My practice in the bronx was keeping me very busy and I was learning lots of things they had never taught in medical school. The first unpleasant experience was to find that virtually all of the doctors I encountered were splitting fees and accepting kickbacks. A specialist would charge the patient a fee and then split it with the referring doctor. A surgeon would operate and split the fee with the family doctor. If you called a private ambulance for a patient, the ambulance company would kickback a portion of their fee. If you ordered a back brace or a truss for a patient, the surgical supply firm would kickback part of the fee. I knew this was wrong and I didn't have to take a course in medical ethics to be certain this was unacceptable. I remember how embarrassed I was when I accompanied one of my early patients for an ENT consultation on the Grand Concourse. The specialist tried to slip a few dollars in cash into my pocket as I left his office. I returned these on the spot like a hot potato and told the doctor that I did not split fees. I never sent him another patient. On another occasion, a check for ten dollars arrived in the mail from an ambulance company. It was promptly sent back. A similar check from a surgical supply house for a back brace was returned by the next mail. Both checks were accompanied by a short letter saying that I did not accept these “referral” fees and suggested that they charge my patient less.

To my chagrin, I soon found out these practices were rampant in the Bronx and presumably elsewhere. When I discussed this with some of my colleagues, various explanations were offered. Times were tough and they needed every dollar they could get to meet their expenses. They said everybody was doing it. Some would later, when they were financially better off, deny that they had ever split fees. Others would claim it was merely another legitimate business expense that served to steer patients to them.