"Are you tired of paying for your doctor's Cadillac and country club?"
So reads the most provocative line in a two-color brochure that has been mailed to thousands of prospective patients in the District and Northern Virginia by Dr. H. Barry Jacobs.
A flamboyant surgeon convicted last May of overcharging the Medicare and Medicaid programs (a verdict he says will be overturned), he now offers those who "want good medical care by doctors . . . more concerned about you (than) your wallet" a wide range of cut-rate services.
That include a "complete physical examination plus 25 blood tests for $55" - less than half the going fee in the area - as well as a $1 allergy shot, a $15 electorcardiogram, a $120 abortion and a free blood-pressure test at "any time" at Washington Falls Church and Manassas offices.
Jacobs' brochures are the first such advertising by a Washington-area physician since the Supreme Court overturned bar association regulations prohibiting lawyers from advertising. Professionals other than lawyers are now turning to advertising.
No other physician here has followed Jacobs' lead. But all over the nation, medical advertising of various kinds is becoming more common.
A Silver Spring dentist has been running ads in The Washington Post and Washington Star offering full or partial dentures for $129 to $139, less than half and often a third of usual charges.
Washington Hospital Center, one of the area's largest hospitals, has prepared on eye-catching display ad for the Metropolitan Washington Board of Trade's annual directory. It states no prices, but displays a hovering helicopter - the hospital has a helipad to receive patients - and lists "24-hour emergency service" and industrial accident care, among other features hospital officials frankly hope will interest employers of workers prone to injury.
Sinai Hospital in Baltimore has used newspaper ads to tell the public, "Get to know us before you need us." Capitol Hill Hospital here has advertised in another Board of Trade publication.
Six area abortion services, some nonprofit, some not, detail their services - not only for abortion, but also for birth control, pregnancy testing, gynecology and menopause care, sterilization and related services - in phone book yellow pages.
Prince George's County doctors, responding to movement toward consumer groups' doctor directories, are about to publish their own directory, though minus the members' fees.
Elsewhere, some California plastic surgeons are blatantly advertising instant beauty with "before" and "after" photos.A grandmotherly Dallas obstetrician, Dr. Imogene Mayfield, has advertised that she will deliver babies at her own clinic (and give nine months' care, including all lab fees) for $675, because, she says, "People ought to know how much things cost - no reason why a woman should have to pay $2,000 (for hospital and medical care) to have a baby."
A Las Vegas hospital advertised a 5 1/4 per cent rebate on bills of patients admitted on Fridays and Saturdays, when occupancy is low. The American Hospital Association, though it frowns on price-cutting ads, says 10 per cent of the nation's hospital have taken out ads "to let the community know what hospitals are about."
On the other side, the nation's Blue Cross-Blue Shield plans have been taking out large ads in newspapers and magazines to decry rising hospital costs. And they ask community support to reorganize hospital services and eliminate beds to save money.
Even among doctors, says Dr. William Robertson, immediate past president of the Washington state medical society, it is clear advertising is "right beneath the surface and ready to happen."
Since the 1975 Supreme Court decision, say Dr. Ronald Stiff of the University of Baltimore Business School and Dr. Paul Bloom of the University of Maryland College of Business and Management, "it seems resonably clear" that price advertising "by doctors and other health care professionals cannot be legally restricted."
So far, no one has tried to restrict Dr. Jacobs' District activities, which began last June at 36 N St. SE. That situation could change if an appeals court upholds his May 5 mail fraud conviction on charges of helping bill Medicare and Medicaid for blood tests that were not done and overcharging for others.
If his fraud conviction is upheld, "I would think the District Commission on Licensure would have grounds to revoke his license or at least take some disciplinary procedure," says Dr. Raymond Scalettar, president of the D.C. Medical Society.
Though Jacobs advertises "$90 surgery," any surgery he or his associate, Dr. Fawaz Zaim does would have to be in the clinic, not a hospital. Jocobs has no hospital privileges since Commonwealth Doctors Hospital in Fairfax expelled him.
The same hospital recently refused to give Zaim privileges, though he was employed in its emergency room for four months and left, he says, with a letter of recommendation from the administrator. He has appealed the decision. Hospital officers would discuss neither case.
Jacobs argues that "I think people are entitled to be aware of fees." He calls fees a subject most doctors "cover up, just as they cover up when they or a hospital violate good standards of care." He says his clinics are "reasonably" busy, seeing 175 to 200 patients a week, "enough so we'll shortly be adding another doctor."
Dr. Daniel Lee Maloof, Silver Spring's advertising dentist, says, "I'm working my tail off, but I'm not going to raise my prices. I'm doing about 50 dentures a week, about all I can handle."
He started advertising only this fall. He had only one admonishing phone call, he reports, from the Maryland Board of Dental Examiners to say "I could get in a lot of trouble." He says he has heard nothing since, except from "all the patients" and "at least eight or 10 other dentists around the Beltway, who say they'd all like to advertise. And I think they will be soon."
If they are, it will be with the blessing of the Federal Trade Commission, which last September launched a major case charging the American Medical Association and its affiliates with illegally restraining competition by restricting advertising.
AMA counsel Newton Minow told the FTC, "We don't think the principles of the marketplace" are healthy for the medical consumer "because there's always someone who will do it cheaper and do it worse."
D.C. Medical Society president Scalettar echoes Minow's words, and adds, "I think the public has to be protected against come-ons that lure patients into the office of persons who may be unscrupulous. Reputable, competent physicians who are referred patients by their own patients and other physicians have no desire to advertise."
Many doctors agree, saying ads could return medicine to an era of snake-oil selling and hucksterism.
But medical and dental society officials and state examining officials all say they are reluctant to do anything against advertisers today because of the Supreme Court and FTC actions.
One medical society stalwart, Dr. Robertson in Washington state, is less rigid. He recently told Medical Tribune, a doctors' newspaper: "Patients and institutions in this day of increasing technology and tremendous diversity of specialities are sometimes at a loss in making a choice of doctor. Any way a patient or institutions can be better informed, we should try to encourage."
Neither the Supreme Court nor the FTC has ruled out regulations to keep advertising informative while still trying to protect the gullible. In several states, courts and bar associations are working on such rules for lawyers.
In Dallas, Dr. Mayfield, the grandmotherly advertising obstetrician, told Ob-Gyn. News, another medical newspaper: "I wasn't trying to defy anybody." She just went to a hospital as a patient, was startled at her long and considerable bill and decided her patients shouldn't be startled.