MEDICAL AUCTIONS: Surgeons Bid for Cases Online

      Elective surgery has taken a leap into cyberspace, the Baltimore Sun reports. A "handful" of Web sites now provide patients with a forum to advertise a desired service through a " reverse auction" in which they can select the physician who posts the ideal combination of cost and credentials. One such example is the California-based Medicine Online, which launched its online medical auctions in March. Within three months, the Web site had matched more than 1,000 patients with physicians through the bidding process, and more than 350 physicians nationwide have registered with the site. Prospective patients using the Web site "fill out an online questionnaire describing their desired surgery, and doctors respond by posting their fees." Patients then peruse the offers, and "can decide whether to click on links to read more about the doctors offering the surgery." Patients can review criteria such as how many procedures doctors have performed in the past, where they earned their medical degree and whether they have faced litigation. Patients don't always select the doctor that posts the lowest fee for a procedure, Medicine Online Vice President David Puffer explains, because if a doctor is "the lowest, the patient is asking what is wrong" and if the doctor is the highest he or she must "be pretty darn good." Puffer advised patients to double-check doctors' credentials, even though Medicine Online ensures that participating doctors are certified and have hospital privileges. Although Medicine Online currently provides auction services free of charge, the company plans to eventually charge patients a 2% fee on each surgery commissioned through the auction service. Medicine Online may soon face competition from a Wisconsin company called PatientWise, which plans to offer a similar service for "more extensive procedures" such as cancer, brain surgery, open-heart surgery and orthopedic operations, according to PatientWise Chair Brad Engel.

Risky Business
      Reflecting on this online trend, Arthur Caplan, head of the Center for Bioethics at the University of Pennsylvania, said, "I wish I could say I was surprised. We've decided that medicine is a marketplace." Other medical ethicists and physicians also are "wary of the online world intruding on medicine." Janie Cordray, a researcher with the California Board of Medicine, said, "Using the Internet is a really stupid way for someone to choose a surgeon. There are a lot of deaths and unhappy patients from even the most qualified surgeons. ... Qualified surgeons do not have to advertise in this aggressive way." Dr. Roger Greenberg, former president of the California Society of Plastic Surgeons, said, "You can't price your bodies like a commodity. Who is likely to quote the lowest bid, the busy surgeon or the not-so-busy surgeon? Buyer beware." However, the California Board of Medicine and Medicine Online have not yet received any complaints from patients obtaining medical services through online auctions. The AMA has not taken an official stance on medical auctions, but board member Dr. Donald Palmisano said, "The AMA doesn't believe that patients should select physicians based on price alone. Going online, getting the lowest bid and then going to that individual, we don't think that is good medicine" (Wilber, Baltimore Sun, 9/25).