What Xmas Means to Me (not really) by Pat Conrad MD

Oh Christmas, many gather to celebrate the birth of a baby born a while back on the other side of the world.  In Florida, doctors and lawyers gather together to celebrate the birth of a different child.  Joining hands in a circle recalling the most hellish of W.H.O.ville’s (ironic, that), all beam inwardly at toward the center of the circle where sits…the neurologically injured newborn.

“The Florida Birth-Related Neurological Injury Compensation Association (NICA) was created by the Florida Legislature in 1988. NICA is a statutory organization that manages the Florida Birth Related Neurological Injury Compensation Plan (“Plan”) used to pay for the care of infants born with certain neurological injuries.  By eliminating costly legal proceedings… ensures that birth-injured infants receive the care they need while reducing the financial burden on medical providers and families.”  Of course malpractice rates never dropped.  Dr. Seuss couldn’t have written it better, but even he would likely have to pony up ……the $250 every Florida physician has to pay every year..  I am not an OB, and my greatest delivery skill is to rapidly get the no-prenatal-care-contractions-all-damn-day multigravida the hell out of my ER and to some nearby L& D as rapidly as legally permissible..  To date I have never had an uncomplicated delivery (when forced to by horrid circumstances), and the only birth complications I tend to see are latent, those of being born to dull-witted progenitors (“parents” seeming a trifle generous).  The point here is that I’m shanked every year for something I have nothing to do with, and no power to improve or prevent.  You might think I’m overly complainful, but I didn’t see you in the ER earning those extra couple of Franklins.

As the old year gives way to the new, the fun is just cranking:  I practice in two different states, and when the New Year’s Eve anascope drops at midnight, my keepers in both states, along with our benevolent federal government will have plucked from my obviously guilty clutches:

Alabama medical license ($300) plus controlled substances license ($150); Florida medical license ($391); ABFM certification maintenance ($235); DEA license renewal ($731); and oh yes, the damnable NICA fund’s $250, for a festive total of $2,057.

This of course does not include required CME, required fingerprinting charges, my own administrative time, and whatever time I wasted, drink in hand, on these idiotic MOC’s)

And now yuletide reader, here is the point:  over two grand may not seem like a lot to some of you, and others of you will sniff that this is merely “the cost of doing business”, through which I should languish more stoically.  But these costs are all incurred at the demand of a society i.e. patients and their surrogates, which mandates, and then forces the target to pay for said activity.  Rent, malpractice premiums, coffee filters, the light bill…those are all proper business costs.  These charges I have listed are the price of force, negative incentives that if not satisfied, will prevent me from making a living. And believe it or not, this rant ain’t about the cash – it’s about the principle, and the functional disdain this society has for those it takes for granted.  Happy #$&^@ Holidays.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  12 comments for “What Xmas Means to Me (not really) by Pat Conrad MD

  1. Susan R
    December 10, 2012 at 6:30 pm

    Agree Agree Agree-we nurses get it too–license fees & malpractice & CE. Perhaps the non-helmeted motorcyclist wrecked becuase he was talking on the OBAMAPHONE that WE all pay for!!!!

  2. Lady Di
    December 9, 2012 at 11:35 am

    Dear Ben VR

    Look at the bright side:
    Many of those motorcyclists who chose to go helmet less are called Organ Donors.

  3. Peter Verrill
    December 6, 2012 at 6:36 pm

    NIFLA has been wonderful in Florida for holding the line and actually reducing liability premiums for us OB’s. Would that all fields of medicine could have similar protection and that NIFLA could be expanded to include shoulder dystocia. Florida Medical Association has this discussion every year and every year re-affirms when the truth is heard. I like the rest of your comments. God bless all of you this Advent and Christmas season.

    • Pat
      December 7, 2012 at 12:03 am

      Then how would OB’s feel about a yearly fee to help keep ER malpractice premiums down? I don’t favor that of course, I just don’t think it’s right to use force to arbitrarily penalize uninvolved parties.

  4. mamadoc
    December 5, 2012 at 9:05 pm

    And you didn’t even mention how much the idiotic MOCs cost!

  5. Nick C
    December 5, 2012 at 7:03 pm

    Med Student’s Perspective: I’ve already been conditioned to be assessed for questionable charges on my quarterly tuition bill. (“Why should I be charged a student activity fee? I’m at the hospital all day, I don’t have time for activities!”) I just knuckle under, though.

    But the answer to your question, whether we’re talking about the egregious registration fees for board exams or licensing fees later on, why do they charge so much?

    Because they can.

  6. Dkogu Given
    December 5, 2012 at 5:12 pm

    @#$%%%%^& Well said!

  7. Steve
    December 5, 2012 at 3:16 pm

    “the light bill”?
    C’mon, Pat!

    • Pat
      December 5, 2012 at 9:32 pm

      What, too antiquated?

  8. phil
    December 5, 2012 at 3:09 pm

    In NC just got hit w/ an additional (and new) $100 required to re-regester with medical assistance! Backdoor tax not instituted by the elected….

  9. December 5, 2012 at 10:08 am

    wow. couldn’t have been said better. the words of ayn rand’s dr. hendricks ring true 50 years later regarding physicians forced to practice at the behest of incompetent leaders. that is why i do not belong to aafp or the ama. money wasted on organizations that roll over on command to our “representatives” latest dictum. pat, those of us who are thinking and conscientious are with you….

  10. Ben VR
    December 5, 2012 at 9:07 am

    And remember it is not the cost of doing business.

    Other businesses can pass along their costs and raise their rates.
    Medicine is the only “business” where costs are dictated and fees are dictated.

    My favorite is being mandated to treat uninsured motorcycle riders without helmets in the ER. Yet they have the “right” not to wear a helmet.

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