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To the Editor: The article by Dr Roberts and colleagues¹ on recognizing the importance of dividing total costs into fixed and variable components deals with an overlooked nuance for physicians who need to be able to converse with and understand how their nonphysician colleagues involved in administrative and fiscal activities think and behave. The article impressively analyzed the split between variable and fixed costs at an inner-city public hospital. The authors' point regarding the difference between short-term and long-term perspectives needs to be reinforced. As reimbursement for health care continues to decrease, there will be a greater need to shed fixed costs within a shorter time frame and not assume that this can only be accomplished over a more protracted course.

Of particular relevance is the concept of operating leverage, which suggests that in an organization in which there is the strong possibility for business to deteriorate (not unlike the . . . [Full Text of this Article]

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RELATED ARTICLE

Distribution of Variable vs Fixed Costs of Hospital Care
Rebecca R. Roberts, Paul W. Frutos, Ginevra G. Ciavarella, Leon M. Gussow, Edward K. Mensah, Linda M. Kampe, Helen E. Straus, Gnanaraj Joseph, and Robert J. Rydman
JAMA. 1999;281(7):644-649.
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