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August 1973

FeesA Perspective

Author Affiliations

Brookline, Mass

Arch Surg. 1973;107(2):127. doi:10.1001/archsurg.1973.01350200001001

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In the profuse discussions about the cost and distribution of medical care, surprisingly little attention has been paid to the question of what determines physicians' fees. Despite complex "relative value" schemes sufficient to choke a computer, many inconsistencies, inequities, and absurdities remain.

Before getting lost in specific enigmas, let us first try to recognize a few guiding generalities.

Physicians are paid according to the service performed without regard to outcome.

A radical mastectomy, for example, has an associated monetary value, irrespective of morbidity, mortality, or cure.

Perhaps the genesis of this modus operandi was the justifiable reluctance of the earliest physicians (and us today) to guarantee health and survival, which are not completely within the control of any human being. With or without a skilled doctor, disease and death eventually supervene.

Another feature often forgotten is that a medical payment does not depend upon the skill with which the service

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