The Doctor Is In

a physician looks at medicine, religion, politics, pets, & passion in life
 

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What is called matriarchy is simply moral anarchy, in which the mother alone remains fixed because all the fathers are fugitive and irresponsible.
--G.K. Chesterton--

Price, Value & Grace

March 3rd, 2007 · 23 Comments

One of my areas of professional expertise is infertility surgery, specifically reversal of vasectomy. Vasectomy is a very common form of permanent birth control, with an estimated 500,000 to 700,00 procedures performed a year in the U.S. It is a procedure which is devilishly simple to perform, while maddeningly difficult to repair. The vas deferens is a small, thick-walled muscular tube (2.5 mm = 1/10 of an inch in diameter) which transports sperm from the testes to the prostate and seminal vesicals. Its division to achieve sterility is a simple office procedure — but the extremely small diameter of its central channel (0.2 mm), and the tendency to form secondary obstructions after vasectomy in an extremely delicate structure called the epididymis, make successful restoration a daunting challenge, requiring that the repair of the duct system reliably be performed under high magnification, using a technique called microsurgery.

While increasing number of urologists are trained to do this specialized surgery, consistently successful outcomes require many hundreds of cases and many years of experience, a factor which few recently-trained urologists bring to the table. I have had the good fortune to have this kind of experience, going back nearly 30 years, and as a result have one of the largest experiences in this procedure in the country, and have performed reversal surgery on patients from all over the U.S. and a number of foreign countries.

Reversal of vasectomy is rarely covered by health insurance, and the procedure is expensive: costing $15-20,000 and up in some large referral centers. I have over the years, built and sustained a large surgical experience by pricing my services well below much of the competition, creating a win-win situation: higher volume (and therefore greater experience and surgical expertise) while providing a substantial cost benefit to my patients.

But the procedure is still very expensive. Too expensive for many.

I receive quite a few e-mails from my web site, most requesting additional information or expressing an interest in scheduling surgery.

So yesterday’s e-mail came as a bit of a jolt:

I am highly disappointed with the fact that your coding on the web implies that your procedure is affordable, do you honestly believe that your fees for this procedure are affordable to anyone desperately wishing to have a child. I am not sure which world you live in — it is not mine.

How much more pain must men suffer for making a mistake; how much more must a man suffer to regain the blessing of GOD to have a child.

My mouse hovered over the Delete button momentarily, atypically restrained. After all, complaining about rich, greedy doctors exploiting the poor is something of a hot-button issue for me, and I waste little time arguing with those so convicted, preferring to leave them to their personal anti-physician jihad.

But this one seemed different. After a few moments, I managed to swallow my annoyance (with a chaser of pride), and at least leave the e-mail untouched. Soon, I realized it was important to reply.

Here’s what I wrote in return:

Dear Bill [not his real name],

I greatly appreciate your note, and understand well your frustration at the high cost of reversal surgery. To you these fees seem unreasonably high, an insurmountable barrier to the deepest need and desire of your heart.

By any objective standard, my fees for this procedure are reasonable. My current expertise in this area has been acquired through a long and arduous education and training experience, augmented by nearly 30 years of experience in performing this microsurgical procedure, which is extremely demanding — perhaps one of the most difficult procedures in all of surgery, regardless of specialty. There are perhaps no more than a few dozen surgeons in the world who bring this kind of experience to the restoration of fertility after vasectomy — yet many surgeons with far less experience, using cruder and often unsuccessful surgical techniques, are charging as much or more than this for the procedure. Top specialists in this field — which you know if you have researched these costs — not uncommonly charge two, three, sometimes four or more times as much as the fees I have quoted. Do I believe that many of these charge far too much? Most definitely — but most have earned that right through rigorous training, long hours, and hard work. They most certainly have the right to charge what they will — as you have the right to have this procedure, or not.

So I make no apologies for my fees. You say I do not live in your world, which is most certainly true; you also do not live in mine. Could you sustain the $40,000 a month which it costs to keep the doors of my small, efficient, one-doctor practice open? Do you believe these fees go merely to line my pockets, to keep me in Porsches and luxury yachts? Believe what you will, of course — but as the apostle Paul says in 1st Timothy (5:18), “The laborer deserves his wages.” The God who judges you also judges me — and before Him I am confident that these fees are just and not extortionary.

But they are, clearly, far more than you can afford — and thus serve to condemn you to a mistake you are convinced you have made. I, too, have made costly mistakes in life — mistakes which not only cost large sums of money, but squandered the far greater treasure of the trust and respect of those I love, and undermined and nearly destroyed a faith in God many years in the building. That same God reached out in immeasurable grace to me, condemned as I was, and restored me in ways unimaginable to me, then and now.

So here is my offer to you: I will perform your reversal surgery at no cost to you. There will be, of course, fees for the hospital and anesthesia which I cannot reduce, as they are not under my control. Their fees as they stand have very little profit margin, and cover little more than their expenses; I have worked with them for many years to keep these costs as low as feasible.

Let me know what you think.

And above all, begin to know something of a God who values grace and mercy more than sacrifice.

Oscar Wilde once described a cynic as a man who knew the price of everything and the value of nothing. Wilde, himself a witty but cynical agnostic, nevertheless had some glimpse of true wisdom here. Sometimes the greatest value comes from that which costs nothing, yet which no amount of money can buy.

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23 comments so far ↓

 

  • Hootsbuddy // Mar 3, 2007 at 4:04 AM

    That is what I call magnanimous. I would not call getting a vasectomy a “mistake.” Your offer is way generous. Please let us know if and how he responds.

  • Rundy // Mar 3, 2007 at 5:18 AM

    Wow . . . I looked at your prices and they are cheap (comparitively)!

    It would be nice if more doctors could be/would be more straightforward about service pricing. Of course in part this goes back to the whole medical billing mess . . .

  • Grumpy Old Man // Mar 3, 2007 at 6:52 AM

    Good of you to make the offer.

    Wise to make it in cyberspace?

  • Dr Bob // Mar 3, 2007 at 10:54 AM

    Grumps,

    Good question — I did have a moment’s hesitation about putting out on the blog. I felt the principle trumped the risk. Nothing like offering free services to boost volume … but a bad business model, generally. My accountant would not approve.

    This sort of offer is rather extraordinary (I’ve done it a few times before, under different circumstances). But in every case it was something I initiated, rather than something the patient asked for.

    So if you’re out there thinking, “Wow! Free reversal surgery!” — think, David Spade: “No!”

  • Dr Bob // Mar 3, 2007 at 10:59 AM

    Hoots,

    I have a fair amount of ambivalence about vasectomy, actually — I do not entirely agree with the Catholic (and some fundamentalist Protestant) position that BC/sterilization is inherently wrong. But I do think it is done far too lightly, and is, at least at times, a manifestation of our self-centered lifestyle (“No more kids, because we need more money for a grander house and a new boat.”)

    Nevertheless, my e-mailer felt for him it was a moral error which felt a strong need to correct, and I respect that position.

  • VanderLeun // Mar 4, 2007 at 8:17 AM

    Ah, yes, the vasectomy as an emblem of the self-centered lifestyle. It is, many times, an all too correct assessment of the procedure. I’ve seen it and written about it and the attempt, decades ago, to reverse it.

    This great essay makes me think it is time to bring it back.

  • Complain about the cost of vasectomy reversal and get it done for free | My Vasectomy Reversal // Mar 4, 2007 at 9:19 AM

    [...] Bob, a Seattle area vasectomy reversal specialist, has offered a free vasectomy reversal surgery to someone who emailed him, complaining about the cost of the procedure. Here’s a snippet of [...]

  • Vicki Small // Mar 4, 2007 at 11:41 AM

    I would have loved to see the person’s face when he read your reply. I’m sure he wasn’t expecting that!

  • Beverly // Mar 5, 2007 at 1:24 PM

    Your blogs never cease to speak to me of God’s grace and how it changes lives. I hope that the man who wrote to you read very carefully your response and, in particular, your last statement to him.

  • Moof // Mar 6, 2007 at 3:03 PM

    Dr. Bob, your reply to the fellow does not surprise me – at all. What I’ve come to know of you makes me realize that I would have been more surprised had you handled it differently.

    Thank you for sharing yourself with us. You’re truly a “physician” in more than one sense of the word.

  • kenju // Mar 9, 2007 at 8:19 AM

    I suspect that man is so surprised by your reply that he cannot close his mouth. You are storing up treasures in Heaven, Dr. Bob.

  • Dr Bob // Mar 9, 2007 at 7:00 PM

    The fellow sent back a nice — if somewhat chastened — e-mail, saying he and his fiance would be praying about it. [Smart move -- Life rule #327: Never piss off the guy who might be working on the family treasures... ]

    As for treasure in heaven, I certainly hope so — but I’ve been robbing the heavenly treasury for so long, its nigh unto time to start giving some back.

  • Jacie // Mar 9, 2007 at 8:25 PM

    Dr. Bob!

    I read this story on another blog (myvasectomyrevesal.com) as noted above. When I read the story and the reaction of the surgeon I said to myself, “wow, that is a righteous doctor”….

    I have been researching and talking to couples who have had a vasectomy reversal for several years now. I understand the costs and risks involved.

    Then I stumbled on to this site and realized that “Dr. Bob” was my doctor!

    You see, my husband was lucky enough to get a vr from you a few years back. We thank our lucky stars we found you.

    Yes, vasectomy reversal is expensive….but you are one of the most reasonably priced in the field, and one of the very best value, in my opinion…

    Thank-you for keeping your costs low so that some of us may (and were) able to afford a vr.

    Gratefully yours,

    Jacie

  • lakshmi // Mar 19, 2007 at 9:12 PM

    It is not often that a blog entry brings tears to my eyes. Yours did.
    I have had some unpleasant experiences with doctors, and had almost started believing that doctors are less human than others.
    You have proven be wrong.
    Thank you.

  • christopher stockwell // Mar 29, 2007 at 8:54 AM

    dear doctor i read this just dismorning and i know this is so wrong of me to ask but i feel the same way as that quy i thought i was making the right decision but half way threw the surgery i wanted to back out but was told it was to late my family always told me that i had enough kids i didnt need more and being young and wanting to please my family and get them off my bakc we did this since our insurence wouldnt pay for birthcontrol for my wife now shes ready to leave me she says she cant keep telling our daughter why she cant have a baby and our daughter crying my wifes up all night every night crying too but i cant afford these prices we dont have alot of money but we have so much love and a great christian home to give if you could extend this offer to one more maybe i could still save my marriage

  • nellie // Apr 5, 2007 at 9:50 AM

    Iam glad to hear that doctor bob is giving the chance for people to have more gifts for god. I live in wyoming and there are not alot of doctors in my area that are willing to do or every talk about veasectomy rev. plus there cost are high. Thank you doctor bob for being so open and keeping your cost low. I wish more doctors in my area looked at it the way you do. It makes me so mad that I can not reach the cost to add other sweet gift to my family.
    thank you
    nellie

  • Jeffrey P. // Apr 30, 2007 at 5:15 AM

    Dear Dr. Bob,

    I have been looking around at getting my reversal done as I made a costly mistake of when I thought I was done with having kids but now im remarried so happy in love with her and the only thing that stands in the way is the price as it is way too much to get a reversal as we are a younger couple having to work really hard to just survive and my wife and I pray that we can someday have a litte one of our own together sometime soon but again all that is in the way is the BIG COSTLY $$$$. If I had the option I would do the surgery with no Anesthesia and be awake for it so it cost less and for them to just numb the area. I just wish I had a break in ife to get this done so my wife and I could complete are little family. I have emailed some doctors around and they were wanting to chare over 25k which is like buying a car not the money I have nor my wife. I had one doctor email my wife back and was so rude to her I felt so bad and there is nothing we can do until we get the money to get this surgery done. All I can repeatingly do s pray that someday god will help us out in our prayer to one day have kids of our own. I wish I had the money of a DR to get this done as they seem to have lots of money if only not everything in this world was all about money but theres no way I can get this done until we get enough to do this and im 24 yrs right now but want it done soon before its too late, please reply back ASAP to let me know what you think DR. BOB.

    Sincerely,

    Jeffrey P.

  • Stephanie // Aug 8, 2007 at 8:41 AM

    Replying to the doctor who performed the free VAs. Reversal….

    I admire you! Very kind of you to offer services for the man who so desperately wanted a child!! My husband and I are also looking to have this procedure done…We have 4 beautiful children and acted quickly and impulsively four years ago!!!

    We are not looking for a FREE surgery, but a great christian surgeon. We live in Charlotte, NC. Where are you?

  • wayne westbrooks // Nov 28, 2007 at 6:17 PM

    I am 47 and my wife is 39 we would like to have another baby but cannot afford all these outragges prices. can any one help

  • Amz // Jan 3, 2008 at 1:54 PM

    Hello there. My husband and I have been searching for the right surgeon to perfom a vasectomy reversal. My husband and I are both in the military and are scheduled to deploy next summer. I have no children of my own and was recently diagnosed with a disease that will eventually prevent me from having children. I want more than anything to have a child of my own, but if I have to wait 3 years, it more than likely will not happen. Of course we are like anyone else, can’t really afford the surgery, but plan to figure out a way. If any of you know how/where we can get a decent price for the reversal, please let me know.

  • Stormi // Mar 10, 2008 at 9:30 AM

    Please…..I am 29 years old, I have been with my husband for 8 years now and we have a wonderful 5 year old little girl, I just had a close brush with cancer, I can tell you that this has caused both my husband and myself to open our eyes….we want another child! I can not begin to tell you how I felt to know that I MIGHT NOT be able to have any more children. God has granted us another chance. If you ask me if I can or will ever be able to afford your price then I would have to say NO WAY….NOT IN THIS LIFE TIME…..I have looked on line until my eyes have crossed and can not find a price that we, or anyone that I know can afford. We are not a poor family by no means, now on the other hand we are not wealthy, ….we get by, we are happy, healthy, and we have a warm home to take our shoes off at the end of the day! How do the doctors expect a family like mine to be able to pay this price? I am very sorry, but this makes me sad, sad to see that there is no hope to have another child if the rates are this high. I know that it is not JUST you giving the price…but gosh, what is a person to do next?

  • Brenda // Apr 9, 2008 at 9:50 AM

    Dear Dr. Bob,

    I am 31 years old I have one child who is 12. I got married to the love of me life in 2003. He was married previously and had children with his exwife. He had a vasectomy done because he thought his life was complete. You see my husband has been serving in the United States Marine Corps for 21 years. While he was serving over seas his wife was unfaithful, and eventually they divorced. We have thought about it a long time now and decided that we want to have a child together more than anything. The problem is every time we start saving up something trumps it, like braces and car repairs. Not to mention that we are stationed in CA. It is so expensive here. I wanted to know if you still offer low cost vasectomy reversals. Please let me know. Thank you!

  • jason hill // May 11, 2008 at 10:30 AM

    Dear, doctor I wished I could get that lucky to be able to get that offer that you have gave that other guy. I to have make a big mistake in getting a vasectomy because of my “ex-wife”. She has been keeping my daughter from me for the past six years, and I can’t do anything about it, because her father works for the county judge. Now my previous mistake may cost me my marriage now. Because my new wife wants a baby so bad she cant stand it. Please consider me for the same offer. Thank you for your time. And god bless.