
Jesse Hackell MD from NY

JR from NYC. Perhaps I was unclear. As I primary care physician I DO dissuade patients from having unnecessary procedures. I do not do them--that us not my role. And I do not need them to stay in business.

But the demand remains despite the tine I spend. And the procedures will be done by those who need to do them to stay in business. And if people demand procedures, they will get done--for a whole host of reasons.

Jan. 28 2014 03:23 PM

What about the ways in which people who engage in /voluntary/ high-risk behaviors drive-up medical costs for the rest of us? Isn't it only fair, just (and, ultimately, sustainable) that such individuals be made to cover more of the disproportionate medical costs that they incur?

(This is one, of what would no doubt be many, modifications that would have to be made before the "Medicare for All" advocated by the physician caller could become a viable, sustainable reality.[1])

I wouldn't be surprised if Ms. Rosenthal has addressed this. At least with regard to examples such as smoking, motorcycle-riding, excessive alchohol consumption, inordinate sedentariness, obesity, etc. These are all areas where it is quite safe-- politically, socially, career-wise-- to tread.

But what about high-risk /sexual/ practices and lifestyles?

Inordinate promiscuity, of course. But also, specifically, the practice of buggery (anal penetration), an inherently unhygienic, unsafe, anatomically and physiologically unsound act which, more than any other, spreads not only HIV/AIDS but numerous other serious and potentially lethal infections as well. The statistics are clear and incontrovertible: A disproportionately high incidence of anal penetration, coupled with an inordinate level of promiscuity, are the two factors that account, /overwhelmingly/, for rates of HIV-AIDS among homosexually active males that are as much as fourty-four times as high as those for the general population (CDC).[2]

[1]By the way, when was the last time an advocate for single-payer/ Medicare-for-all was on the show?

[2]"Homophobic" [sic] to merely point these facts out?

The most cogent and comprehensive expose` of the hideous reality of this gruesome act and the downright-Orwellian ways in which it is actively whitewashed and promoted (with taxpayer money, no less) that I have seen is from someone who could hardly be more emphatically and unapologetically PRO-homoerotic: Man2Man Alliance and Frot Movement founder Bill Weintraub: (*Graphic content)

Also see Rob McGee, whose blogs include and .

Jan. 28 2014 03:05 PM
m. from Manhattan

KUDOS for putting Elizabeth and her series on the show again!!Please keep these issues upfront !! I used to be a RN many years ago and quit because I saw so much of this abuse and entrepreneurial treatment of the most vulnerable (the poor, the unknowing and the ill) in our society. Any one interested in how the insurance system has shaped our health care systems might read the book "Medical Nemesis" by Ivan Illich. At this place in time, even a wealthy person paying top dollar may get really bad medical treatment. A cat that I rescued was treated better and more humanely by the vet than I was treated by the dentists I consulted for help last month.

Jan. 28 2014 02:15 PM
Daina from Brooklyn

Healthcare costs are so incredibly complex as the last discussion point makes clear. The guest spoke of how the transition of chemotherapy from the hospital to specialists (oncologists) offices led to perverse incentives to administer chemotherapy. While true, today chemotherapy and other infused oncology therapies are consistently more expensive in hospitals than in specialists offices (~30% more), because hospitals can negotiate more aggressively with payers for higher reimbursement!

Jan. 28 2014 02:06 PM
john campo from NYC

I thought I had a kidney stone because it wasn't that I couldn't pass urine but I had to go every 5 to 10 minutes adding up to 1000's of times a day. I went to my urologist but he couldn't see me they took a scan but found nothing and sent me to get a magnetic scan at the hospital. I couldn't wait for the appointment and went to the emergency room to spend a day there to have them tell me they couldn't find anything wrong either and sent me home. I went to my GP and explained my problem - I almost didn't make it because the train ride was over the 10 min limit when I have to pass liquid. My GP couldn't find anything and gave me some pain pills which I didn't take. I went for the Magnetic scan and I had to drink this liquid that was so painful I passed out. Nothing was found. I went on the computer to the Mayo Clinic site and found that there is a thing called Uteritis and in some cases it can be caused by washing with liquid soap. Then I remembered that I did wash with a liquid soap that caused a slight pain. I was at me wits end and was booked to go on a trip to Italy. My head was busting my kidneys were screaming and as a last resort I took a two Tylenol and went to sleep in the morning I took one more. That was it I was cured and it only cost close to 10,000 in office & emergency room visits, drugs, imagining visits and whatnot. This is crazy and it seem this type of thing happens to me once a year where I have some simple problem that no one can cure and it turns out to be the most simple ailment a witch doctor could cure with common sense.

Jan. 28 2014 02:04 PM
Jennifer from NYC

Yes! Re oncologists. After overcoming initial numbness over cancer diagnosis, I asked my oncologist why she was administering a kind of chemotherapy that only helped 2% of the woman with my kind of breast cancer. Only then did she agree to my getting half the course.

Jan. 28 2014 01:57 PM

Sorry, the Rudd Clinic (Toronto) is for is the Shouldice Clinic that does hernia repair in Thornhill-Toronto, Canada.

Jan. 28 2014 01:56 PM
Linda P. from New York City

When you say that it's unnecessary to perform colonoscopies on the elderly, at what age do you consider that they be discontinued?

Thank you.

Linda P.

Jan. 28 2014 01:52 PM
Joel from Nyack

I just saw my dermatologist this morning and he had to freeze a number of pre-cancerous spots on my scalp. I have had this done many times over the years. I am always surprised when I get the report from Medicare showing the charges for this procedure, hundreds of $. Each time the doctor sprays one spot for a second or two is considered a separate surgical procedure. At the most, I spent 5 minutes with the doctor.

Jan. 28 2014 01:51 PM
suzinne from bronx

Listening to this story today, just reinforces my feeling that I've held since my father died at 43 as a result of medical malpractice. He went in for a polyp removal from his colon and died a month later in the same hospital the procedure was done.

Had malignant melanoma surgery twice. Was told to return every six months. Yeah right. I'll take my chances because I have no money for all these doctor visits. And with Obamacare, my husbands medical insurance costs MORE, doctor copay is MORE, prescriptions are MORE. So thanks prez!

Do NOT go to the doctor unless it is absolutely necessary. That's my motto.

Jan. 28 2014 01:50 PM
JR from NYC

@Jesse Hackell MD from NY: where are your ethics?? let me guess - your wallet?

Jan. 28 2014 01:50 PM

As for colonoscopies, here they say they do "conscious sedation" but they don't; an IV is set up and you're totally out - and then they will actually dispute you over the rhetoric. In Canada, they only give you a shot (Versed-Demeral)and one can view the monitor of the procedure...and it is $1500.00 less. They do hernia repair at the Rudd Clinic, the best in North America - with a local...and there is less pressure/constipation post-op...and way cheaper again.

Jan. 28 2014 01:48 PM
PHILIOR from Brooklyn

Dear Ms. Rosenthal,

Thank you for writing not about what's great, but bringing our attention to what's wrong and what's unnecessary.
To pay you back I would bring to your attention that the transcript of your conversation will show that the frequency of your using a meaningless expression "you know" is close to two per sentence.
I am sure you'll find this comment useful and will get rid of unnecessary parts of your speech.

Best of luck and thanks for your work.

Jan. 28 2014 01:46 PM
Martha Kolko from Montclair, NJ

I took my son in to get a mole removed from behind his ear. I thought the dermatologist would remove it in his office that day. Instead he referred us to a plastic surgeon that took our insurance. We had to take my son to the Short Hills surgery center where he had the doctor, an anesthesiologist and a nurse with him. The anesthesiologist was there only in case of an emergency. I don't even know how much it cost. I was scared to look. It seems crazy that we had to go through so much trouble for a little mole.

Jan. 28 2014 01:46 PM
Alexandra from Upper Westside

I am glad to hear your guest speak about the practice of dermatologists.
My last dermatologist gave very little in the way of explanation and was always scrapping and removing things (which left scars on occasion). Worst was the contact allergy patch test that was performed (much to my discomfort) that was quite unnecessary as per my next dermatologist (who said my "allergy symptoms" did not present at all like a contact allergy and that she would not have ordered the test.)
And the dubious results of this test sent me into a neurotic search for all kinds of specialty products that I really did not need.

Jan. 28 2014 01:45 PM
Opal S from NYC

I am a senior who is taking blood pressure medication which slows up my heart rate but I function fine. The cardiologist took it upon himself to have a heart rate monitor sent to me that I was to wear for two weeks--during the hot summer. I returned it. Would he have received a fee for this monitoring? I have dumped him since he was not a good doc anyway.

Jan. 28 2014 01:45 PM

Why aren't the insurance companies fighting this? They certainly have influence in Washington.

Jan. 28 2014 01:44 PM
Jesse Hackell MD from NY

The word hypocrisy comes to mind. The neurosurgeon who operated on her daughter was worth whatever he charged. Most of the procedures done are critically important to SOMEONE.

How about addressing the patient demand for doing everything, with the latest technology?

As a primary care doctor, I get paid for doing a procedure. I get nothing for talking a patient out of what I think they really do not need. And I need to stay in practice, so the end result is obvious.

Jan. 28 2014 01:44 PM
Romeo from Greenwich, CT

Just turned 50 and had the "routine" Colonscopy at my GI doctors "facility" in Stamford. $5K out of pocket later, I have a stomach ache. Is it possible to fight excessive charges after the procedure.

Jan. 28 2014 01:44 PM
Eva from Brooklyn

Where are the patient advocates? If we can't trust doctors to advocate for our health, who can we count on to make ethical decisions?

Jan. 28 2014 01:44 PM
Jim from Manhattan

I had keratosis that my doctor wanted to remove with surgery on a separate visit. I rinsed them with vinegar over several days and they vanished.

Jan. 28 2014 01:33 PM
Truth & Beauty from Brooklyn

Don't costs include increasing medical malpractice insurance, as well as paying their personnel a living wage and benefits?

Jan. 28 2014 01:25 PM
John A

In your spots you ask 'why so many specialists?'
Why? The AMG. Only from Mercedes Benz.
Seriously, if I spot one in the parkinglot, my days as a patient there will be numbered.

Jan. 28 2014 01:07 PM
Ann from Westchester

I listened to Elisabeth Rosenthal speak on your show about colonoscopies after she published an article on that topic in the New York Times. Her article contained inaccuracies, and you folks did not call her out on anything. Of course, neither did her employer, the New York Times. For example, Rosenthal claimed that other screening methods were equally effective and less costly than colonoscopies. The very source that she cited didn't support her. Her colleagues at the New York Times had, in the same year and the preceding one, written articles suggesting that colonoscopies were still the gold standard (see Andrew Pollack and Denise O'Grady). I, for one, was not impressed that you folks did none of your own fact-checking. You just gave Rosenthal free reign to make her case, which should have been much more nuanced than it was. As a result, I will not be listening today, but I hope you did your homework this time.

Jan. 28 2014 12:20 PM

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