I walk into the exam room with my attending, and introduce her to the patient.
"The two of us work together, and she's going to take a look at you, if that's okay."
"So the two of you are partners?"
"Sort of. I'm in my fellowship, so I'm still being trained, and she's one of the attendings who supervises."
"So you both get paid for seeing me?"
"We both get paid regardless of whether we see you. I get a salary. It doesn't change based on whether I see you or not."
"So how do you split the profits on me? 50/50? Or do you get more because you spent more time with me?"
"Like I said, I don't get anything for seeing you. I get paid a salary. It doesn't change based on how many patients I see or how much time I spend with them."
"So you want to spend as little time with me as you can and go see the patients who pay you?"
"No. No patients pay me. Medicare pays the hospital. The hospital pays me a salary. I spend as much time as I need to with you. I have other patients waiting, but there's no monetary reason why I would spend less time with you."
"What if I paid you directly?"
"I get a salary. Patients don't pay me."
"But would you spend more time with me if I paid you?"
"There's nothing I could do for you with more time. I'm spending the right amount of time with you. You paid into Medicare your entire working life. Medicare pays the hospital. If you have a co-payment, that is something you and Medicare deal with. I don't deal with your money. I don't know how much you pay, or who gets it. Doesn't matter."
"Matters to me."
"Okay, but it doesn't matter to me."
"So if I pay you a little bit on the side, you can't give me a better medicine or something like that."
"I can't give you any medicine. I can just write prescriptions. The pharmacy gives you medicine."
"So if I pay the pharmacist, I can get better medicine?"
"No. You get the medicine I prescribe, which is the medicine you need. We're not holding back the good stuff for the people who pay more. There's nothing better than what I'm giving you."
"That's not very reassuring."
"Medicine isn't perfect. We're doing our best."
"You would do better if I gave you more money."
"I wish that was how it worked. I would love to be able to charge patients for the good doctoring. But it just doesn't work that way. You're stuck with the best we can do, and we're stuck with our salaries."
"I thought doctors got rich."
"Some might, but fellows don't."
"So you're saying the women do?"
"No. Fellow means someone still in training. It has nothing to do with gender."