Last night, my family ordered dinner delivered from a Chinese food restaurant. As I handed over a $5 bill as a tip, I reflected
back to my early teens, working after school in my family's 400-square-foot corner grocery store. I was responsible for deliveries
and my usual expectation for a tip (not always a sure thing) was a nickel. Of course, around the holidays, I looked forward
to a quarter, and just once I got a whole dollar.
Those were the days when a carton of cigarettes was $2 and a gallon of milk or a loaf of good bread was a quarter. Nine college
years and four years of duty in the Air Force later, I joined a practice with a $5 examination fee (standard at the time),
which, by the way, included a fecal.
Hundred dollar bills only started to show up in the 1980s on the heels of our last recession. Before then, only museums and
banks had seen them. Fifties are now poised to replace the twenty as twenties have replaced tens in today's circulation.
Today, medical examinations are $50, ten times the standard of my first days, just as the tip I gave was 100 times what I
received for the same service in the 1950s.
The immediate result, and the motivation for this month's column, is guilt. What practitioner who started with a $10, $20
or $30 examination fee doesn't feel a little queasy charging $50? The disease caused by the higher fee produces, for too many,
a subconscious reduction in other fees and a drop in the average transaction fee.
What's the problem? Well, if you put an $80,000 associate and a $14/hour technician in your exam room with a client for 15
minutes and fail to produce an average invoice of $105.30, you're well on your way to bankruptcy. In practice after practice,
where multiple owners and associates see clients, there soon appears one associate or owner most requested by pet owners.
I would love the reason to be because of his or her diagnostic or communication skills, but that's seldom the case. Nine times
out of 10, the doctor might say, "I need to give two injections, but I'm only going to charge you for one," or "I should look
at this again in a week, but why don't you just call me in a week so we can save you a trip!"
I can relate. In my ancient days of $5 exam fees, I distinctly remember the first time I had to ask a client for $35 for services
rendered. That was a fortune to me, but that's what that practice's fee schedule called for in those days. I trembled and
started breathing again only when the client whipped out his checkbook.