"Should Doctors Fire Their Anti-Vaccine Patients?"

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Specializes in Anesthesia.

"Perhaps in frustration, doctors have started to "fire" their patients if they refuse to vaccinate. As reported by Shirley Wang in The Wall St. Journal last week, 20-30% of doctors in two different surveys, in Connecticut and the Midwest, reported having to kick patients out of their practices because of vaccine refusal. These numbers have roughly doubled over the past ten years, according to the American Academy of Pediatrics."

http://www.forbes.com/sites/stevensalzberg/2012/02/25/should-doctors-fire-anti-vaccine/

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I guess the more pt are vaccinated the higher reimbursement from insurance companies they get. So it is more profitable for them to fire unvaccinated patients in order to have a higher percentage of vaccinated ones and enjoy more reimbursements.

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Specializes in Anesthesia.
I guess the more pt are vaccinated the higher reimbursement from insurance companies they get. So it is more profitable for them to fire unvaccinated patients in order to have a higher percentage of vaccinated ones and enjoy more reimbursements.

The reason that these patients are being fired is because of the danger to themselves and to other patients. Why would any physician/APN/or PA want to take the responsibility for patients that do not follow the recommendation of their medical provider.

Medical providers get very little money from vaccinations. Vaccinations are often a losing venture for the medical providers. Normal childhood vaccines being this great money maker is just another myth in the anti-vaccine movement.

"Providers can incur huge debt to vaccine manufacturers for months at a time while awaiting reimbursement from insurance companies for the cost of vaccines. When finally repaid, the return often does not meet the cost. In fact, under some reimbursement systems, vaccine administration can be a cost rather than a revenue source. Due to these high prices and long compensation periods, some pediatric and family medicine practices are now foregoing vaccine disbursement altogether."

http://www.medscape.com/viewarticle/753140

Vaccine Reimbursement | athenahealth

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Specializes in Geriatrics, Home Health.

MDs "firing" patients who refuse to follow a treatment plan is nothing new.

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I guess the more pt are vaccinated the higher reimbursement from insurance companies they get. So it is more profitable for them to fire unvaccinated patients in order to have a higher percentage of vaccinated ones and enjoy more reimbursements.

Individuals are free to choose to not follow their healthcare providers recommendations; and the reverse is also true, healthcare providers are free to end their relationships with individuals who choose to not follow their recommendations. I agree with the others that I think this is more about sincere frustration than financial issues. Nobody is making money off basic vaccines.

I remember a huge public flap quite a few years ago, in the medium-sized Southern city in which I was living at the time (in the heart of the Tobacco Belt), when the best-known and -respected cardiac surgeon in the city announced publicly that he was no longer going to operate on smokers, because, in his experience over time, it was a waste of his time and effort. It wasn't about money; he was just fed up.

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I guess the more pt are vaccinated the higher reimbursement from insurance companies they get. So it is more profitable for them to fire unvaccinated patients in order to have a higher percentage of vaccinated ones and enjoy more reimbursements.
From a behavioral economic perspective, the logic expressed here does not hold.

Both the cost and reimbursement rates for most vaccines are relatively low, so there is little financial incentive for doctors to immunize patients. In addition, many patients are not immunized at the doctors office, further decreasing the incentive for doctors to encourage immunization. Finally, patients who are immunized do not usually wind up in the doctor's office to be treated for the diseases that they are immunized against, which even further depresses the financial incentive for the doctor to encourage immunization. So from a purely financial perspective, the logical conclusion is that doctors should discourage immunization in order to maximize revenues. Yet in practice, the reverse seems to be happening, with a substantial percentage of doctors both encouraging vaccination and indicating a clear preference for the lower-revenue, vaccinated patients.

While it's unclear what the motivation is, the only logical conclusion would seem to be that the non-financial considerations considerably outweigh the financial, not the reverse.

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We live in a country with a lot of "freedoms." If a doctor wants to "fire" the patient, it's his/her right. But I am just wondering...if your obese patient doesn't lose weight, are you going to fire him? If your patient who smokes continues to smoke, is he gone too? There is no evidence whatsoever that not taking a flu vaccination hurts that person or anyone else. And if all of his other patients are vaccinated and taking his advice, good for them! They purportedly won't get the 'flu from the non-vaccinated one.

I don't believe this has anything to do with finances. But it may have something to do with the physician attempting to force his opinion on others. So, good riddance. I hope my doctor is a little more open-minded and compassionate than that.

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Specializes in Anesthesia.
From a behavioral economic perspective, the logic expressed here does not hold.

Both the cost and reimbursement rates for most vaccines are relatively low, so there is little financial incentive for doctors to immunize patients. In addition, many patients are not immunized at the doctors office, further decreasing the incentive for doctors to encourage immunization. Finally, patients who are immunized do not usually wind up in the doctor's office to be treated for the diseases that they are immunized against, which even further depresses the financial incentive for the doctor to encourage immunization. So from a purely financial perspective, the logical conclusion is that doctors should discourage immunization in order to maximize revenues. Yet in practice, the reverse seems to be happening, with a substantial percentage of doctors both encouraging vaccination and indicating a clear preference for the lower-revenue, vaccinated patients.

While it's unclear what the motivation is, the only logical conclusion would seem to be that the non-financial considerations considerably outweigh the financial, not the reverse.

I think we would be happy to see any articles to support your theories on here.

Depending on the area of the country patients are living in going to their peditrician or PCM for the immunizations is the norm, and for the many vaccine preventable diseases the PCM is going to be the first to see these patients. Most of these vaccine preventable diseases are going to show up with URI symptoms and/or rash. Most parents aren't going to rush their children or selves off to the ER unless the symptoms are severe, especially if they already have an established relationship with their PCM. PCMs make their money off bulkT they are not going to make a lot more money seeing a healthy child/adult with an acute vaccine preventable disease.

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Specializes in Anesthesia.
We live in a country with a lot of "freedoms." If a doctor wants to "fire" the patient, it's his/her right. But I am just wondering...if your obese patient doesn't lose weight, are you going to fire him? If your patient who smokes continues to smoke, is he gone too? There is no evidence whatsoever that not taking a flu vaccination hurts that person or anyone else. And if all of his other patients are vaccinated and taking his advice, good for them! They purportedly won't get the 'flu from the non-vaccinated one.

I don't believe this has anything to do with finances. But it may have something to do with the physician attempting to force his opinion on others. So, good riddance. I hope my doctor is a little more open-minded and compassionate than that.

That is incorrect! Their is a multitude of peer-reviewed scientific evidence that shows that not getting influenza shot is danger to your own health and others.

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Specializes in Complex pedi to LTC/SA & now a manager.

I know several cardiologists & pulmonologist's that have fired patients who, despite multiple interventions & extensive patient education , refuse to stop smoking.

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We live in a country with a lot of "freedoms." If a doctor wants to "fire" the patient, it's his/her right. But I am just wondering...if your obese patient doesn't lose weight, are you going to fire him?

If it were me, I wouldn't "fire" someone for not losing weight, but I would seriously consider "firing" someone who isn't making a serious effort to lose weight ... Ditto for smokers.

How "open-minded and compassionate" do you expect PCPs to be, and for how long, when people come to them, c/o or exhibit serious health problems, and repeatedly choose to not follow recommendations on improving their health? If they don't want to make changes, fine; again, that's their choice.

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Specializes in OR, Nursing Professional Development.
I know several cardiologists & pulmonologist's that have fired patients who, despite multiple interventions & extensive patient education , refuse to stop smoking.

Not to mention surgeons who refuse to do CABGs or valves until patients stop smoking.

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