Bartering With Patients

August 5, 2011

Bartering is a concept that is generally not practiced in today's times. In years past when patients had no money to pay their physician, it was common for them to bring an object other than money for payment: a chicken, a barrel of vegetables, etc.

As I reflect on the happenings of this week and the economic dismay that we find our nation in presently, I was reminded of the value that our patients place in the services we provide. I will describe two very memorable experiences in my practice over the years that involve a lost concept of trade between two persons - bartering.

Bartering is a concept that is generally not practiced in today's times. In years past when patients had no money to pay their physician, it was common for them to bring an object other than money for payment: a chicken, a barrel of vegetables, etc. Anything that would be valued by both the physician and the patient was a candidate for exchange.

A couple of years ago, my Blackberry alerted me to an incoming email. Of course I am the typical physician nerd and I wear my cell phone while mowing the yard. It was a patient of mine who happened to be a co-worker of my mother. My patient explained that her football coach husband, also a patient of mine, cut his hand in football practice a few days prior. He had been cleaning the wound daily and applying over the counter Neosporin, but the cut was now infected and she was worried. I called my patient and told her that my office was closed, however if her husband wanted to come over and let me see his finger I would be happy to provide my advice. A few short minutes later the coach showed up. I looked at his finger and clearly it was infected. I told the coach that he needed an oral antibiotic and I would call the medication to his pharmacy. He thanked me and asked me what he owed me for the service. A little shocked, I replied that no payment was necessary. He smiled and said, "... well Doc, I am going to help you mow." Did I mention that the coach also had a lawn mowing service? To this day, both of us still reminisce about that trade and both of us feel that we got the better deal.

A few weeks ago one of my patients told me that she was going to go see the dermatologist to have a mole removed and wanted me to look at it before she went for her appointment. She was concerned about the cost of such a procedure and wanted my opinion first. A quick inspection revealed an irritated seborrheic keratosis present on her shoulder. I told her that if she wanted to cancel her appointment I would be happy to do the procedure for her. She obliged and it was easily removed with no complications later that week. As she left, I instructed my staff to inform her that today's procedure had no charge. The reason? A few weeks earlier her husband, the contractor that built my house, came over to replace some damaged roofing shingles after a storm blew them off. After the repairs were completed and I asked for a bill, he smiled and said have a nice day.

Unfortunately, there is a little catch to bartering. The IRS expects you to adequately report such values of bartered services or goods. Now that you know that rules, the rest is up to you for reporting. Our present economic times are concerning for physicians and especially those of us in private practice that have overhead and staff to pay. We must also remember that our patients we care for are having hard times as well. Although we cannot pay our bills and pay our staff by bartering, the occasional trade will show your patients that value and appreciate them just as much as they value and appreciate you.

For more from J. Scott Litton and our other Practice Notes bloggers, click here.