Ship Doctors are paid commission?!

[Cruisercl]

This thread is very interesting to me; I have been in the heath care industry for many, many, many years as an BSN,RN, RRT, MSHS. Practiced in a major University (SICU) and corporate biomed industry for many years.

One thing I am always concerned about when on a cruise ship are the credentials of the medical staff....I hope they are all well qualified.

 

Many "MDs" that come to the USA are not qualified or licensed (where?) to practice as a physician in the USA, and are not allowed to practice without more education and internship/residency, but cruise lines hire them because they have "MD" behind their name. Very often their education and experience are not an advanced practice education and experience and really are not capable or qualified for many diagnoses. I have seen this but not on a cruise ship. :)

 

If they are a true physician/nurse, IMO , there is never a commission involved to treat someone; usually the Hippocratic oath takes care of that. And as far as the 'perks' from salespeople; the Sunshine Act has taken care of that.

 

It is good to ask. :)

Edited September 16, 2015 by Cruisercl

[Cruisercl]

Exactly! Drug companies spend billions of dollars a year to convince doctors to prescribe their drugs. HERE is a good article about this practice. Just because you don't get a buck a pill commission doesn't mean you aren't benefiting financially from drug companies!

 

As a midwife I don't generally get in on the pharmaceutical handouts, but several years ago I was invited to a series of 5 dinners by a cord blood collecting company. They took us, mostly physicians and a few midwives, to the fanciest of restaurants (Ruth Chris, Commanders Palace, etc), wined and dined us, gave us a presentation that lasted about 30 minutes and handed us a check for $250 on the way out. They also offered to waive all their costs for cord blood collections for office staff and immediate relatives, which amounted to a couple of thousand dollars per procedure!!! On the occasion of one of these dinners a doctor friend of mine told me that she had already been to a breakfast presentation of another company that morning. A nice gig if you can get it. :D

 

Hi Desertbelle!

 

Are you still practicing? If so/not you may realize it is VERY different than it was several years ago. No more fancy restaurants etc.; this is one reason physicians do not want to participate in research etc.

 

This is also one reason why drugs take so long to get through the FDA.:)

 

Just an FYI.

[Desertbelle]

Hi Desertbelle!

 

Are you still practicing? If so/not you may realize it is VERY different than it was several years ago. No more fancy restaurants etc.; this is one reason physicians do not want to participate in research etc.

 

This is also one reason why drugs take so long to get through the FDA.:)

 

Just an FYI.

I am a practicing midwife, but as I mentioned, I don't get invited much to these types of functions because I don't prescribe drugs, nor do I own or operate expensive diagnostic equipment or machinery....so I was unaware of the reduction of these affairs in the last years. Thanks for the heads up.

[Ayton lady]

As a UK GP we also used to get wined and dined by the reps but that all stopped here quite a few years ago. To be honest our work load now is so heavy we haven't got time to even see the reps let alone have a lunch out. These days : What's lunch!!! Did it affect our choice of treatments, no I don't think so but they did provide a lot of education and information which obviously was valuable to us as long as we assessed them properly.

[need2bespoiled]

This sounds to me like it is the doctors who are in the Spa. They're most certainly often "full" doctors / MDs and from the U.S. I'm hoping that's the case anyway, as I don't see them getting commission as big a deal as those that treat sick and injured patients. In fact I wouldn't be surprised if they're cruising for fun, for free, doing procedures attached to the spa and paid commons / per procedure.

 

Happy sailing,

Jenna

[jveevers]

I don't think X charges PAX who are diagnosed with Noro. And I don't think medications are generally dispensed either, one just has to get thru it. It's a virus so antibiotics won't do anything to treat.

 

But they are told to stay in cabin and I have seen where security has been placed outside of staterooms because some have refused to follow the policy.

From one whose wife contracted Noro 3 weeks ago I can confirm that X does not charge for consultation, shot or medication. For all other consultations they charge huge $$$.

I would expect that Dr's would receive part of billed income or be on a very salary compared to other staff .

[need2bespoiled]

From one whose wife contracted Noro 3 weeks ago I can confirm that X does not charge for consultation, shot or medication. For all other consultations they charge huge $$$.

I would expect that Dr's would receive part of billed income or be on a very salary compared to other staff .

 

I don't think their prices were that unreasonable. My partner needed crutches on our cruise in Asia. They charged her $19. Seemed fair to me. Maybe other services are expensive but that was reasonable.

 

Happy sailing,

Jenna

[busybead]

As a RN i find it concerning that these Doctors get are to get paid for prescriptions. How many prescribe drugs, when its not really called for? But hey, they want a new set of golf clubs...Cipro for everyone!!

 

I returned from the Solstice Sept 11. Out of 16 people in our party 13 of us were sick. I was by far the worst. When I went to the Dr, I was given an ekg, multiple blood and urine tests and I don't even remember what else. I was having severe breathing problems. I was given 7 nebullizer treatments over 3 1/2 days and confined to my cabin with an oxygen machine. Along with the treatments I was given broad spectrum antibiotics when I specifically told the Dr I did not do well with them and the last time I took them I almost died. He assured me these were "safe". Well, they weren't. Not only did they cost almost $300 for 20 pills, they started a digestive issue. I'm still not well, but did stop the pills on the 3rd day. Needless to say this was the worst vacation I've ever taken and will not be cruising again. Oh, my total medical bill was almost $2000.

[cherylroslyn]

My uncle had a bad kidney stone on Summit a couple of years ago. He was given pain meds, antibiotics. The whole thing cost about 100. I though it was well worth it.

[NCHPcruiser]

Last week I begged the doctor on the Reflection (Neill, I believe) for an antibiotic and he wouldn't give me one. My throat and neck were so sore it was very painful to swallow much less enjoy the wonderful food being served or enjoy my beverage package. This went on for three days and was not getting better. He said his guidelines specified he had to wait seven days. It was the first time in 23 years I had been sick or taken an antibiotic. The next morning in Rhodes we were able to buy a Z-pack at a pharmacy in Old Town. By dinner time I was a little better and able to eat something beside risotto, within 24 hours could actually enjoy a glass of wine and by the third day almost 100%. I can't believe this doctor was receiving a commission on prescriptions. He was useless as far I was concerned! After months of planning, not to mention the expense, had I not been able to get the z-pack it would have completely ruined our much anticipated trip. This should have been taken into consideration. I'll never travel again without an antibiotic.

[HokiePoq]

I returned from the Solstice Sept 11. Out of 16 people in our party 13 of us were sick. I was by far the worst. When I went to the Dr, I was given an ekg, multiple blood and urine tests and I don't even remember what else. I was having severe breathing problems. I was given 7 nebullizer treatments over 3 1/2 days and confined to my cabin with an oxygen machine. Along with the treatments I was given broad spectrum antibiotics when I specifically told the Dr I did not do well with them and the last time I took them I almost died. He assured me these were "safe". Well, they weren't. Not only did they cost almost $300 for 20 pills, they started a digestive issue. I'm still not well, but did stop the pills on the 3rd day. Needless to say this was the worst vacation I've ever taken and will not be cruising again. Oh, my total medical bill was almost $2000.

 

So sorry you were so sick! Our friend got great treatment on the Infinity which included several IV antibiotic treatments.

We met the doctor on our recent HAL cruise. He was an American physician who has an active practice in Florida. I think it was a "working vacation" He was kept busy with several very serious events on a cruise with many elderly passengers.

I hope you'll be able to enjoy a cruise in the future. We did not get sick on our recent cruise....I think it was the same respiratory illness that went around on the Millie in the spring. Bad bug.

Hope you are feeling better now and had trip insurance to reimburse you. The cost sounds like mine before insurance kicks in.

[DannyS]

The spa doctors are often "real" doctors. I spent a good time talking to one a few years ago. He was an ObGyn in India, but found that he couldn't make much money because of malpractice insurance costs. So he moved to Dubai and began practicing what he called "Aesthetic Medicine."

 

He decided why live in Dubai when he could travel the world? So he now works on ships doing Botox injections and other cosmetic treatments that must be done by a doctor.

 

Most interesting was that he would occasionally be called by the ship's doctors to assist when there were issues that would benefit from an ObGyn consult. (Mostly for crew)

[Hlitner]

Interesting issue. In the USA there used to be a lot of related problems when it came to the relationships between physicians and pharmaceutical companies. Many medical insurance companies (I worked in this industry for over thirty years) had major issues with these relationships for multiple reasons including it contributing to the high price of drugs. It also encouraged some physicians to prescribe the drugs that would generate the most profit for the physician, whether or not is was the most appropriate treatment. So a physician might prescribe a new antibiotic that costs $10 a dose rather then another antibiotic (which might be even more effective) that cost 10 cents a dose.

 

So the US Government (and some states) got into the act and part of the problem was rectified with the so-called "Stark Law" which made many of these referral deals illegal! And some medical societies/associations have also gotten involved calling some of these practices unethical. Once upon a time some physicians would actually dispense prescription drugs in their office and simply add the cost to the patients bill. Those days are long gone (with a few exceptions) in the USA where nearly all drug prescriptions are now filled by licensed pharmacists/pharmacies who are independent of the physician.

 

If true, it is a shame that cruise lines have not adopted some of the Ethical standards designed to discourage the unnecessary dispensing of drugs...and also discourage to dispensing or expensive drugs when a cheap alternative is just (or more) effective.

 

Hank

[leisuretraveler223]

Last week I begged the doctor on the Reflection (Neill, I believe) for an antibiotic and he wouldn't give me one. My throat and neck were so sore it was very painful to swallow much less enjoy the wonderful food being served or enjoy my beverage package. This went on for three days and was not getting better. He said his guidelines specified he had to wait seven days. It was the first time in 23 years I had been sick or taken an antibiotic. The next morning in Rhodes we were able to buy a Z-pack at a pharmacy in Old Town. By dinner time I was a little better and able to eat something beside risotto, within 24 hours could actually enjoy a glass of wine and by the third day almost 100%. I can't believe this doctor was receiving a commission on prescriptions. He was useless as far I was concerned! After months of planning, not to mention the expense, had I not been able to get the z-pack it would have completely ruined our much anticipated trip. This should have been taken into consideration. I'll never travel again without an antibiotic.

 

Congratulations on taking what was most certainly an unnecessary course of azithromycin for a viral upper respiratory illness. Those symptoms usually last 4-7 days, which is why every reputable medical organization strongly discourages the use of antibiotics for these symptoms with less than 10-14 days of symptoms.

 

But, you of course perpetuate the misguided idea that the antibiotics are the reason you got better. WRONG! Four days into your viral illness, your symptoms began to improve, because that's the natural course of most viral illnesses. Take antibiotics on day four and get better... Coincidence. You could have applied leaches to your shins on day four and you would have improved. Then you'd be on here singing the praises of leaches....

[leisuretraveler223]

Once upon a time some physicians would actually dispense prescription drugs in their office and simply add the cost to the patients bill.

 

This is the same scam most of the holistic or naturpathic doctors continue to run. Go see them and find out all these vitamins and natural supplements you supposedly "need", and lo and behold, the sell them right there in their office!

[Karynanne]

I returned from the Solstice Sept 11. Out of 16 people in our party 13 of us were sick. I was by far the worst. When I went to the Dr, I was given an ekg, multiple blood and urine tests and I don't even remember what else. I was having severe breathing problems. I was given 7 nebullizer treatments over 3 1/2 days and confined to my cabin with an oxygen machine. Along with the treatments I was given broad spectrum antibiotics when I specifically told the Dr I did not do well with them and the last time I took them I almost died. He assured me these were "safe". Well, they weren't. Not only did they cost almost $300 for 20 pills, they started a digestive issue. I'm still not well, but did stop the pills on the 3rd day. Needless to say this was the worst vacation I've ever taken and will not be cruising again. Oh, my total medical bill was almost $2000.

 

Just curious...did you submit your onboard medical bill to the insurance company you use at home?

 

Hypothetically, if you did not have any medical insurance at home, and were treated for the exact same issues at home, your medical bill could possibly be much higher.

 

Many years ago, I too had a health issue while cruising. I had the same treatments you were given. My onboard bill was over $2000.00.

 

Once home, I submitted all the paperwork to my insurance company and I was reimbursed everything, minus my deductible.

[rwb]

According to the court of appeals decision, the case deals with doctors who worked directly for the cruise line between 2004 and 2009. That is, they were not employed by the subcontractors who operated the spas.

 

The lawsuit is based on the fact that their contracts included a provision to pay a percentage of "total medical revenues", which they are arguing should have included medications as well as procedures.

 

The fact that some of their pay was in the form of commission doesn't seem unreasonable to me. Surely that is relatively common in private practices. I know in my father's multi-physician practice, a part of the doctors' income was based on the firm's billings.