Doctor, businessperson, or both?

In this 5-minute Consult column, John Santa, M.D., M.P.H., an internist and director of the Consumer Reports Health Ratings Center, discusses how your doctor's approach to business can affect your health.

Doctors, like everyone else, have to make money. But how they handle that end of the job says a lot about whether they see themselves mainly as a medical professional, a businessperson, or both. And it can affect the kind of care you get. There's not necessarily a right or a wrong way, but you should be comfortable with your doctor's business practices. Here's what to consider.

Is there a drug rep in the waiting room?
The simplest sign that your doctor might have a relationship with a drug company is the presence of a representative in the waiting room. He or she might be toting a suitcase of samples and other freebies, chatting up the office staff, even ordering lunch for everyone—and competing with you for your doctor's time and attention. In some cases, it might go no further than that. (And to be fair, some doctors allow the visits because they give the free samples to low-income patients.) But to find out whether the relationship goes deeper—whether a company has paid your doctor for speaking engagements or consulting, for example—go to Dollars for Doctors. It's a project of ProPublica, a nonprofit investigative-journalism group that collects publicly reported data on payments from 12 drug companies.

Some health-care systems, including Kaiser Permanente and Veterans Affairs, make it easier for you: They prohibit doctors altogether from having financial relationships with companies that make drugs or medical devices.

Are there testing machines on site?
Having a bone-density scanner or CT, MRI, or X-ray machine in the office could make it more likely that a doctor will order unnecessary tests, since he or she makes money on each one. That's different from testing done at an independent center with a radiologist who has no relationship to your doctor, because there may be less financial incentive for excessive testing. And prices vary significantly depending on where tests are done, so it makes sense to find out whether you could save money by going to an imaging facility. (For advice on shopping around for lower prices, see our report That CT Scan Costs How Much?)

Does your doctor work for a hospital?
If so, keep an eye on the hospital services he or she orders. They might be priced higher than those elsewhere. And there could be an incentive for excessive or unwarranted testing if, say, the hospital expects your doctor to bring in a certain amount of revenue or order a certain number of tests per year to help cover his or her salary. You should also feel confident that your doctor would refer you to another hospital if it would be in your best interest.

Do the charges seem fair?
In the past, people with health insurance often weren't concerned about the cost of the medical care they received. But rising health-care costs have forced many employers to revise their plans, shifting a larger portion of the cost to employees in the form of higher deductibles and co-payments. What's more, prices for doctors' services can vary considerably, even within an insurance company's group of providers. To compare your doctor's fees to others in your region, go to healthcarebluebook.com, which analyzes the payments that providers in the same area accept from insurance companies.

How does insurance pay your doctor?
Most use a "fee for service" plan: The more tests and treatments doctors do, the more they're paid. Others, like Kaiser, pay doctors a salary. Newer arrangements offer a "fixed fee" for care provided for a specific illness. Your doctor should be able to explain how your plan pays, which can give you some insight into whether it encourages too much, too little, or just the right amount of care.