To the Editor:

I read with interest Dr. James Dykes’ article “Making Time to Listen” [September 2004, page 45]. Working the numbers – 10 patients a day, 4 days a week and gross income of $350,000, and assuming 48 working weeks per year and a 100-percent collection rate – I determined this would be an average charge of $182 per patient. Perhaps I’m missing something, but this appears to be a very steep fee for a family physician. Few family physicians have a 95-percent collection rate, let alone so many patients who are able to pay that amount for an office visit. Does Dr. Dykes care for any indigent patients? Most inner-city practices, mine included, require some sort of subsidization because of patients’ inability to afford medical care. Is Durham, N.C., a particularly affluent city, or can such an ideal practice be imitated elsewhere? I ask these questions because the article painted a very attractive picture that was far different from my experience in private practice.

Author’s response:

Compared to specialists’ fees in my area ($400 for initial consultation), my fees are a bargain. I do not consider my care to be of any lesser value than that of my more expensive colleagues.

I charge $250 for a one-hour physical and $187 for a highly complex, 45-minute visit. I charge $125 for a 30-minute, semi-complex follow-up visit and $75 for a 15-minute, single-problem visit. Lab fees are charged on top of this.

There is no incentive for patients to return if they do not value the service they receive and feel comfortable with my charges. In Durham, N.C., the home of Duke Medical Center, physicians practice on every corner. Yet many of my patients have stuck with me for more than 15 years.

By way of comparison, I took my tractor in for its 200-hour maintenance the other day. My bill was $695. Are we worth any less?

I do pro bono work and consider it a privilege. But I do not accept insurance contracts that devalue my time and my profession.

It takes time to counsel patients in distress, to conduct a careful and competent physical exam, and to educate patients effectively to prevent illness. I value my time and believe my high collection ratio indicates my patients value me.