When Medicine Takes a Toll

Finding a new doctor or dentist can be one of life’s little hassles.

Not to worry. Operators are standing by.

Increasingly, hospitals, medical associations and private firms are taking the 800-line approach to health care with toll-free telephone services that promise to play matchmaker for your medical needs. And the trend--fueled by health care providers worried about losing patients in today’s managed-care environment--has yet to peak, experts say.

While the match-up services run by hospitals and professional medical associations typically don’t charge providers, those run by entrepreneurs charge monthly membership fees--sometimes hundreds or thousands of dollars. (The fees are used primarily to cover advertising costs.)

But it’s that payment arrangement that has sparked criticism, with some doctors wondering if colleagues who belong to such services might suggest unnecessary procedures to recoup the costs of attracting the new patients.

“There’s no question that doctors do feel more pressure to do surgery--especially plastic surgery--on patients who come to them through any form of patient advertising,” says Dr. Michael F. McGuire, chief of plastic surgery at St. John’s Hospital and Health Center, Santa Monica, and UCLA assistant clinical professor of plastic surgery.

Dr. Robert Kotler, a Beverly Hills facial plastic surgeon, disagrees even though he, too, does not pay for an 800-number service. “I think most doctors deal quite ethically with their patients.”

Whether the 800-number service is free or fee, the calls keep coming.

“We generate 100,000 calls a month,” says Michael Apstein, CEO of Futuredontics Inc., which runs 1-800-DENTIST in 23 states and charges its 1,500 members $750-1,500 per month, depending on location.

Also logging 100,000 calls a month is the Dental Referral Service ([800] 917-6453) in Oceanside, says Dr. Thomas Miller, the dentist who founded it in 1978. His 1,000 members pay $455 monthly.

At the fledgling 1-800-BEAUTIFY, set up three years ago to help consumers find California plastic surgeons, founder Judith Cohen says she gets 600 calls a month. Her 43 doctor members pay $1,000 to $3,500 in monthly membership fees, she says.

Hospital-based referral services and those run by medical societies--which typically don’t charge--report a brisk business too. About 1,300 callers a month dial the 10-year-old service at Cedars-Sinai Medical Center ([800] CEDARS-1) to find a physician, says Sandy Schultz, program manager.

And every month, about 4,500 calls and letters flood the Plastic Surgery Information Service ([800] 635-0635) at the American Society of Plastic and Reconstructive Surgeons, says spokeswoman Nancy Ryan.

Some services go beyond simply providing a name and phone number. At 1-800-DENTIST, for instance, callers can be patched right through to a dentist’s office, bypassing a patient’s natural procrastination in making an appointment.

At Cedars, a sophisticated computer system tries to find the best match from 900 physicians, taking into account the caller’s language, location and insurance.

Administrators of the telephone services say they do rigorous background checks, verifying a health care provider’s license and checking the candidate’s record for disciplinary actions and malpractice suits. Annual reviews of members are often required; complaints from callers are taken into account.

And not everyone passes muster.

At Cedars, only physicians who have been on staff for “a couple of years” are allowed on the referral service, says Schultz.

“We turn down doctors every day,” says Cohen of 1-800-BEAUTIFY, who says she accepts only board-certified plastic surgeons.

And sometimes it’s the doctors and dentists who do the rejecting.

“Our best source of patients is friends of former patients,” says Dr. C. Dennis Bucko, a La Jolla plastic and reconstructive surgeon and UCSD clinical assistant professor who has been approached by several telephone services but has declined.

“I’ve definitely been heavily recruited,” says one prominent Westside plastic surgeon who did not join a private service. “They were very aggressive,” he adds. They took him to dinner at expensive restaurants to explain their program. Because his name would probably attract other physicians, “they were willing to make me a better offer.”

Critics of the entrepreneurial services also complain that some 800 services try to imply an association with professional associations.

One of the 1-800-BEAUTIFY ads, for instance, carried a quote--”No matter what type of plastic surgery you’re considering, the most important factor in its success is the surgeon you choose”--and attributes it to the American Society of Plastic and Reconstructive Surgeons.

“The quote is certainly our philosophy, but we have not endorsed this ad or 1-800-BEAUTIFY,” says Dr. Garry S. Brody, professor of plastic surgery at USC and president of the American Society of Plastic and Reconstructive Surgeons. “I think it comes from one of our educational brochures, which are copyrighted.”

Cohen says she stopped running the ad after an official from the surgeons’ group requested they not use the quote.

The use of models versus real people in the ads has also sparked debate. Most people who appear in the 1-800-BEAUTIFY campaign are not patients but models, Cohen says. The dentists in 1-800-DENTIST ads are actual members, according to a representative.

Cohen defends the practice of using models, saying that it protects the anonymity of patients. “This is standard advertising practice,” she says, “and the public knows and understands this. Do you think people really believe that Jaclyn Smith buys her clothes at Kmart?”

The use of models in ads, says Brody, “is an issue that has come up more than once. According to our [society’s] ethics code, advertising should not be deceptive in any way.”

While advertising is allowed and regulated by California Business and Professions Code, some doctors and dentists still shy away from it in any form.

But Susan and Brent Hale have only good things to say about 1-800-DENTIST. They joined when they opened their Santa Monica dental practice nine years ago.

“It gives us a continuing source of referrals and it is an ethical way of advertising,” she says. “We average 12 or 15 new patients a month from it.”

Some of her colleagues now say they wish they had joined earlier. “We know a lot of dentists who are on the waiting list,” she says.

McGuire, of St. John’s Hospital, says the demand will continue to grow because “the physician community is becoming more desperate, if you will. . . . The pie of patients will be cut up into smaller and smaller pieces.”

The prediction is especially true for his specialty, McGuire says. “More doctors are going into ‘plastic surgery’ as their other work dries up,” he says. “We had a thoracic surgeon apply for liposuction privileges.”

The request was denied.