This is a topic I wrote about several years ago on Mothers in Medicine, but I've decided to revisit it here. (Because it's my blog and I'll do what I want to!)
When my older daughter was two, she woke up one Sunday morning and one of her eyes was really swollen. This had never happened to her before and I was concerned, so I called our pediatrician's office (it was a large, university-affiliated practice). I was met with the following message:
Due to the high cost of after hours phone calls, all calls to the advice nurse after regular business hours will be charged a $20 fee.
At the time, I was a resident and my husband was a student. I thought about the $20 and decided her eye didn't look that bad and decided not to pay the $20.
In retrospect, I'm still pissed off. I think this is a terrible practice. I can understand charging parents who call excessively a copay, but I don't feel like it's fair to put a parent in the position of deciding if their kid's swollen eye is worth the $20. And what if my kid had a health problem that required more monitoring? Would I just be screwed and have to keep paying $20 every time my kid got sick and I wasn't sure whether to go to the ER? What if it's the middle of the night and I need to give my kid some Tylenol??
I've used two different pediatrics practices since then and neither charged a fee for after-hours advice. (My current practice actually has an amazing email line that I use frequently for rashes and appointment scheduling.)
When I initially posted this, several people vehemently disagreed with me and said I was wrong. And this bothered me because I'm never wrong. (Just kidding! (Or am I? (Yes, I am.)))
The biggest argument against me was that other people aren't expected to give advice for free, so why should doctors? Also, that if there's no $20 charge for calls, that cost will be otherwise worked into your bill anyway. Also, I was told I just "didn't get it" because I never ran a private practice.
I'd say that, yes, I'd rather the charge for all services go up than have to make a decision about whether my child's health problem is bad enough to call the pediatrician. And I say this as a doctor, who is probably better at making these decisions than the average person. If I were a pediatrician, I'd be a little frightened about discouraging parents from calling when there might be something serious going on. On my Tylenol post, a resident commented she didn't even trust parents to correctly give their kids Tylenol!
And there are tons of professionals who will talk to you on the phone or on off-hours for free. If I have a problem with my cable and call the company at 9PM, they don't tell me that I'm going to have to pay $20 to talk to someone about it. When I have an after-hours plumbing emergency, I don't have to pay $20 to talk to the super. Part of what is generally expected is for people to be able to call their medical practice if they need advice.
Do people abuse it? Yes, of course. But I'd say to deal with the abusers individually rather than punish everyone.