Geriatricians on the decline, and why physician payment needs to be reformed

With a majority of Baby Boomers entering Medicare age, doctors who specialize in treating the elderly are become scarce.

It’s a demanding field, with physicians forced to deal with multiple, complex issues within a 15-minute time span. For their trouble, they are paid disproportionally low when compared to proceduralists.

Surgeon Atul Gawande asks, “is the time I spend as a surgeon excising a patient’s cancer worth 10 times more than the time the primary care doctor spent finding the cancer in the first place?”

No it’s not. And this has to change if Medicare has any hope of staying out of bankruptcy.

Comments

scalpel
Medicare is going to go bankrupt anyway no matter how they apportion physician charges.
thecountrydocreport
Very good point, but is the surgeon willing to give up some of his or her procedure reimbursement so primary care physicians and geriatricians can be compensated more appropriately?
daccarte
Please see my blog post on this topic. I also pose the question, “can Elderly Wellness Centers in communities be established”? I am not in the medical field but am the daughter of an aging parent in a retirement community…and have seen the wonderful benefits of my mother’s access to a Wellness Center onsite.
I’d love to hear feedback from others on this idea?Thank you. Dale
http://daleblogg.blogspot.com/2008/12/facing-critical-decline-of.html
Anonymous
What’s REALLY crazy is that people who opt for a fellowship in geriatrics can expect to make LESS money as a reward for their extra time. So much for specialists claiming they should get more money because their training is longer.
Anonymous
Geriatricians work in a government run single-payor system–and unless they graduated before 1966, they knew that is what they were choosing to do. Are they complaining about it now? Are they complaining about the predictable outcome of that scenario now? Should we pity them. I think rather we should hold their plight up as an example to all the the other collectivists out there who advocate single-payor.
Anonymous
IANAD, but IMHO primary care doctors need to be compensated more fairly for what they do. Those who are concerned about the impending doom of ‘income redistribution’ might wish to relocate to a climate more favorable to their opinion. “We, the people” have had it with the current health care debacle and have made our desire for change known.
Bad Medicine, Good Solutions
The current debacle you speak of is the byproduct of government influence on medical care.
The government is everything but the solution to our nation’s medical problems.
Anonymous
If the government isn’t paying for health care for the elderly, who will? I don’t see any way to keep the government out of providing health care for elders. The majority of them can’t afford to pay for their own health insurance. It’s like when you see people holding up signs that say, “Keep the government away from my medicare.” Guess what? The government IS your medicare. How do you propose we keep government out of it?
Anonymous
It seems to me this is more an example of Government having given up its influence to the medical profession, whose goals and priorities are not in line with the general public interest.
I’d much rather spend more to have Grandma off 6 medications and able to move around without falling and breaking her hip — but the medical profession has set it up to get a fat fee for replacing her hip after she breaks it.
It’s time for the public to set priorities, not the medical profession.
Not to single out Physicians, there are plenty of other parties who benefit – device makers, drug companies, hospitals. Keeping someone well and functioning is not as profitable as fixing them up after the fact — for individual parties. For the public as a whole it is.
I’d like to think that the new leadership in this county has the backbone to stand up for the public and straighten priorities out, but I don’t think it’s something that can be done overnight.
Anonymous
The whole public versus private debate is a sham. Right now, there is a very unholy alliance between the public (medicare, medicaid) and private (insurance companies)spheres of influence.
Examples:
1) insurance companies almost always set their reimbursements as a percentage of medicare. Therefore, they have significant interest in keeping reimbursements low.
2) insurance companies set to benefit from alternatives to medicare and medicaid, such as medicare advantage and medicaid managed care programs.
3) health policy wonks fequently have backgrounds in private insurance, similar to the revolving door politician/lobbyist system on the infamous K Street in D.C.
Back to the issue at hand. The outlook for geriatrics as a specialty is bleak because income is dependent on non-procedural, ie cognitive, cpt medicare reimbursements which are kept low by a cabal of the following: a specialist dominated but AMA sponsored RVU system, penny pinching but short sighted politicians, private insurance companies who want to smell rosier than public insurance and an indifferent and under-appreciative public.
Starting in January, 2009, my family practice in upstate New York will stop accepting new medicare patients. I encourage all pcps out there to do the same. Let those selfish baby boomers have nowhere to go. Then maybe there will be some change.

Geriatricians on the decline, and why physician payment needs to be reformed

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