An ongoing dialogue on HIV/AIDS, infectious diseases,
June 15th, 2008
Curbside Consults: What are They Worth?
Below is a friendly email exchange I had last week with with one of our hospital’s primary care providers:
Dear Paul, do you know anything about whether pts should be given prophylactic antibiotics prior to dental procedures etc. if they have an indwelling IV catheter? I have a pt. who has a BardPort porta cath in her subclavian that was placed surgically for her chemo treatment about 2 years ago and she is doing well but asked me this question and I could not find an answer.
It is not formally recommended; and in this virulent C diff era, I wouldn’t do it. But some oncologists still recommend prophylaxis (and/or some patients really want it), so if they insist, I suggest you use the endocarditis prevention guidelines.Regards, Paul
Thanks much, very helpful. Cathy
According to the Allied Physicians Salary Survey, the average salary of an Infectious Diseases Specialist with at least 3 years experience is $178,000/year. If we assume a fifty-hour work-week (ha), with 4 weeks for vacation, that comes to an hourly rate of $74/hour, or $1.24/minute.
The time it took me to read the email, type a response, then open her gracious note of thanks (note to curbsiders — we like being thanked) was all of around 5 minutes. Applying the above hourly rate, we find the email curbside consultation was worth approximately … 6 dollars.
In other words, for what a curbside consult “costs”, you could get a gallon of gas and a cup of coffee at your nearby Quik Mart. But not much more.
But is that really all a curbside consult is worth? Didn’t my response also save the primary care provider some time? The patient a potentially severe (and costly) adverse effect (C difficile colitis — very scary these days)? What about the training and experience required to to answer the question authoritatively? Or the time it took away from other critically important activities?
Sure, I’ve been asked this question before (so it was kind of a slam dunk, to invoke the currently appropriate Boston sports metaphor), but isn’t that why we pay the experienced neurosurgeon his/her $500K+ a year? Because they’ve done brain surgery before?
The sad fact (for us ID doctors, at least) is that curbside consultations don’t fit into any reimbursement model for health care. And by the way, the “price” for a curbside consult isn’t even $6 — it’s $0.