It definitely DID happen, and your disbelief does not negate that.
A fairly analogous exxample, which I am EXTREMELY familiar with is how a couple Docs will puchase/build an Outpatient Imaging Center. They will then order exams that their office schedules (per Doc’s orders/demands) at the Imaging Center they own, therefore making more money. Lots of overuse of imaging due to profit-driven motives, no doubt at all. I have heard more than a few such Docs proudly state how they upped profit by forcing pt’s to use their outpatient Centers -v- patient choice/convenience for exact same result/images of exam.
My personal on-hand experience(s) is that when a patient says they prefer to have their exam/test elsewhere (maybe they live 100+ miles away and exact same exam/results can be done 5 miles from their home) is that the Doc(s) pitch a fit and say if they don’t get exam(s) done where Doc wants, the patient can find anonther Doc to take care of them. One Doc, the most adamant of any I have ever worked with, actually cursed and swore at young patient’s mother who had called for legal advice from a close family-friend who was a known to be staunch defender of Doc ‘abuse of system’ She was firm in her stance that if he dropped patient for not going to the Doc-owned place, the Doc could be facing some serious issues with various licensing agencies, etc, as attorney was going to take their case pro bono out of priniciple and drag him through the mud publically. The mother chose to be referred to another Ortho (which first Doc resisted by any means, delayed purposely by at least a week by his refusal to allow records to be sent, etc, and with more than a tinge of hatred) who she was told did not do such ‘forced-exam-location scheduling’ BS. I know the Doc received a stern warning letter giving him 24 hours or attorney was going straight to Courthouse to file complaint(s) and to be given access to all patient records, etc. The rage Doc displayed in his office made everyone else laugh since he had to do what he refused to do or be revealed to his cohorts as a sumbitch.
All who worked in that office could overhear the Doc screaming at manager about keeping his ‘secret’ of referring for additional income. “NEVER schedule anything at a place I do not own!” The person(s) who scheduled exams were told explicitly that if they (patients) asked about another more-convenient location as Image Center (CT/MRI outpatient place), they would be referred out without delay (but delays wsa the standard Doc gave every time. If patient made any fuss at all, the patient went to status of 'refer to any other Ortho at that time - plus patient was not allowed to ask Doc why they were being referred elsewhere without being given reason at all. I saw at least three front-desk persons trying to not explain why they were being cast out, and Doc fired them immediately for whatever reason he chose to make up.
Very crooked Doc. I quit working there promptly when his covering-up all of his dirtiness and blaming workers for failures to get stuff done became overwhelming. He blamed me personally for losing an important set of films the day he neded them for a surgery. Manager, who tried to cover for me as I had kept records of films leaving the shelf whre films were kept were shown to manager. Records showed he was last in possession, so manager went to Doc’s car and looked in trunk, and there lay the films he said he never had! Obvious he was making me look like a fool. But his stance was I ‘planted’ them there to make him a fool - how in hell would I have access to his car’s trunk, right? Stuff like that that only he could do, or required his signature but he would not sign it due to refusal to address anything that wasn’t ‘perfect’ (ie missed deadline for returning renewals of various associations. etc).
It was employees’ fault, always, even though papers were placed in timely manner where he wanted - right under his nose in front of his chair in his personal office. Usually, the stuff got placed in a pile about three foot high behind him on floor and disregarded until he learned of missed deadline. Always employees’ fault. Always. I was well-versed in ‘installing’ plaster/fiberglass casts, and stood by him as he incorrectly applied fiberglass cast for broken elbow without using the ‘padding’ first. Doc took a few days off and patient returned as ‘ememrgency’ since area under cast was becoming raw/bleeding/near-infected due to his not using protective padding (kinda like thickish cotton strips, it varied, but purpose was clear). I was asked by manager to remake cast appropriately (due to years of other Ortho experiences making great casts) and when Doc returned and found out, his excuse was that he did not use padding for a good reason, but would say what the reason was! He could not admit he fucked up no matter how bad patient’s condition was. I even hada ‘manual’ for casting procedures opened up to pages that described neccessity of padding with casting process. He took book and threw it out of room as he “knew more than they did”!
When I brought up improper sterilization technique (long-time broken autoclave, zero training of non-experienced assitant(s) on use of sterile techniqueas they came and went almost bi-weekly, reusing staple/stitches removal items on numerous patients w/out any cleaning whatsoever (at most, wipe with paper towel and just toss 'em back in drawer after digging out staples/stitches from blood-covered wounds and the like). Office was to appear to be perfect, while the gears driving the office were typically subjected to demeaning pressure to “Do what I say because I don’t care about how its done - just do it!”.
Spending any money to repair faulty necessary items was not to be mentioned - “Find a way or walk away from here” was the mission statement for the most part. I found falsified sterilazation records that were ‘back-dated’ and I had already made copies of originals that did not have such entries. The State office charged with overseeing use of proper sterile technique (and lots of other office practices) was VERY interested for me to send to them, which I did. I got a call from Doc who was cursing at me immediately, so I simply hung up on him. Kept calling back for hours and I just ignored him.
Heck, the ‘floating table top’ of cheap X-ray unit I used kept having the magnetic ‘locks’ that held table in place once I had positioned patient kept failing due to ancient-type relays and power source to them being out of whack. Unit so old that parts to replace were becoming archaic and hard to find. I was told by manager to use duct tape to hold table top in place, per Docs direction, which was near impossible since table top would float from aimed-at area quickly when I tried to place tape at several areas for non-movement. Repair guys eventually told Doc they would no longer service the X-ray unit as Doc often refused to pay them since they kept telling him he neededto get another unit for patient safety and reliability, etc. His response was always ~“They are fools - everything can be fixed at low-cost”. When I left, there were zero repair companies willing to even take a call from his office, sad to say as related to patients’ safety (and the added exposure to ionization events because many films had to be redone due to table top’s movement during exposure for films.
More Docs than people would want to know about do very similar actions in regards to patient (and their safety overall) being the most important part of their office, IME. Scary, but true.
Why would some profs not be of ~same mind-set if they could raise their income by having a vested interest in source of book purchase(s)? Happens in many different professions, no doubt. Most likely a low percentage of Docs overall, but such things DO happen and usually under-the-radar until called out on it forcefully (as I did). There will always be someone ‘gaming’ the sytem in which they work, IMHO.