September 10, 2015

The Fallacy of Hard Work for Determining Healthcare Costs

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One day, I lost the key to a safe deposit box I keep in the house. I called the locksmith who came and got the door to the safe open with his lock-picks in under 3 minutes. The charge? $400.

For many people, this charge may seem outrageous. $400 for 3 minutes of work? If it had taken the locksmith an hour, most people would probably not have complained about a $400 charge, because he put in a lot of "hard work."

What people may not realize is that when it comes to specialized professions, the charge is not equal to the effort or the amount of "hard work" required to accomplish something, whatever that may be.

A true skilled professional can accomplish a given specialized task very quickly, whereas someone who is less skilled would take MUCH longer (if even able to successfully complete). A skilled professional has put in hundreds/thousands of hours of "hard work" first during his training in order to reach a level of supreme competence and skill to allow him to complete a task very quickly that would take others much longer to do... and the charges reflect that.

As such, charges for skilled professions will not necessarily reflect the amount of time/effort, but rather the task being addressed.

The same is true for the healthcare profession.

A skilled and experienced dermatologist can literally take 2 seconds to make an accurate diagnosis and come up with a treatment plan (and charge hundreds of dollars) whereas a less-skilled dermatologist may take 15-30 minutes to come up with a diagnosis that may not even be correct (and also charge hundreds of dollars). But most patients will complain about the first and not the second dermatologist because of the perceived "lack of hard work" displayed by the more highly skilled dermatologist.

In the ENT world, the same complaint also occurs, especially when it comes to foreign body removals from the ears or nose (as well as other procedures). It is not unusual for a child to put things they shouldn't into such locations, and when it happens, the parents will often take the child to the ER or their pediatrician's office. In the ER or pediatrician's office, they may spend 30-60 minutes trying to get it out... unsuccessfully... and be charged hundreds of dollars. When the child comes to an ENT office, it is not unusual (assuming the child is still cooperative), to be able to remove the foreign object in under 5 minutes... and also be charged hundreds of dollars.

But invariably, the parents will complain to the ENT office about how much was charged for a procedure that only "took a few minutes."

That is the fallacy of hard work when it comes to skilled professionals. Charges are often based on the procedure... not the amount of time, effort, hard work put into a problem/task whereas the customer/patient expects the charges to be based on the amount of time or hard work rather than the skill level of the professional regardless of the results.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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