The "How Much Is Really Enough" Exam

I just finished my 6-year recertificationexam in family practiceand, fortunately, passedwith a better grade than thelast time. It was a gruelingexperience, and afterwards I askedmyself if it was worth it. "After all,"I said to myself, "how does this testpredict my success as a physician?"My patients couldn't care less. Theyassume I'm competent, and just wantme to do what's best for them.

Realizing that personal success is acomplex mixture of adequate incomeand professional satisfaction, I decidedto write an exam that would test forthese elements. So, I give you my versionof a realistic recertification exam.

Question 1

You receive a call from the emergencyroom regarding a patient withan arm fracture. What do you do next?

a) Drop everything you are doing,miss your daughter's piano recital,rush down to the hospital, and takecare of the patient.

b) Ask if the patient is insured, andthen decide when you will respond.

c) Calculate how much profit youcan make on that patient before youleave the operating room, where youare performing a $2000 cerebroplasty.

d) Advise the nurses to administerpain meds so you won't have to botherwith the patient until tomorrow,when you have more time.

Question 2

Your patient has congestive heartfailure. Complications arise, and youspend all night with the patient. Comemorning, you discover that yourpatient is uninsured. How much doyou bill the patient?

a) Nothing. Hopefully the patientwill be grateful for your generosity.

b) $100. You know you'll never getpaid, so why bother artificially inflatingyour accounts receivable?

c) $500. Your services are worthmuch more than that, but you wouldnot want to bankrupt the patient.

d) $10,000. You never know—hecould be independently wealthy orhave just won the lottery. There's achance he could be very, very gratefulto you for saving his life.

Question 3

You see a patient in the officewhom you haven't seen for years.Although the initial reason for thevisit is an upper respiratory infection,you discover multiple untreated medicalproblems and wind up performinga complete physical exam. Whatdo you charge?

a) The usual 99213 code. You couldcharge more, but you don't want tocharge an arm and a leg to a patient whois not physician-friendly. Plus, you wantthe patient to come back regularly.

b) Charge the maximum, 99215,plus any procedures. You don't care ifthe patient receives a bill for $300. Younever see her anyway.

c) You examine her carefully with theidea that she may need lucrative procedureson the next visit, and then scareher that she might die if she does notcome back and get those procedures.

d) Since you're not quite sure whatthe code is, you send her on her wayfree of charge. It's only money, right?As with any test, you no doubtwant to know your score. Did youpass? Well, the passing score is up toyou. There are many ways to scorethis test, and the right way for youdepends on your personal goals as aphysician. How much money do youwant to make? How do you want toearn it? How important is patient careand their satisfaction? The answers tothese questions and your personalsuccess are up to you.

Louis L. Constan, a family practice physician

in Saginaw, Mich, is the editor of the

Saginaw County Medical Society Bulletin

and Michigan Family Practice. He welcomes

questions or comments at 3350 Shattuck

Road, Saginaw, MI 48603, 989-792-1899, or louisconstan@hotmail.com.