Medicine: Fee-Splitting

As new president of the New York Academy of Medicine and hencea quasi-national personage, Dr. John Augustus Hartwell last week assumed boldness and denounced the profession’s chronic evil— fee-splitting. The practice of medicine has become so complex that the generalpractitioner must usually call in a specialist for many services which formerly he did himself. The patient pays two fees, usually (in Manhattan and other large communities) $10 to the family doctor, $35 to the specialist. And usually the specialist secretly rebates a few dollars to the small doctor who called him into consultation. Fee-splitting in the U. S. “has grown to alarming proportions.” It results, stated Dr. Hartwell categorically, “in two evils: 1) the selection by the family physician of a specialist who will pay the rebate, which may readily lead to the employing of a less qualified man than would otherwise be obtained; 2) an increased charge by the specialist to cover the unacknowledged rebate. It is a secret understanding between two professional men which they dare not bring into the open.” To such rebuke Dr. Hartwell’s Manhattan colleagues listened, as doctors elsewhere would listen, some queasy, most phlegmatic.