Recently, I saw new patient in my office who presented with a progressive change in vision. He had been aware for years that he had a cataract, and he now believed it was time to consider surgery. What complicated the matter, though, was that he had lost his other eye to trauma at age 8, so he was quite fearful of proceeding with surgery. However, he admitted that he was having distinct difficulties with seeing figures--he was an accountant and had essentially delegated driving the car to his wife.

At some length, I discussed with him various strategies I thought would help optimize his chances of a successful outcome. He scheduled the procedure. As it turned out, his health insurance deductible was very high, and he hadn’t yet met the limit. That meant he would have to pay for the surgery and the facility fees himself. Not only did he need to know pricing but, being an accountant, he wanted to evaluate the specific charges as well. When he learned what I would receive based upon Medicare rates, he was appalled. By all measures, this gentleman was quite successful financially. It was clear that he understood the value of my services--and it was equally clear that he thought I would be underpaid for them. Although this was flattering, it also made me think about how ophthalmologists and other physicians have been financially battered in the time since I began practicing 17 years ago.

It seems that we have allowed ourselves to be lumped into the category of technologists. As we know, the price of technology tends to drop over time, as is evident with the prices of computers, digital cameras, flat screen TVs and the like. We have seen the same in terms of surgery, whether it’s LASIK, cataract surgery or retinal surgery. As the results and the technology improve, we have increasingly felt downward pressure on our fees.

Let’s not forget about the substantial cerebral activity involved in surgery planning and execution and in post-surgical care. It seems to me that "brain power" does not get discounted as readily as technical expertise. Certainly, my accountant and lawyer have not reduced their fees over the past decade, and I pay them to think. Patients pay us to think as well--not just to do. Those lasers, keratomes, phacoemulsification units and vitrectors are useless without our experience, training and intelligence.

Stephen E. Pascucci, MD Medical Editor [email protected]