But, we get what we vote for, and we had better not forget it.

http://tinyurl.com/378vwq

Corvallis (OR) clinic limits Medicare:

http://tinyurl.com/3942xp

also covered here on this blog in 2007. And that’s just the Northwest. It’s already happening.

Of course, this just shows the profound ignorance of Pete Stark.

That is pure BS. I trained in one of the largest teaching hospitals in NYC, something like 100 residents/year across all specialties. And probably 60% were FMG’s. Not just in Internal Medicine, but also in general surgery, ob/gyn, psych, neuro, ortho, & urology.

Granted it was slanted towards internal med, but then those grads funneled in to the IM subspecialties: cardiol, GI, heme-onc, etc. were almost exclusively FMGs. And they were about the brightest trainees in the hospital.

And as far as specialists’ cherry-picking, most internists maintain a relationship with a VERY SMALL group of specialists, so it’s quick & easy to refer when necessary. So the cardiologist or GI who refuses insurance X generally gets crossed off the list quickly, in favor of someone who makes the PCPs life easier. After all, for them to see a medicare patient on a “referral” basis versus without a referral increases their reimbursement dramatically (you knew that, right?)

Those specialists that had any inkling of superiority are generally blackballed from referrals by the IM community in my hospital, and are starving for business. In my area there is a tremendous surplus of certain specialties (4 dermatologists & at least 6 ophthalmologists in my building), versus about 5 internists taking new patients.

The fallacy is you can and do refuse medicaid pt’s and shortly medicare. With the exception of the boutique docs most PCP’s don’t easily have that luxury. The payment scale hurts us all. However, it is killing the PCP’s at the bottom of the payment ladder. Also as you well know most insurance key’s off of some variation of medicare rates. Again the same result. Also do you referrals come out of thin air? My don’t. I have relationships with PCP’s. I take their medicare not just because of the patient’s (and I agree I definitely like seeing the appreciative members of the depression/WWII generation more than “some” of the self-entitled prebaby boomers), but because they make the other referrals to me. I understand that these primary docs are in a bind with subspecialist coverage. We are collegues after all right? Additionally, depending on your insurance contracts you might want to think long and hard about “refusing” medicare, as I have seen PCP’s just stop sending all patient’s to subspeicalist’s who start cherry picking. Food for thought. Pete Stark is a jackass who has no clue as to what is really going on in medicine. If the other members of congress follow suit with his line of thought then they all will have a shock in June.

PS: About FMG’s, some of the brightest docs I have ever met were “FMG’s”. They have already been self-selected by getting in to this country in the first place…get over yourself.