Medicare, Physician Shortage, Doctor Shortage - Doctors and Medicare's Dirty Little Secret

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

Julie Connelly, “Doctors Opting Out of Medicare,“New York Times, April 1, 2009

I have a prominent friend, a staunch friend of doctors and long a leader of organized medicine, who has often told me words to this effect,” If it weren’t for Medicare, doctors would have supported single payer a long time ago.” Many doctors simply can't stomach Medicare's policies.

This bodes badly for the future. Some 78 million baby boomers will start becoming eligible for Medicare in 2011; a shortage on internists is developing and is expected to reach 35,000 to 45,000 by 2025; 29% of Medicare beneficiaries are already having a hard time finding a doctor; and only 40% of primary care doctors now take new Medicare patients.

The root problem is that Medicare pays less, usually 20% to 40% less than private plans, depending on the state and region of the country and the paperwork is time-consuming and distracts from care for other patients. For practices having a hard time making a go of it, new Medicare patients are simply not worth the trouble or the expense. Given the current Medicare fee structures, many doctors feel a single-payer Medicare-for-all would put them out of business.

For patients not yet Medicare-eligible, the best thing to do is find a primary care physician now. Most doctors are willing to let existing Medicare patients stay on. If you’re over 65 and don’t have a doctor, the best bets are to visit www.medicare.gov to find doctors enrolled in Medicare, or to identify a nearby urgent care center. There are 18,000 of these centers nationwide, and most take Medicare patients.

Another alternative is sign up with a concierge doctor. But these doctors generally charge about $1500 per patient per year. A website www.conciergemedicinemd.com contains a list of 500 concierge physicians.

The dirty little secret? Current Medicare payment and bureaucratic policies have alienated physicians and driven them away. Medicare, in essence, has priced itself out of business for about 40% of doctors, a shortage of which already exists. Unless Congress were to mandate that physicians have to take Medicare patients, a single payer system based on Medicare is unthinkable and unworkable.

Conclusion

For new Medicare patients there lurks an unpleasant surprise,

For them primary care practitioners will be in short supplies.

And many still in practice no longer take Medicare patients,

No matter what or how dire the patients’ medical situations,

Why? Between doctors and Medicare deep conflict underlies.