October 20, 1911] 



SCIENCE 



503 



on a salary, althovigh a small sum, in addi- 

 tion to room and board, may be paid the 

 interne. At the Johns Hopkins Hospital, 

 where some of the members of the staff 

 have always had some salary as compensa- 

 tion for their eare of the indigent, it has 

 recently been proposed to put all of the 

 members of the regular staff on a salary 

 basis, on the understanding that they are 

 not to engage in private practise. The 

 private patients at the hospital would pay 

 the hospital directly, and not the attending 

 physician or surgeon, for their medical care. 

 How widespread such a movement will be- 

 come can not at present be predicted. In 

 all probability, however, for many years to 

 come the majority of physicians will de- 

 pend for their support upon fees from pa- 

 tients rather than upon a salary from a 

 hospital or other organization. The freer 

 use of hospitals by no means precludes this. 

 On the other hand, it is quite apparent 

 that the custom of the employment of 

 physicians on a salary to give medical at- 

 tendance to groups of people is growing 

 throughout the civilized world. In public 

 institutions for the care of the criminal, 

 insane and defectives, as well as in the 

 army and navy, this custom has long pre- 

 vailed and in this country has received the 

 general sanction of the medical profession. 

 The employment of physicians by corpora- 

 tions to look after men in remote districts 

 has also received general sanction. But 

 the profession has not looked favorably on 

 the employment by corporations of physi- 

 cians to look after employees and their 

 families in settled communities where there 

 is an abundance of private practitioners. 

 Nor has the profession looked with favor on 

 the employment at a salary by lodges and 

 other social organizations of physicians to 

 look after members and their families. 

 "Contract practise," as these forms of 

 practise are called, has a bad name, in 



large part deserved, because too often a 

 physician will contract to treat for a sum 

 too small to make good service possible. 

 When a fair salary is paid for first-class 

 work no legitimate criticism can be made. 

 Certainly there is nothing sacred about the 

 prevalent system of small fees for visits, 

 fees which resemble in some respects tips 

 to a servant for personal service, except 

 that the physician's fee is less often pai(i 

 in cash. On the other hand, there is noth-. 

 ing especially to be commended in the. 

 custom of the specialist, Robin-Iiood-like,. 

 to hold up the rich sick to pay for the sick 

 poor. The public at large should pay for- 

 its necessary charity. 



A physician should be paid for his time 

 and his skill and be paid enough to make 

 it possible for him to give good service and 

 improve himself in his profession. But 

 whether he is paid a salary or a fair 

 amount for a definite service makes little 

 difference. The evil to the medical profes- 

 sion of the medical insurance laws of Ger- 

 many comes not from the fact that the 

 state hires physicians to treat the insured, 

 but from the fact that the state pays far 

 too little for this service. 



Much complaint is made of the large 

 numbers who seek free treatment at dis- 

 pensaries and hospitals in our larger cities, 

 frequently a quarter or more of the pop- 

 ulation. It is doubtful if so large a part 

 of the population are either paupers or 

 dead beats. Many can not afford fancy 

 fees and know of no way of getting the 

 best treatment except to go to a dispensary 

 or hospital where treatment is organized. 

 Make it possible for the average man to get 

 the benefits of organized treatment at a 

 moderate charge and a large part of the 

 so-called dispensary and hospital abuse will 

 disappear. 



There will doubtless always be some 

 necessity for charity work. The com-. 



