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JAMA 100 Years Ago
December 23/30, 1998


Author Affiliations

Edited by Jennifer Reiling, Editorial Assistant.

JAMA. 1998;280(24):2121A. doi:10.1001/jama.280.24.2121-a

NEW YORK CITY, Dec. 19, 1898.

To the Editor:— In response to my request for specific information about instances in which the specialist has paid commission to the general practitioner for referred cases, I have received several communications which indicate that the practice is not uncommon in a section of our country which is renowned for its "hustling" spirit. Personal inquiry among representative members of the profession in New York convinces me that my first impression was right, and that a division of the fee is never likely to become a practice here, excepting in instances where the patient agrees to pay a definite sum for the entire management of the case. This is rare, and would be an openly conducted transaction. I am in a position to see two sides of the matter. I have dropped from my practice everything excepting operative surgery, but during the year a good many other sorts of cases come in, which are referred to men who I believe are best authority. If any one of these men had been in the habit of offering a commission it certainly would have come to my knowledge, and further, he certainly would never have another one of my cases. On the other hand, I am constantly in contact with physicians who bring cases from all over the country, and not one of them has ever suggested that he would like a commission. As some of these physicians have come from the commission-infected area, they must have lost the symptoms on arrival in our atmosphere.