My take: Preventive care, geriatricians, lifestyle

1) 80% of preventive care occurred outside of yearly physicals.

My take: Interesting study questioning the usefulness of a routine physical. In many cases, unnecessary tests are performed during these visits, driving up health care costs.

However, I find a routine preventive health visit helpful. It is a way to consolidate a patient’s screening status in a setting where preventive care takes priority. This enhances the probability that the patient is up to date with the appropriate screening tests, rather than tacking it on at the end of an acute visit.

2) The number of geriatricians declined 22 percent since 2000.

My take: That’s a pretty frightening statistic considering we are on the cusp of the Medicare baby boom era.

Primary care physicians are already under siege. Geriatricians are compensated even less. Hard to believe the short-sightedness going on here.

3) Jacob Goldstein, who runs the WSJ Health Blog, has a front page article discussing the priority new physicians place on lifestyle. Older physicians are resentful:

“It really gets on your nerves when you get these young guys coming in and interviewing and they say, ‘I’m not doing this, I’m not doing that.’”

My take: Deal with it. Placing an emphasis on lifestyle makes for happier doctors who are less prone to burnout. With physicians being held in lower regard these days, it is no wonder more are seeing medicine simply as a job, not a calling:

Walter Cheng, 32 years old, is in the profession’s new guard. Upon graduating from the Johns Hopkins School of Medicine in 2004, he bristled at the notion espoused by some senior physicians that a doctor should put medicine above all else. “I thought, ‘I don’t really want to be that kind of doctor.’… My family is as important, if not more important, than my career.”

Well said.

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  • Anonymous

    “The number of geriatricians declined 22 percent since 2000.”

    Geriatrics: A business where expenses increase yearly and income declines yearly.

    From a Economics 101 model, geriatrics is completely non-viable. It is amazing the field only declined 22%. I am board certified in geriatric psychiatry and I must reluctantly limit my Medicares to only those already in my practice.

  • Buckeye Surgeon

    The argument is self defeating. If you want doctors to be esteemed by society to a higher degree, then there has to be a perception that our profession puts the needs and ills of others above our own concerns. Coming out and admitting that medicine is simply a job that pays the bills better than other jobs (rather than a true professional calling) is a good way to further erode the prestige of a career in medicine. It may be inevitable, but please, let’s not hasten our own demise….I should hope that someone like Walter Cheng (ooooo Johns Hopkins) is not the “new guard” of medicine. That’s not the guard I want watching over me and my loved ones at night when we’re ill.

  • Anonymous

    I have seen a number of docs with geriatrics training who stop advertising the training. They call themselves general internists or FP’s.

  • Anonymous

    Treating medicine as a true calling is just another form of complacency by a generation of docs who rode the third party payer gravy train for years and now are leaving such a mess for younger docs that we’re suckers to treat this as anything but another job.

  • Anonymous

    If you don’t feel that practicing medicine is a calling, then don’t do it. My med school class is full of people who clearly didn’t apply as an answer to that call. I am afraid of them.
    Also, my medical school talks a big game throughout the admissions process about training primary care docs, but now that we’re in, we hardly hear a word about it. I wonder how many other schools are the same.
    Compensation for geriatricians will improve over the next few years as we move into caring for the aging Baby Boomers. From the 60′s on, everything has been about them and will continue to be. They played in the 60′s and 70′s(admittedly I’m generalizing here), were greedy in the 80′s and 90′s and now they will want us to take care of them. Whatever changes occur in our broken health-care system will be driven by the demands of the baby-boom generation. You can bet that whatever changes do happen, they won’t help the young, the working poor or the uninsured except as a by-product of making care better, more accessible and probably cheaper for the baby-boomers.

  • The Happy Hospitalist

    The idea of medicine as a calling went out the door when CMS turned medicine into a financially destructive game of take and take.

  • Anonymous

    as our prestige and lack of respect go down,us gen x ers and gen y’ers will not put our job ahead of our families or our health. As for the shortage of primary care physiciansd and geriatricians , we need to ask for at least the MGMA median salary or not accept the job.( 160,000 at least )

  • Anonymous

    Gotta say anon 5:03, yours is one of the more uninformed posts. Not the medcine is a calling part, rather the idea the polyanna idea the geriatrics pay will increase because the baby boomers are becoming retirement age. Tell me anon 05:03, have you been paying attention to the latest medicare proposed budget cuts (10.1% on July 1st). Have you been paying attention to the fact that the day medicare goes net negative was just movwed up. Have you been paying attention to what medicare is now calling “never events” and will not pay for (hint: some of them are not close to never events). Have you been paying attention to how medicare picks a different specialty to drop the axe on (two years ago onc then rads then ???). Question for you ohh enlightened med student. Just WHERE do you think all this money is going to come from in this setting. Just because the boomers want the moon, doesn’t mean they will get it.

  • Michael Rack, MD

    I agree with anon 6:28. The revenue from office visits for geriatricians and primary care docs will continue to go down (on an inflation-adjusted basis). However, one possible source of increasing revenues for geriatricians is medical director stipends from nursing homes. Geriatricians could try to squeeze more $ out of the nursing homes.

  • Anonymous

    “Compensation for geriatricians will improve over the next few years as we move into caring for the aging Baby Boomers.”


    I want some of whatever it is you are smoking.

  • Leo

    No offense, but doctors like Buckeye Surgeon and Anon 5:03 are part of the problem. I care about my patients’ well-being. I believe I practice good, ethical medicine. That said, why is it that if I don’t sacrifice my income and livelihood for the “good of society” that I am just another greedy doctor?

    In a free market, no one is “owed” anything, so I certainly don’t think that doctors deserve a high income simply because we have spent lots of years in higher education. There are plenty of unemployed MBAs and PhDs. However, people clearly place a high value on their health (obvious from malpractice awards and the general attitudes of society toward healthcare), so if the demand is there then it should be compensated. In any case, we certainly should not be condemned for seeking fair value for our hard work.

  • Anonymous

    Anon 5:03 needs to get out in the world a little more. Most societies approach to the problem of public demand for healthcare services is not to raise the fees of doctors, but rather within the limits of their abilities to control the emmigration of doctors, to force them into involuntary servitude–to use the power of the state to close off other options so they will acquiesce to accepting whatever rate the state wants to pay, their only other option being to discard their half-lifetime of preparation and leave the medical profession.

    We already have anticipatory calls from baby boomers to address the long-term care expense problems by compulsory national service. Rather than pay the young a competetive market wage to wipe their incontinent butts they, in all their infantile narcissism, are more than happy to enslave them to do it for free. Don’t think they hold your liberty in any higher esteem.

  • Anonymous

    As an informed consumer of medical services, here’s my take:

    the powers that be have succeeded in taking the art out of the art of medicine in order to weed out non-prescribing types. Sadly, what I see down the line is an army of prescribers checking lookup tables with barely a glance at the patient.

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