Americans facing surgery can get a second surgeon's opinion anywhere, but only here can they get one free.
As cries of dismay over rising medical costs multiply even faster than the costs themselves, and many medical associations have opposed second opinions Portland's surgeons are testing a unique program.
Joseph Califano, secretary of health, education and welfare, has praised their effort as being "in the highest sense of responsibility of the medical profession.' Free second opinions, Califano said, would eliminate much unnecessary surgery and "be a significant measure toward lowering health costs in this country."
Whenever any of Cumberland County's 83 surgeons recommends an operation, he also urges the patient to get a second opinion, and provides the patient with names of other specialists. The cost of the second opinion is borne by Portland's doctors themselves; no money changes hands.
"That's kind of Shangri-la," a New York Blue Cross-Blue Shield official said of the Portland plan.
Less than 2 percnet of Portland's surgical patients, however, are availing themselves of the pioneering program, and those second opinions that have been sought have not raised serious disagreements among surgeons, according to Portland doctors.
Portland's Dr. Robert McAfee said the second of these findings did not surprise him because the city's surgeons had already been reviewing each other's work and were confidnet that not much unnecessary surgery was being performed here.
The doctors organized their plan last August not only because they believe in second opinions, but also to preempt what they considered less good second-opinion plans that seemed likely to be imposed on them by Blue Cross-Blue Shield and HEW.
"The thing that got our hackles up was the guidelines the Blues were setting," McAfee said in an interview. "They would have effectively destroyed the consultative process" among doctors.
Unlike Blue Shield, Portland's surgeons wanted the second opinion to be shared with the first surgeon. McAfee and his colleagues think that one important advantage of a second-opinion program is telling doctors what their colleagues think.
They also wanted to run their own program in order to save the health care system what they considered an unnecessary cost of a new bureaucracy to administer second opinions.
Blue Cross-Blue Shield of Maine, for example, has budgeted $160,000 to administer the first year of its program. It has issued a brochure describing the program as free to patients, but all the plan's members would share the cost of administration and of fees up to $40, which Blue Shield would pay for second opinions.
McAfee is dismayed by the $40 fee. He said his four-surgeon office charges a top of $25 for an opinion on surgery. He expects that now there may be a lot of $40 opinions around Marine.
Insurance plans used to pay $10 for draining a small abscess and $15 for a large one, McAfee recalls: "For 35 years there never was a small abscess in the state of Maine."
A third reason that Portland surgeons wanted their own program was to insure that the two opinions would be rendered by similarly trained doctors. The proposed Blue Shield plan would have permitted doctors of many kinds, including family osteopaths, to render second opinions. "We couldn't live with that," McAfee said.
Surgeons here have found that, despite their urgings, very few of the roughly 75 people who have nonemergency surgery daily in Portland have taken advantage of the second-opinion program.
That, McAfee said, undoubtedly reflects patients' desires to trust their surgeons and in a relatively small city like Portland, probably also results from having known something about a surgeon before they consult him.
However, in Hartford, Conn. a city about eight times as large as Portland, medical association executive director Joseph Gordon said a similarly tiny number of patients are asking for second opinions, which in Hartford are paid for by insurance plans.
In New York City, where the huge population makes it even less likely that a patient knows much about his surgeon, requests for second opinions under Blue Shield-Blue Cross have more than doubled in that program's second year, "We attribute this to advertising," a spokesman said. But participation is still relatively low.
McAfee, who is chairman of the New England delegation to the American Medical Association, said the small number of patients availing themselves of the second opinion should remove the concern of surgeons elsewhere that their offices would be overwhelmed if they emulated Portland.
Asked what other reasons there have been for local medical associations' opposition to second opinion programs, McAfee said: "We're all a little paranoid to begin with. Some are more paranoid than others."