Doctor on Dichotomy

The American College of Surgeons, American College of Physicians, American Medical Association all bind their members not to split fees. Nevertheless, the practice of dichotomy--by which one physician refers a patient to another for a price--is almost as widespread in the U. S. as it is in France, where it has been regulated. So flagrant has the practice become in New York City, where medical competition is keen and many a physician has to scratch gravel to survive, that last week the president of the Association of Private Hospitals Inc. called in the press to expostulate.

Dr. Harold M. Hays, Episcopalian brother of the Jewish civil libertarian, Arthur Garfield Hays, operates two private hospitals in Manhattan. He also is an otolaryngologist of note and gets many cases referred to him from other physicians. "It is possible that as many as 60% to 70% of the 14,000 doctors in the metropolitan area are engaged in this pernicious practice of splitting fees. Best evidence we have of this is the vote taken last month by the Kings County Medical Society, when 579 out of 770 doctors voted against establishing a law to stop the practice."

As a savage example of fee-splitting, Dr. Hays recalled: "About a year ago a Bronx doctor called me. He said that he had a case of mastoiditis, a child, and would I operate. This was on a Saturday, and the doctor suggested that the operation be performed the following Monday. I asked what temperature the child had. He said, 103DEG. I told him that he must be crazy if he didn't think that the operation should be performed right away. 'Well,' said he, 'we have to make an arrangement.' The 'arrangement' was that he wanted me to charge $1,000 for the operation and offer him a substantial portion. Over the week end he was going to persuade the child's family that $1,000 was a fair price."

As a healthy substitute for fee-splitting, thousands of U. S. doctors practice patient-splitting. A group which is friendly or has been to the same school will pass their cases around to each other when they need various specialist attentions. Dr. Hays last week recommended another solution, suggested that the practice of dichotomy be established aboveboard. It was his idea that specialists pay 15% of the patient's fee to the diagnostician or general practitioner for recommending him. The general practitioner, under this system, is not to charge the patient any other fee.

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