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bonuses for ordering procedures

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I worked for a private practice that had a standard order set for new patients and they were done at an outside lab.  Once we had an in-house lab that order set mysteriously tripled in size.  One PA was reprimanded with hours cut for not ordering them....she of course just quit.  I was questioned multiple times about not ordering everything.  Not being medically necessary wasn't the answer they were looking for.  Don't ever order something that isn't medically necessary in order for the practice to make a profit. 

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I agree with dizzyjon and others who have said that ordering things that are not indicated is a crap way to practice medicine even if the docs love us for doing it.  See the NYT article on dermatology practices around the country.

But I'm going to play devil's advocate for a second.  If you are part of a practice owned by a doctor who does echocardiograms and your Pt has a new murmur that needs to be investigated, where are you going to send the Pt?  Will you support the practice you work for or an outside facility?

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