Home The Iron Triangle



I got the feeling, especially after the lawsuit was filed, that the doctors at New England Baptist Hospital believed they were above the law. Perhaps one of the reasons they feel this way is that they make so much more money than the average physician. In addition to having access to an exclusive patient population that includes very few uninsured people or Medicare patients, the surgeons at the Baptist have the ability to reject patients because they don't like their form of insurance. Because the Baptist is chartered as a “private referral” hospital, doctors are free, under most circumstances, to discard any patient who can't pay what they want. This has led to some remarkable income levels for the surgeons there. Here's one example:

Dr. Alan Curtis, who was my shoulder doctor before the accident that brought me to the Baptist, seemed like a good guy. But he was very hard to reach on the phone, and unless it was a grave emergency, it was difficult even for established patients to get in to see him sooner then six weeks from when you called his office.

Once you got an appointment, there was often a two or three-hour wait to see him from the time the appointment was scheduled. Frequently, the women who ran the office at ProSports Orthopedics would lie when I called them to ask how far behind Dr. Curtis was running, and I would arrive an hour after my scheduled appointment time, as instructed, and discover that there was still a two-hour wait to come. If he was too busy to answer my calls promptly, they would lie to me and tell me he was “out of the office,” and I would discover later, by talking to other patients at D.O.T.S., the physical therapy clinic that acted as a subcontractor for the physicians at ProSports, that he had, in fact, been there all along. And it’s not like I was calling him frequently. In the just under two years that I was his patient, I think I called his office needing to speak with him three or four times total. That’s an average of once every six months. Regardless of Dr. Curtis’ blowing me off, I was always pleasant and friendly to the staff at his offices; it's been a principle of mine for years never to hold wage-earning women responsible for delays or problems that generally originate with their wealthy employers.

After a few visits, I caught on to what was happening and began scheduling my follow-up appointments for 9 a.m., the “first” appointment in the morning. I would arrive right on time, and discover as many as six other people in the waiting room. Once I asked the receptionist when their appointments were, and she replied that Dr. Curtis was “fitting them in” before his morning appointments. But he often didn't start seeing them until 9 a.m., or later, which meant that my 9 o'clock appointment would take place at 10:30 a.m., or later. My time with Dr. Curtis, when I was finally able to see him, rarely exceeded three or four minutes, even though I had a somewhat complicated shoulder problem that required a lot of managing. Alan Curtis never even sat down to talk to his patients, but stood, file folder in hand, right next to the open door of the examining room, ready to dash off to the next person right away.

During the first year or so, I thought that all of this waiting, having my phone calls blown off, and having little access to advice from Dr. Curtis, even though I had paid him thousands of dollars for surgery and office visits, had to do with his popularity as a physician. But one day, as I was reaching hour number three of the wait to see him, I took an envelope out of my handbag and began calculating an estimate of how much money he was making, and a quite different picture began to emerge.

It came to me as I did the math that Alan Curtis wasn't a busy guy trying to help the largest number of people he could, but rather a businessman maximizing his income. And, suddenly, lots of the bizarre stuff I had experienced as his patient fell into place and began to make sense. Let's have a look at my back-of-the-envelope calculations of his income stream.

The physical therapists at D.O.T.S. and his staff told me that Alan Curtis' work week looked like this:

Monday: Administrative work at the Baptist -- teaching and training. He also returned phone calls on this day to selected patients, as I discovered later. My impression, as I looked at the people who were accorded this privilege, was that they comprised a group of the younger, most attractive, most athletic patients. Although I was in very nice shape myself at this time, and was working full-time as a personal trainer, apparently I didn't fall into this category. The once or twice I called in to the ProSports offices on a Monday, I was told that Dr. Curtis “was not in” and “could not call you back until tomorrow.”

Tuesday: Seeing patients at his office. Technically, he was scheduled to see people from 9 AM until 4 PM, but as I have mentioned, he often fitted in half-a-dozen extra people in the morning, and the same in the afternoon. My impression was that his staff scheduled six people an hour, with a 1-hour break for lunch that often did not occur. Let's estimate six patients an hour times six hours per day, plus six extra patients in the morning and six in the afternoon. That's 36 scheduled patients, plus 12 more “fitted in”, for a total of 48.

Wednesday: First of two days a week to do surgery. The nurses told me that Dr. Curtis operated on three or four patients on each surgery day, depending on how complex the surgeries were, and how long they took. Surgeries were booked at least eight weeks in advance.

Thursday: Same as Tuesday. 48 patients processed through the office. Heaven forfend if you were, as I was, a Wednesday surgery patient who had a post-surgical problem. Thursday was Alan Curtis' last day during the week to see patients in his office, and my experience was that his staff was certainly not about to interrupt his working day to ask him to answer a question or solve a problem, even for someone he had operated on the previous day.

After all, we had just seen him the day before, which was more than the patients who were sitting in the waiting room could say. They hadn't seen him for six weeks. Whatever post-surgical problem it was, we, “should have thought of it yesterday....” I suppose that would have been between the time when the anesthesia wore off and when the staff moved you out of the day surgery center.

Friday: Same as Wednesday. Three or four surgeries, depending on their complexity.

Alan Curtis kept to this schedule whenever he was working. I was told by the physical therapists at D.O.T.S. that he took two entire months off every year, February and August, and also took some time, though not a lot, at Christmas, and occasionally a week off here or there.

Now that we are a little more familiar with Dr. Curtis' schedule, let's start doing the math. These are all back-of-the-envelope calculations, but they are illuminating nonetheless.

With two months, and, let's say, another two weeks off per year, I estimate that he worked a total of 42 weeks a year on the schedule you see above.

He charged me $60 a throw for those 3-minute office visits. He had office hours two days a week, seeing approximately 48 patients per day, at, let's say, what he charged me, $60 per visit. That's 48 times $60 times two days a week, or $5,760 per week in income derived from office visits alone. Multiply this by 42 weeks a year, and you get $241,920 in income per year just from office visits. And don't forget the co-payments most people are making.

Mine was $10 per visit. Let's say that 30 of Dr. Curtis' patients per day have a $10 co-payment. That's $600 a week, or $25,200 per year, in cash, paid directly to him. To put it another way, Alan Curtis was making the same income from his office co-payments that many Americans get from a full-time job. Rounding, we have $242,000 per year so far.

Now let's look at the surgery days. Alan Curtis billed my insurance company $5,700 for my shoulder surgery, which was a not-very-technical arthroscopic procedure including a subacromial decompression, a clean-out, breaking adhesions from an adhesive capsulitis, and cleaning some scar tissue off my rotator cuff. Because my insurance company had a deal going with ProSports, he was ultimately paid $1,800, plus several hundred dollars in associated fees as well. Let's call it between a third and a half of what he billed us, or $2,365. Now, remember, some of his patients are paying a little less, but doctors at the Baptist see very few poor, uninsured, or Medicare patients, and his WorldPath patients are paying the full $5,700. (See The WorldPath Connection.)

Mine was a medium-length surgery for him, which occupied about an hour and a half. It took longer than a routine subacromial decompression or biceps tear repair, but was faster than a total shoulder reconstruction, or the surgical do-overs that he often performed on patients who had had other, less-skilled surgeons do their initial procedures. Let's call mine average in length and expense. Since he performed between three and four of these per day, two days a week, let's call this seven surgeries a week on average, at $2,365 a throw. That's seven times $2,365 times 42, or $695,310 per year for performing surgeries.

I also believe that he gets paid for the administrative and teaching work he does at the hospital on Mondays. Since he is giving up close to $350,000 in income he could be receiving from performing surgeries that day, we have to assume that the management of NEBH is compensating him. Let's put in a guess, based on what I overheard at D.O.T.S., of approximately $100,000 a year. Now, he also has to pay for the office space and staff he shared with three other doctors. On the other hand, they Cox-and-Box-ed it so that they were each in the office on different days, fitting four physicians into a modest office space with 3 small examining rooms and one large shared office. But, since most people's income is stated as gross numbers, let's stick with that for Dr. Curtis, too. After all, we don't say, “My husband makes $55,000 a year after taxes and expenses.” People, even consultants and other self-employed folks, express their income as gross figures.

Keep in mind that I did not feel at the time, nor do I think now, that Alan Curtis is an avaricious man. It just seems to me that there's a connection between the days-long waits for callbacks and the breathtakingly brief office visits I had, and how much money he made. And remember that Dr. Curtis had an independent practice with the other three doctors at ProSports, and does not have his hours or working conditions specified to him by an HMO or by the hospital. He gets to choose.

Rounding down, we have $695,000 per year for performing surgery, $242,000 for office visits, and an estimated $100,000 for his administrative and teaching work at NEBH. That adds up to approximately $1,037,000 as Dr. Alan Curtis' gross income.

All of those hours I was sitting in the waiting room, and all of those days I spent waiting for callbacks, I had assumed that Dr. Curtis was just another harried physician. But after I ran the numbers, I began to see those long waits in a very different light. Dr. Curtis was making over a million dollars a year! The average general surgeon's income, as reported by the AMA in 1997, the year before my shoulder surgery, was $225,000. And the average orthopedic surgeon's income was $200,000. This means that Alan Curtis was most likely making more than four times the average surgeon or orthopedist. I believe that most of the physicians at New England Baptist Hospital are making similar multiples of an ordinary physician's income, because they can cherry-pick from the most profitable patients, and because the system at the Baptist is set up to maximize their income, rather than support some other goal, such as, for example, serving the community. Dr. Curtis owned a nice house in tony, exclusive Weston, Massachusetts' wealthiest town, as do many of the physicians at the Baptist, and drove a late-model BMW sedan.

Imagine how different my life as a patient would have been if Alan Curtis had chosen, for example, to see fewer patients in a week. Would he still have forgotten that, in the week before my surgery, he had no X-rays of my shoulder? Would he have made time to take a brief medical history from me, or even just an orthopedic history, and discovered the low-grade inflammatory process that was keeping my shoulders from healing on schedule, rather than blaming me for it? Dr. Schweitzer's* partner at Newton-Wellesley figured it out right away when he took an orthopedic history from me after the accident. What would my office visits have been like, and what would my callback times have been, if he had limited his patients to four or five per hour, and set aside a few appointments each week for emergencies?

The sad thing is that, even processing many fewer patients through his office, he still would have had a full surgery schedule, and still been making close to $700,000 a year from performing surgery alone. But instead of making around $250,000 a year from office visits, he would have been making less, say, $200,000. This would still total close to a million dollars a year, and amount to four times more than most orthopedists are making, not to mention 10 times more than my family practice doctor was making. (This kind gentleman was forced to step in and manage my medications and try to answer my questions when my calls to Dr. Curtis' office went unanswered for days at a time.) My family practice doctor lives in Arlington, a Boston suburb of people of mixed income levels, and drives a 7-year-old Subaru station wagon.

At the time I did all of these calculations, Alan Curtis' making all of this money didn't bother me that much. When I actually got the chance to talk to him, we got along fine. In fact, I was sort of impressed and fascinated at his ability to work the system. I told myself, hey, it's a capitalist society, he's entitled to do this for as long as he can get away with it. Many of the patients seemed content with their three-minute office visits, and the long delays to have their phone calls returned. And Alan Curtis is a talented surgeon, and has an air of fabulousness about him that is very compelling. But I made my living using my body, and was becoming increasingly unwilling to assist him in making that kind of dough when I couldn't even get my phone calls returned, and eventually asked for a referral to another doctor (See Fascinating Documents.)

But after the accident, and the way I was treated by the other orthopedists at the Baptist, and the way Alan Curtis apparently violated my confidentiality and then abandoned me, and especially after his C.Y.A. visit, (See Aftermath and also Abused at the Baptist: A Chronology -- Wednesday), all of this extra money didn't seem so harmless after all. It seems to me that it is one of the main factors driving the hospital's culture of amorality, avarice, and arrogance that harmed me so much when I was a helpless multiple-trauma patient there.

Now, keep in mind that your orthopedist from a community hospital, or even from a teaching hospital, especially younger orthopedists, are not making anywhere near this kind of money. That's because they are doing fewer surgeries than Alan Curtis, they are charging less for them, and a goodly proportion of their patients are on Medicare, are uninsured, or are from HMO's. Your orthopedist from a community hospital or a teaching hospital is probably making quite a bit less than the average of $200,000. Most of the doctors at Newton-Wellesley, for example, are driving Toyotas, Volvos and minivans. But this is not the case at the New England Baptist Hospital.

When I was a multiple-trauma inpatient there, many of the older doctors at the Baptist, especially the orthopedics staff, seemed very spoiled. Certainly, screaming at and then abandoning a desperate multiple-trauma patient (with insurance) who badly needs immediate surgery indicates a level of selfishness and arrogance most doctors would never even consider. A number of them seemed utterly outraged, for example, at the idea that they might be asked to work in the evening or on a weekend. Looking closely at Dr. Alan Curtis's income, and at the probable income of his partners at ProSports Orthopedics, one can start to see why -- these guys are making way too much money.

Perhaps I should have known.

“Now 'tis spring, and weeds are shallow-rooted;
Suffer them now, and they'll o'ergrow the garden.”
— William Shakespeare, King Henry VI



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