People quick to phone their family doctor for medical advice, a prescription renewal or information for a health-history form may soon find themselves paying for the convenience.
Doctors across the country have begun charging patients for services that have traditionally been free, according to the American College of Physicians.
The fees range from per-page charges for copies of medical records to $10 or $20 for filling out the forms people need to apply for medical-leave benefits. A few doctors have begun charging patients up to $20 to respond to e-mail questions about their health.
Dr. John Saranko, president of the Florida chapter of the Academy of Family Physicians and part of a five-doctor practice in Plant City, said his office started charging a fee for personalized letters a couple of years ago.
"When the patient needs something typed out _ a letter telling the boss you're sick or the airline you need your money back _ we charge," said Saranko, who said the fee averages $5. "We don't charge for phone consultations and I don't know anybody personally who does, but we could. If I call my accountant or attorney, they certainly charge."
Saranko said the fees, which don't apply to form letters, reflect the growing administrative burden in physicians' offices.
"These things take administrative time, and time costs money," he said. "Everybody wants to lump everything we do under medical care, but when we explain it to patients, generally they accept it fairly well."
Dr. Allen M. Dennison of Barrington, R.I., said he charges patients $2 a minute to diagnose minor ailments over the telephone, and about $15 to fill out the health history forms parents need to send their children to camp.
"We are really on the ropes financially," he said. "I think the patients know that if they are going to take a doctor's time, they are going to have to pay for it."
Dr. Joel S. Levine, dean of clinical affairs at University of Colorado School of Medicine, said doctors' administrative responsibilities have grown tremendously over the past two decades.
Most primary-care doctors now spend an average of two to three hours a day on tasks for which they are not compensated, such as returning phone calls and filling out insurance forms, he said.
That means less time to see patients, and the fewer patients doctors see in person, the less they get paid, he said.
Dr. Paul Williams, president of the Pennsylvania chapter of the American Academy of Family Practitioners, said he has considered imposing fees for after-hours phone calls, which he now routinely handles at no charge, but worries patients will react badly.
"If you call your attorney at 4 o'clock in the afternoon on a Friday, they are going to send you a bill. I don't understand why I shouldn't send a bill if someone wakes me out of a dead sleep at 4 a.m.," he said. "The problem is, we get this reaction: "You are part of a learned profession, and how dare you nickel-and-dime patients.' "
Margie Kahn of Oakland, Calif., said she switched doctors after she called for guidance on an illness and was rebuffed.
"She basically interrupted me in mid-sentence and said, "Are you looking for free medical advice? If I can't bill for my time, I can't survive,' " Kahn said. "Doctors do spend a lot of time on the phone, but to me, that is part of their job description. The time that they spend reviewing charts or returning phone calls, that should all be built into their charges."
Still, many practices feel that with operating costs on the rise and reimbursements from insurance companies and government health programs stagnating, they have no choice but to charge patients for more things.
Queen City Physicians, a doctors group in Cincinnati, is thinking of charging $12 to $15 for the calls that anxious parents make to the office's late-night pediatric triage service. The phones are staffed by nurses who take questions about colicky babies and feverish toddlers and decide whether the child needs to see a doctor right away.
"Our patients absolutely love it," said Pamela Coyle-Toerner, Queen City's president, "but it is a very expensive service to offer for free."
_ Times staff writer Kris Hundley contributed to this report.