Challenging Doctor Shortage

[justjim]

Village Health will not accept our State Government Medicare Advantage plan, and our Primary Physician of 20 plus years has retired. Ironically, the doctor recommended by our retiring physician left for “greener pastures” before we could even get into to see him. Makes you wonder what is happening to our medical system that has such a shortage of doctors, nurses and other medical technicians. We would prefer an internal medicine doctor where we could develop a patient/doctor relationship but we have already found it challenging to find any doctor taking on new patients in the surrounding area. Perhaps the Walk-in emergency clinics with doctors and physician Assistants are the only solution now available for medical care in the area. Unless you are having a heart attack, we have marked off the hospital’s E.R. as a place of very last resort.

[retiredguy123]

Village Health will not accept our State Government Medicare Advantage plan, and our Primary Physician of 20 plus years has retired. Ironically, the doctor recommended by our retiring physician left for “greener pastures” before we could even get into to see him. Makes you wonder what is happening to our medical system that has such a shortage of doctors, nurses and other medical technicians. We would prefer an internal medicine doctor where we could develop a patient/doctor relationship but we have already found it challenging to find any doctor taking on new patients in the surrounding area. Perhaps the Walk-in emergency clinics with doctors and physician Assistants are the only solution now available for medical care in the area. Unless you are having a heart attack, we have marked off the hospital’s E.R. as a place of very last resort.
Note that there is a huge difference between an emergency clinic and an urgent care facility, especially in the cost. You can get treatment at an urgent care facility and it won't cost an arm and a leg.

[JGibson]

The days of establishing a long term relationship with a TVH doctor are over as that place is a revolving door because they don't want to pay.

Specialists are more important anyway.

[villagetinker]

OP, IMHO, the first thing you need to do is call your health care insurance and get a list of local providers that accept your ADVANTAGE plan, then you will need to start calling these doctors to see if they are accepting new patients. Also, IMHO, you might ask to see if it is possible to get back to original Medicare and supplemental without a huge cost increase, as there are a lot more doctors accepting original Medicare and supplemental than Advantage plans.
Hope this helps.

[justjim]

Note that there is a huge difference between an emergency clinic and an urgent care facility, especially in the cost. You can get treatment at an urgent care facility and it won't cost an arm and a leg.

You make a good point. I should have included urgent care facility. We have used a couple of them and your doctor urges you to use urgent care when you have something you think is relative minor, colds, sinus, etc.

[Blueblaze]

It must really be getting bad.

I switched to Humana a couple of years ago for the dental, after they told me Villages would take it, then discovered the lie after it was too late to switch back. So we used PMA for a couple of years, and although we liked the doctor, the staff was so incompetent that we were already thinking about switching when we heard they'd been busted for Medicare fraud. So we switched to a different doctor this year, at Orlando Health. It was the first time I have ever encountered a doctor who seemed mad at me for bothering her (after waiting a month for a new patient appointment). No wonder the waiting room was a ghost town. So we decided to go back to Villages. But while we were gone, our previous doctor had quit, and when I looked up the only doctor taking new patients on the Northside, I discovered a Wisconsin native with an unpronounceable name, who graduated from some lousy medical school in the Caribbean with a reputation for selling degrees. Worst part -- he'd lost his Wisconsin certification for writing fake prescriptions.

It's crazy! You'd think every doctor in the country would want to work in a town where both the average age and the average annual temperature is 72! Why is this so hard?

[Berwin]

We've lived here for about a year and a half now. The problem with health care around here was explained to me as basically being the snowbird situation. Half the year, there aren't enough patients to attract quality doctors and the other half there are too many patients for the few doctors that are here. I was told that if it was a life threatening situation, do whatever you can to get to Gainesville. Ironically, several months later our primary care doctor referred my wife to his colleague who in turn referred her to another specialist who sent her to Gainesville where she got the treatment she needed.

[mdmurrell]

Medicare Advantage plans are less expensive to consumers but pay healthcare providers very little. Most providers refuse new patients as a result. Many providers are moving to strictly cash based practices due to the high overhead and low pay from 3rd part payers.

[golfing eagles]

The days of establishing a long term relationship with a TVH doctor are over as that place is a revolving door because they don't want to pay.

Specialists are more important anyway.

First correction for this thread:

What makes you think "they" won't "pay"????? Are you privy to some information that I'm not?

When they first started TVH, one of my partners and I were invited to join. I retired, he took a job as medical director at one of the centers. This was 10 years ago and the compensation package was more than competitive for this area. It has kept up with inflation, and there are other incentives that I'm not at liberty to discuss.

Second correction:

"Specialists are more important anyway."

For some things, mostly procedures and certain specific conditions. For most conditions, a "specialist" is superfluous. Unfortunately, due to the proliferation of lawsuits, even well trained internists are quick to make an unnecessary referral to reduce liability.

Third correction:

There is turnover in medicine everywhere you go. Due to an increasing and aging population, there is a relative shortage of doctors , nurses, and almost all other health care workers. Forty years ago, there were 120,000 applications for 17,000 medical school seats. Five years ago there were only 25,000 applications. Our best and brightest are avoiding careers in medicine due to the many years of education, the increase in litigation, and relatively low compensation in comparison to other careers available to them.

Fourth correction:

Medicare advantage plans pay the same as traditional Medicare. Their savins is from limiting panels of physicians, deals on pharmaceuticals and medical supply companies, etc.

The Villages is a challenging location for recruitment of physicians. If they are younger with young families, there is little to attract them here. Therefore, we usually get older physicians near the end of their careers, contributing to the "revolving door". In addition, offers are VERY competitive elsewhere. As an example, even though I'm retired for 8+ years, I still get contacted with offers every week. Yesterday's was from the Tampa area, offered a 4 day work week, limited patient schedule, no "on call" responsibilities, 6 weeks vacation, and a compensation package of about $500,000/year. There is no way TVH can compete with that.

More corrections may be forthcoming as posts with "inaccurate" information accumulate.

[Ski Bum]

Spouse of a soon to be retired doctor here. Likely a concern about the earlier mentioned seasonality of population. But, I think, just as important is this. Have you all thought about the time it takes to treat an older person? Funny, but just this week, me wife created a new appointment type for patients over 65 so they don't put her behind for the rest of the day. (She doesn't get paid more, it's just for scheduling). She has been practicing for almost 30 years and a lot of her original patients are at the end of the road. Time-wise, she can't take on more older patients. If she loses one, there are always more that are aging. Taking on younger patients is possible, but it's not really fair. She knows she will be gone soon.

We have thought about coming to TV and her working part time. Maybe an army of semi-retired doctors could help serve the population here. But think about it. You could never develop a relationship, even at half-time it's not likely the doctor would be available when needed. So a lot of visits are first time patients. They take forever.

I really do not like posting without offering a solution. But the best I can do is offer another perspective.

[davephan]

Medicare Advantage is really named incorrectly, it should be named Medicare Disadvantage. I’ve heard that 30% of all claims are routinely denied. If your doctor prescribes 12 treatments, they might only approve 8 treatments. You are also restricted to going to clinics that you probably wouldn’t have chosen on your own.

One of the worst things about Medicare Advantage is after one year of switching to Medicare Advantage, you have to medically qualify to switch back to Original Medicare. If you’re health declined, then you could be stuck with Medicare Advantage for life. The best option is to stay on Original Medicare with a good supplement.

[Ski Bum]

Spouse of a soon to be retired doctor here. Likely a concern about the earlier mentioned seasonality of population. But, I think, just as important is this. Have you all thought about the time it takes to treat an older person? Funny, but just this week, me wife created a new appointment type for patients over 65 so they don't put her behind for the rest of the day. (She doesn't get paid more, it's just for scheduling). She has been practicing for almost 30 years and a lot of her original patients are at the end of the road. Time-wise, she can't take on more older patients. If she loses one, there are always more that are aging. Taking on younger patients is possible, but it's not really fair. She knows she will be gone soon.

We have thought about coming to TV and her working part time. Maybe an army of semi-retired doctors could help serve the population here. But think about it. You could never develop a relationship, even at half-time it's not likely the doctor would be available when needed. So a lot of visits are first time patients. They take forever.

I really do not like posting without offering a solution. But the best I can do is offer another perspective.

And don't get me started about medical schools and why we have so few doctors, PAs and nurses.

[spinner1001]

It's crazy! You'd think every doctor in the country would want to work in a town where both the average age and the average annual temperature is 72! Why is this so hard?

Medicare pays the least to medical providers (physicians, hospitals, etc.) compared to private health insurance companies. On average, good physicians can make more money for the same effort other places with warm temperatures.

If you want to get into the Medicare financial weeds, read this:

https://www.cbo.gov/system/files/2022-01/57422-medical-prices.pdf

[golfing eagles]

Medicare Advantage is really named incorrectly, it should be named Medicare Disadvantage. I’ve heard that 30% of all claims are routinely denied. If your doctor prescribes 12 treatments, they might only approve 8 treatments. You are also restricted to going to clinics that you probably wouldn’t have chosen on your own.

One of the worst things about Medicare Advantage is after one year of switching to Medicare Advantage, you have to medically qualify to switch back to Original Medicare. If you’re health declined, then you could be stuck with Medicare Advantage for life. The best option is to stay on Original Medicare with a good supplement.

Sounds about right, except just about ALL insurances deny at least 15-20% of claims, as a minimum. We had 4 FT employees just dealing with denied claims. Then, on top of legitimate billing, this is Florida where Medicare fraud abounds. Also realize that most insurances limit fully or partially reimbursement for "out of network" providers. The part about switching back to traditional Medicare, however, is unfortunately true.

[patrickj]

First correction for this thread:

What makes you think "they" won't "pay"????? Are you privy to some information that I'm not?

When they first started TVH, one of my partners and I were invited to join. I retired, he took a job as medical director at one of the centers. This was 10 years ago and the compensation package was more than competitive for this area. It has kept up with inflation, and there are other incentives that I'm not at liberty to discuss.

Second correction:

"Specialists are more important anyway."

For some things, mostly procedures and certain specific conditions. For most conditions, a "specialist" is superfluous. Unfortunately, due to the proliferation of lawsuits, even well trained internists are quick to make an unnecessary referral to reduce liability.

Third correction:

There is turnover in medicine everywhere you go. Due to an increasing and aging population, there is a relative shortage of doctors , nurses, and almost all other health care workers. Forty years ago, there were 120,000 applications for 17,000 medical school seats. Five years ago there were only 25,000 applications. Our best and brightest are avoiding careers in medicine due to the many years of education, the increase in litigation, and relatively low compensation in comparison to other careers available to them.

Fourth correction:

Medicare advantage plans pay the same as traditional Medicare. Their savins is from limiting panels of physicians, deals on pharmaceuticals and medical supply companies, etc.

The Villages is a challenging location for recruitment of physicians. If they are younger with young families, there is little to attract them here. Therefore, we usually get older physicians near the end of their careers, contributing to the "revolving door". In addition, offers are VERY competitive elsewhere. As an example, even though I'm retired for 8+ years, I still get contacted with offers every week. Yesterday's was from the Tampa area, offered a 4 day work week, limited patient schedule, no "on call" responsibilities, 6 weeks vacation, and a compensation package of about $500,000/year. There is no way TVH can compete with that.

More corrections may be forthcoming as posts with "inaccurate" information accumulate.

Thanks for writing this.

[BoatRatKat]

Interesting that we all live here and have different takes. I've not had any problems with Drs here. I get into my Dr. easily and if he's booked up longer than I care to wait then I am perfectly happy with either of the PAs. My husband switched to Medicare Advantage and loves it. Has seen every Dr. he has wanted to. The plan pays for his gym membership, it pays him to get a 6 month check up, it pays him to have routine screenings...so far it's been very good. About 6 months ago a specialist I regularly saw discharged me because the entire practice was switching over to accepting only Medicare Advantage and I don't have it.

[garykoca427@gmail.com]

We live in Illinois and in Florida. As far as I am concerned, the health care in Illinois is way better than health care in The Villages. Just my opinion.

[bowlingal]

Retiredguy....doesn't cost anything when you go to an ER if you have traditional Medicare with a supplement

[golfing eagles]

We live in Illinois and in Florida. As far as I am concerned, the health care in Illinois is way better than health care in The Villages. Just my opinion.

Kind of depends on where in Illinois. Some rural areas may still have an 85 year old GP making house calls in his horse and buggy :1rotfl::1rotfl::1rotfl:

[Justputt]

Medicare doesn't require preauthorization, Advantage plans often do. Medicare doesn't generally tell providers what to do by virtue of what they'll pay for. e.g. If we want to do 28 radiation treatments for breast cancer, an Advantage plan may say they'll only pay for 15 treatments hypofractionated. If we want to do 45 radiation treatments for prostate cancer, an Advantage plan may only authorize 28 treatments. No, the insurance companies (private and Advantage) can't practice medicine, but they can tell you what they'll pay for, which can drive the treatment offered. Medicare doesn't have dental, vision, or hearing coverage, but Advantage does. Advantage plans are PPOs or HMOs, so you have to be in network, and as a snowbird do you want to be in network at TV or your other home? See an advisor BEFORE you chose. Rusty Nelson (TV local) did a series of 3 YouTube videos with an insurance advisor/consultant that I found very informative. Between private insurance and Medicare, Medicare always pays less. Some insurance companies pay a percentage of billed (e.g. 50%), so in order to get what Medicare pays, they have to bill twice as much, but usually they bill much more to private insurance because they'll pay more than Medicare and percent of billed is usually a lot lower. I'll probably stay straight Medicare once I retire and keep my PCP and specialists here and just use clinics at/around TV.

[Ptmcbriz]

I feel your pain. My husband has a rare heart condition which on the west coast where we lived for 30 years were top notch specialists everywhere treating his condition. We move to TV and find out there are only two specialists in the entire state that treat it. One physician at Mayo in Jacksonville which isn’t taking new patients, and the other at Cleveland Clinic near Miami. He has to travel 4 hours down there to see his cardiologist. We are amazed at how behind the state is compared to other states.

[golfing eagles]

I feel your pain. My husband has a rare heart condition which on the west coast where we lived for 30 years were top notch specialists everywhere treating his condition. We move to TV and find out there are only two specialists in the entire state that treat it. One physician at Mayo in Jacksonville which isn’t taking new patients, and the other at Cleveland Clinic near Miami. He has to travel 4 hours down there to see his cardiologist. We are amazed at how behind the state is compared to other states.

Might I inquire as to what his "rare heart condition" is????

[kendi]

Exactly why I keep my doctors up North. The medical care in this area is extremely poor. Have a primary down here too at TVH just in case but once I’m off private insurance I’ll probably just rely on the urgent care. As a previous poster said there’s a revolving door at TVH. Have become less impressed with them over time. The quality of care is definitely declining.

[tombpot]

No problem with traditional Medicare and a supplement

[Singerlady]

BEFORE we moved, I found doctors and made appointments. Wouldn’t have done it any other way. If we couldn’t have found doctors, not sure we would’ve moved. Too iffy. I recommend all prospective newbies to do the same. Our doctor said it’s difficult to attract new doctors just like the OPs have said. Thank goodness we could go to Ocala, Orlando and/or Gainesville if needed.

[mntlblok]

First


Forty years ago, there were 120,000 applications for 17,000 medical school seats. Five years ago there were only 25,000 applications. Our best and brightest are avoiding careers in medicine due to the many years of education, the increase in litigation, and relatively low compensation in comparison to other careers available to them.



Yesterday's was from the Tampa area, offered a 4 day work week, limited patient schedule, no "on call" responsibilities, 6 weeks vacation, and a compensation package of about $500,000/year. There is no way TVH can compete with that.



I'll bet I missed something. 500k and relatively low compensation would apply to a different world from where *I* hang out. You've got me right curious. . .

[mntlblok]

And don't get me started about medical schools and why we have so few doctors, PAs and nurses.

*Please* start. Very curious and don't really have a clue.

[Stu from NYC]

Kind of depends on where in Illinois. Some rural areas may still have an 85 year old GP making house calls in his horse and buggy :1rotfl::1rotfl::1rotfl:

Thank you for continuing to add your voice of reason and sanity to these health care threads

[golfing eagles]

I'll bet I missed something. 500k and relatively low compensation would apply to a different world from where *I* hang out. You've got me right curious. . .

It's a different world from where I hung out when I was practicing as well. But times have changed. Like any shortage, offers go up to compete for available resources, in this case physicians. It looks like everything is starting to get ridiculous----$15.00/hr minimum wage for flipping burgers at Micky D's? UAW, whose high school educated (maybe) factory assembly workers, may have the most ridiculous demand.

As of now, "The average compensation for a union auto worker, including wages, bonuses, overtime, and paid time off, is about $40 an hour. When benefits such as health insurance and pensions are added, the average compensation increases to about $55 an hour1. Union members may also enjoy other benefits such as a pension plan, education and training opportunities, tenure, and legal representation in work-related matters" Based on a 40 hour work week, that's compensation of $110,000 per year. They now are demanding a 40% pay increase and a 4 day work week. Imagine the price of a car if the big 3 give in to that garbage.

So, while $500,000 seemed high for a general internist, if an uneducated factory worker in Detroit might get pushed to $170,000/year, it seems reasonable in perspective.

[Vermilion Villager]

Exactly why I keep my doctors up North. The medical care in this area is extremely poor. Have a primary down here too at TVH just in case but once I’m off private insurance I’ll probably just rely on the urgent care. As a previous poster said there’s a revolving door at TVH. Have become less impressed with them over time. The quality of care is definitely declining.

Same here....one of the MANY reason we snowbirds are snowbirds!!

[blueash]

What makes you think "they" won't "pay"????? Are you privy to some information that I'm not?
This was 10 years ago and the compensation package was more than competitive for this area. It has kept up with inflation, and there are other incentives that I'm not at liberty to discuss. .


The Villages is a challenging location for recruitment of physicians. ..Yesterday's was from the Tampa area, offered a 4 day work week, limited patient schedule, no "on call" responsibilities, 6 weeks vacation, and a compensation package of about $500,000/year. There is no way TVH can compete with that.

.

Remember the game to find out which one doesn't belong?
So which is it?

Either TVH has a highly competitive pay and incentive package similar to other offers in Florida...

Or

There is no way it can compete with the package being offered elsewhere in addition to the disadvantages of this being isolated and old people.

[golfing eagles]

*Please* start. Very curious and don't really have a clue.

Ok, I'll start, maybe ski bum can add to this. First of all, it is a very complex issue with a long history. The problem starts in 1966 with "The Great Society" and the formation of Medicare and Medicaid, as well as the birth of health care insurance as a near necessity and the massive proliferation of lawyers and litigation. As opposed to the "old days" when an office visit was cheap, there were now 3rd party payers that shoveled taxpayer money at providers. We had records on an index card from the stone age prior to EMRs and an office visit was $3.00. Going further back, my mother saved her obstetricians bill from 1947 and all pre-natal, delivery and post-partum care was a whopping $45.50.

Now, along with these government programs came government regulation that further drove up the cost of care. And of course , in order to pay, they wanted a specific diagnosis. This led to a complex system of charge coding under CPT and diagnostic coding under ICDM. To get these diagnoses, the technology exploded as well as specialists and sub-specialists, further driving up cost. So about 1972 those "wise" men in DC decided to "capitate" medical schools---pay them $$$$ to increase total medical school class size from about 9,000 to over 17,000. Remember, our population was only about 210 million back then. So with tons of taxpayer money on the table, almost all 100+ medical schools double their class size. But just like major league pitchers on a 5 day rotation and 20 expansion teams, this was the first dilution of the talent pool. The theory was that more doctors would drive competition up and cost down. However, it turns out, that more doctors just make more work for more doctors, particularly higher cost specialists. Then, technology exploded----ultrasound, CTs, MRIs, endoscopy, cardiac catheterizations, bypass surgery. And every new procedure was dumped into Medicare part B at an exorbitant starting cost, diluting the $$$ pool for routine primary care. The litigation forced doctors to order these expensive imaging procedures and refer to specialists, mostly unnecessarily just out of self preservation.

So now the next phase: When I applied to med school, there were 125,000 American graduate applications for 17,000 seats. Between lower physician compensation, increased regulation and increased litigation, our best candidates decided to get an MBA in 2 years and get better salaries rather than spend 7+ more years to start a medical career. That, plus the huge amount of student loans incurred. So once again the talent pool was diluted. Our teaching hospital can no longer fill their programs with American graduates, so they had to turn to FMGs for bodies to fill the space. Some are very good, some are dreadful. My residency program had 14 positions for 3 year Internal Medicine candidates and received 10,000 applications. Nine thousand were from FMGs and went immediately into the garbage. The remaining 1000 were easily pared down to 200 from which 14 were chosen. Now, 45 years later, I recently had reason to look at the staff of that program----much to my surprise I couldn't even pronounce the names of over 1/2 of them.

So now, fast forward to our situation in TV: Diluted talent pool due to the reasons listed above as well as a population that is now 330 million, residency programs filling with FMGs, and a less than desirable area of Florida for young physicians with a young family. Of course medical care is less than spectacular compared with Boston or NY. That doesn't mean it is horrible either. Remember, let's just assume there are 35,000 cardiologists in the US---only one of them is the best---and he can't keep all 120,000,000 appointments with cardiologists---somebody gets second best, and third, and down the line.

Hope this helps

[tophcfa]

The part about switching back to traditional Medicare, however, is unfortunately true.

Doc, why is that unfortunate? Insurance would be way too expensive if people didn’t have to pay for it until they need it. If everyone was allowed to get a less expensive Advantage plan when they are healthy, and then switch to a Medigap plan without underwriting when they come down with a serious and expensive illness, traditional Medicare supplemental plan prices would skyrocket.

[MSGirl]

Medicare Advantage is really named incorrectly, it should be named Medicare Disadvantage. I’ve heard that 30% of all claims are routinely denied. If your doctor prescribes 12 treatments, they might only approve 8 treatments. You are also restricted to going to clinics that you probably wouldn’t have chosen on your own.

One of the worst things about Medicare Advantage is after one year of switching to Medicare Advantage, you have to medically qualify to switch back to Original Medicare. If you’re health declined, then you could be stuck with Medicare Advantage for life. The best option is to stay on Original Medicare with a good supplement.

You HEARD incorrectly. Unless you know for sure because you experienced it, then why bring it up? Medicare Advantage plans follow traditional Medicare. If a procedure is denied with a Medicare Advantage plan, then it’s because it didn’t follow Medicare guidelines. So the same procedure would be denied with traditional Medicare. You actually have one year to decide if a Medicare advantage plan is right for you. At that time you can switch back without going through hoops.

[golfing eagles]

Remember the game to find out which one doesn't belong?
So which is it?

Either TVH has a highly competitive pay and incentive package similar to other offers in Florida...

Or

There is no way it can compete with the package being offered elsewhere in addition to the disadvantages of this being isolated and old people.

Remember I posted competitive for THIS AREA. And that was 10 years ago. Remember I posted TIMES CHANGE. So yes, it WAS competitive at the time, and it is still not poverty level. However, other areas can afford to make better offers. So, if you were still practicing, late 30's and had 3 kids ages 3-10, which offer would you take-----TVH in a community of 90% Medicare and very little geared toward kids and families for say 300K, or Tampa/Clearwater with young people, families, proximity to the gulf, and a better private payer mix for closer to 500K?????

PS: Did you get that postcard as well? Many of these offers are truly astronomical.

[golfing eagles]

Doc, why is that unfortunate? Insurance would be way too expensive if people didn’t have to pay for it until they need it. If everyone was allowed to get a less expensive Advantage plan when they are healthy, and then switch to a Medigap plan without underwriting when they come down with a serious and expensive illness, traditional Medicare supplemental plan prices would skyrocket.

It is only unfortunate for those that thought they would be OK with an advantage plan, only to find out it wasn't the right fit for their medical problems.

[tophcfa]

Kind of depends on where in Illinois. Some rural areas may still have an 85 year old GP making house calls in his horse and buggy :1rotfl::1rotfl::1rotfl:

Same in every state. We live in rural western Ma, where good health care is hard to come by if you need a highly qualified specialist or are on a short timeline. We use local health care for our minor usual and customary health needs that don’t require immediate care. If one of us comes down with a more serious health care need, we hit the Massachusetts Turnpike eastbound to Boston where we have in network access to the likes of Mass General, Brigham and Women’s, Beth Israel Deaconess, Dana Farber, etc…. There are many great things about living in a rural area, but access to health care isn’t one of them.

[blueash]

Forty years ago, there were 120,000 applications for 17,000 medical school seats. Five years ago there were only 25,000 applications.

Sometimes what you read on TOTV is opinion. Sometime people claim to be experts and are so wrong, so wrong.

And here was a statement that is in the so wrong category and easily checked.
See the graph below from https://www.aamc.org/media/9581/download?attachment

Forty years ago, 1983 there were about 36000 applicants for US allopathic medical schools. About 25000 were first time attempting to gain admission and about 11000 were trying again after previously failing to gain admission.

Five years ago, 2018, there were about 52000 applicants for US allopathic schools, 39000 were first time and 13000 repeats.

Please, readers, do not repeat the false claim that the number of people applying to medical school is down from 120000 to 25000. It is blatantly, totally , completely untrue.

[tophcfa]

It is only unfortunate for those that thought they would be OK with an advantage plan, only to find out it wasn't the right fit for their medical problems.

Poor long term planning trying to save a buck in the short run.

[Topspinmo]

Village Health will not accept our State Government Medicare Advantage plan, and our Primary Physician of 20 plus years has retired. Ironically, the doctor recommended by our retiring physician left for “greener pastures” before we could even get into to see him. Makes you wonder what is happening to our medical system that has such a shortage of doctors, nurses and other medical technicians. We would prefer an internal medicine doctor where we could develop a patient/doctor relationship but we have already found it challenging to find any doctor taking on new patients in the surrounding area. Perhaps the Walk-in emergency clinics with doctors and physician Assistants are the only solution now available for medical care in the area. Unless you are having a heart attack, we have marked off the hospital’s E.R. as a place of very last resort.


I thought AHC act was supposed fix the health care system?

[Burgy]

I agree with you. I also think too many snowbirds can't let lose of their up north plans expecting coverage here. Perhaps they should change to a local advantage plan that may cover up north too.

[golfing eagles]

Sometimes what you read on TOTV is opinion. Sometime people claim to be experts and are so wrong, so wrong.

And here was a statement that is in the so wrong category and easily checked.
See the graph below from https://www.aamc.org/media/9581/download?attachment

Forty years ago, 1983 there were about 36000 applicants for US allopathic medical schools. About 25000 were first time attempting to gain admission and about 11000 were trying again after previously failing to gain admission.

Five years ago, 2018, there were about 52000 applicants for US allopathic schools, 39000 were first time and 13000 repeats.

Please, readers, do not repeat the false claim that the number of people applying to medical school is down from 120000 to 25000. It is blatantly, totally , completely untrue.

And I found sources that support my position previously. Maybe I was wrong in the actual number, my source might have been in error. No matter. So, using the numbers you posted above, of the "increase" in applicants from 36,000 to 52,000, how many are Americans who attended American Universities and how many are learning English as a second language?

[Pres1939]

First correction for this thread:

What makes you think "they" won't "pay"????? Are you privy to some information that I'm not?

When they first started TVH, one of my partners and I were invited to join. I retired, he took a job as medical director at one of the centers. This was 10 years ago and the compensation package was more than competitive for this area. It has kept up with inflation, and there are other incentives that I'm not at liberty to discuss.

Second correction:

"Specialists are more important anyway."

For some things, mostly procedures and certain specific conditions. For most conditions, a "specialist" is superfluous. Unfortunately, due to the proliferation of lawsuits, even well trained internists are quick to make an unnecessary referral to reduce liability.

Third correction:

There is turnover in medicine everywhere you go. Due to an increasing and aging population, there is a relative shortage of doctors , nurses, and almost all other health care workers. Forty years ago, there were 120,000 applications for 17,000 medical school seats. Five years ago there were only 25,000 applications. Our best and brightest are avoiding careers in medicine due to the many years of education, the increase in litigation, and relatively low compensation in comparison to other careers available to them.

Fourth correction:

Medicare advantage plans pay the same as traditional Medicare. Their savins is from limiting panels of physicians, deals on pharmaceuticals and medical supply companies, etc.

The Villages is a challenging location for recruitment of physicians. If they are younger with young families, there is little to attract them here. Therefore, we usually get older physicians near the end of their careers, contributing to the "revolving door". In addition, offers are VERY competitive elsewhere. As an example, even though I'm retired for 8+ years, I still get contacted with offers every week. Yesterday's was from the Tampa area, offered a 4 day work week, limited patient schedule, no "on call" responsibilities, 6 weeks vacation, and a compensation package of about $500,000/year. There is no way TVH can compete with that.

More corrections may be forthcoming as posts with "inaccurate" information accumulate.

Very thorough response to the OP. I have a Medicare Advantage plan (Devoted North Florida Core HMO), and they have been wonderful to deal with.

[Ponygirl]

Sometimes what you read on TOTV is opinion. Sometime people claim to be experts and are so wrong, so wrong.

And here was a statement that is in the so wrong category and easily checked.
See the graph below from https://www.aamc.org/media/9581/download?attachment

Forty years ago, 1983 there were about 36000 applicants for US allopathic medical schools. About 25000 were first time attempting to gain admission and about 11000 were trying again after previously failing to gain admission.

Five years ago, 2018, there were about 52000 applicants for US allopathic schools, 39000 were first time and 13000 repeats.

Please, readers, do not repeat the false claim that the number of people applying to medical school is down from 120000 to 25000. It is blatantly, totally , completely untrue.

Thank you blueash

I too was confused abt the stats for people applying to medical school.

If you use the 52,000 number for 17,000 slots. That’s an acceptance rate of over 32%.

In actuality the number for acceptance is closer to 4%

Some exact numbers are: My son went to George Washington university med school. 15.216 applications for 181 slots. Acceptance rate of 1.09%

[rustyp]

OP, IMHO, the first thing you need to do is call your health care insurance and get a list of local providers that accept your ADVANTAGE plan, then you will need to start calling these doctors to see if they are accepting new patients. Also, IMHO, you might ask to see if it is possible to get back to original Medicare and supplemental without a huge cost increase, as there are a lot more doctors accepting original Medicare and supplemental than Advantage plans.
Hope this helps.

It is only unfortunate for those that thought they would be OK with an advantage plan, only to find out it wasn't the right fit for their medical problems.

Historically, most Medicare beneficiaries have chosen to receive their benefits through traditional Medicare, but enrollment in Medicare Advantage plans has grown rapidly over the past decade. Forty-five percent of Medicare beneficiaries are enrolled in Medicare Advantage plans in 2022, a share that is projected to rise to more than 50 percent by 2025.

I'll also offer up the fact that a portion of seniors on traditional Medicare have not considered a choice due to the fact they stick with the plan their company provides (usually Medicare plus a supplement) as part of their retirement package.

Makes me wonder if these Advantage Plans are so horrible why is their popularity growing ?

[golfing eagles]

Thank you blueash

I too was confused abt the stats for people applying to medical school.

If you use the 52,000 number for 17,000 slots. That’s an acceptance rate of over 32%.

In actuality the number for acceptance is closer to 4%

Some exact numbers are: My son went to George Washington university med school. 15.216 applications for 181 slots. Acceptance rate of 1.09%

As usual, statistics don't lie, but people are "confused" with statistics. Blue and I were referring to the number of individuals that applied 40 years ago and more recently. She cited 36,000 in 1983, I remembered 125,000 from something I've seen in the past. She may very well be right in the number, but I believe the point I was making is valid regardless.

The statistics cited in the post above are for applications, not individuals. Most candidates apply to 5,10,15 or even more schools, so the total number of applications far exceeds the number of applicants.

[SusanStCatherine]

I thought AHC act was supposed fix the health care system?

Here's my take on why the ACA did not fix the healthcare system.

I have often heard the ACA was designed to fail so that the American general public would be asking for total government control - "Medicare for All."

Before the ACA, there were many people with pre-existing health conditions who could not obtain health insurance or afford healthcare. The ACA addressed that by offering coverage to all and requiring everyone to have coverage. Requiring all to pay was later found unconstitutional. Therfore, many people don't pay into it, and the premiums and deductibles have skyrocketed. People who can afford to pay will purchase the health insurance, while others either qualify for subsidies or skip coverage. Basically those who have $ are paying for those who do not.

I know my family has suffered these astronomical premiums and never reach our deductible. We do not yet qualify for Medicare. We did not have an employer plan and are limited to the plans on the ACA exchange. Here in Florida we have Florida Blue and I have not found a decent provider to take it. As we approach age 65, the premiums skyrocket based on what I consider a pre-existing condition I cannot control - my age. None of the other conditions matter. Nevermind if we are extremely healthy and in our early sixties. Yet those who are most likely to use the health insurance (those with pre-existing conditions), are not charged any more for their high risk.

Government regulations and insurance company involvement drive up the cost of healthcare. Insurance companies donate to government office holders and this cycle continues.

You could say the ACA was successful in making health insurance affordable to those who could not obtain it before. Insurance is not healthcare, as many found out. Some of these people have subsidies for low premiums and deductibles and yet they still cannot afford the bills.

That's my take from what I've seen FWIW, and I'm sure some will disagree.

[Glarramendy]

Village Health will not accept our State Government Medicare Advantage plan, and our Primary Physician of 20 plus years has retired. Ironically, the doctor recommended by our retiring physician left for “greener pastures” before we could even get into to see him. Makes you wonder what is happening to our medical system that has such a shortage of doctors, nurses and other medical technicians. We would prefer an internal medicine doctor where we could develop a patient/doctor relationship but we have already found it challenging to find any doctor taking on new patients in the surrounding area. Perhaps the Walk-in emergency clinics with doctors and physician Assistants are the only solution now available for medical care in the area. Unless you are having a heart attack, we have marked off the hospital’s E.R. as a place of very last resort.

Try a family nurse practitioner.
Or PA.
My personal belief you can’t go wrong with either.

[golfing eagles]

Try a family nurse practitioner.
Or PA.
My personal belief you can’t go wrong with either.

Unfortunately , you can.

[GoRedSox!]

Regarding the ACA, I don't think the costliest increase was the elimination of pre-existing conditions...because if the plans are affordable, many people will buy them and not have pre-existing conditions. But the elimination of the individual mandate ensured that the population on ACA plans were sicker and costlier individuals. If everyone was required to have a plan, the costs would be spread over more plans with healthier/younger people.

I know some people will say that the healthy are subsiding the unhealthy. While this may be true, none of us really knows when we may go from being healthy to not as healthy.

So much of the total medical spend in this country is for people in the final year of life. So no matter what, we all pay for that.

As for Florida, I believe that there is a math problem which manifests itself in several ways, and one of them is health care. There are so many people moving here and the growth has been so fast that medical care can't keep up with population growth. The same percentage of physicians would have to be moving here as the rest of the population, but I don't think physicians are as likely to give up a job or location they have been in as the rest of the population so this is one of several areas FL has to play catch up.

I am stating my opinion, not claiming to know it all or stating hard facts or statistics. As always and as my wife will happily verify, I could be wrong.

[kkingston57]

We've lived here for about a year and a half now. The problem with health care around here was explained to me as basically being the snowbird situation. Half the year, there aren't enough patients to attract quality doctors and the other half there are too many patients for the few doctors that are here. I was told that if it was a life threatening situation, do whatever you can to get to Gainesville. Ironically, several months later our primary care doctor referred my wife to his colleague who in turn referred her to another specialist who sent her to Gainesville where she got the treatment she needed.

Small part of the problem. In meantime developers including others in the area are building homes for retirees and very little is being developed for the worker bees including professionals. A good new doctor(except for geriatrics) has 0 incentive to work here.

[kkingston57]

First correction for this thread:

What makes you think "they" won't "pay"????? Are you privy to some information that I'm not?

When they first started TVH, one of my partners and I were invited to join. I retired, he took a job as medical director at one of the centers. This was 10 years ago and the compensation package was more than competitive for this area. It has kept up with inflation, and there are other incentives that I'm not at liberty to discuss.

Second correction:

"Specialists are more important anyway."

For some things, mostly procedures and certain specific conditions. For most conditions, a "specialist" is superfluous. Unfortunately, due to the proliferation of lawsuits, even well trained internists are quick to make an unnecessary referral to reduce liability.

Third correction:

There is turnover in medicine everywhere you go. Due to an increasing and aging population, there is a relative shortage of doctors , nurses, and almost all other health care workers. Forty years ago, there were 120,000 applications for 17,000 medical school seats. Five years ago there were only 25,000 applications. Our best and brightest are avoiding careers in medicine due to the many years of education, the increase in litigation, and relatively low compensation in comparison to other careers available to them.

Fourth correction:

Medicare advantage plans pay the same as traditional Medicare. Their savins is from limiting panels of physicians, deals on pharmaceuticals and medical supply companies, etc.

The Villages is a challenging location for recruitment of physicians. If they are younger with young families, there is little to attract them here. Therefore, we usually get older physicians near the end of their careers, contributing to the "revolving door". In addition, offers are VERY competitive elsewhere. As an example, even though I'm retired for 8+ years, I still get contacted with offers every week. Yesterday's was from the Tampa area, offered a 4 day work week, limited patient schedule, no "on call" responsibilities, 6 weeks vacation, and a compensation package of about $500,000/year. There is no way TVH can compete with that.

More corrections may be forthcoming as posts with "inaccurate" information accumulate.

Good response especially your last paragraph.

[Cliff Fr]

Both my wife and I are on an Advantage plan and are satisfied with it. We live outside the Villages in the Ocala area. We both have been able to get referrals to specialists when needed. We've also been to an urgent care center and the PA there was also very good. We both use the annual blood panel test to modify our lifestyle and eating habits as necessary in lieu of taking a script to cover up a symptom.

[ThirdOfFive]

And I found sources that support my position previously. Maybe I was wrong in the actual number, my source might have been in error. No matter. So, using the numbers you posted above, of the "increase" in applicants from 36,000 to 52,000, how many are Americans who attended American Universities and how many are learning English as a second language?
Many thanks for your informed replies in this thread. Learned a few (quite a few) things I didn't know.

Quite interested in your take on foreign applicants for local positions, especially as we have a niece in her second year of residency in Bangkok, Thailand, and who is looking to emigrate to America once her degree is finished. I heard that the local hospital is (or was) offering $10,000 for a referral of any applicant for the position of MD, if it would be his or her first position after fulfilling degree requirements and if that person is hired. She is looking at coming to Florida, specifically here.

Do you know anything about this?

[golfing eagles]

Many thanks for your informed replies in this thread. Learned a few (quite a few) things I didn't know.

Quite interested in your take on foreign applicants for local positions, especially as we have a niece in her second year of residency in Bangkok, Thailand, and who is looking to emigrate to America once her degree is finished. I heard that the local hospital is (or was) offering $10,000 for a referral of any applicant for the position of MD, if it would be his or her first position after fulfilling degree requirements and if that person is hired. She is looking at coming to Florida, specifically here.

Do you know anything about this?

Sorry, not much. It used to be called the "fifth pathway", I don't know if that's changed. In general, I believe, even if a doctor completed a residency internationally, even if they were in practice for a while, they still had to repeat their residency in an accredited US hospital program. This may have changed. I'm sure if you niece is contemplating this action she will have more up to date and accurate information than I do.

[ThirdOfFive]

Sorry, not much. It used to be called the "fifth pathway", I don't know if that's changed. In general, I believe, even if a doctor completed a residency internationally, even if they were in practice for a while, they still had to repeat their residency in an accredited US hospital program. This may have changed. I'm sure if you niece is contemplating this action she will have more up to date and accurate information than I do.
Thanks.

[mntlblok]

Ok, I'll start, maybe ski bum can add to this. First of all, it is a very complex issue with a long history. The problem starts in 1966 with "The Great Society" and the formation of Medicare and Medicaid, as well as the birth of health care insurance as a near necessity and the massive proliferation of lawyers and litigation. As opposed to the "old days" when an office visit was cheap, there were now 3rd party payers that shoveled taxpayer money at providers. We had records on an index card from the stone age prior to EMRs and an office visit was $3.00. Going further back, my mother saved her obstetricians bill from 1947 and all pre-natal, delivery and post-partum care was a whopping $45.50.

Now, along with these government programs came government regulation that further drove up the cost of care. And of course , in order to pay, they wanted a specific diagnosis. This led to a complex system of charge coding under CPT and diagnostic coding under ICDM. To get these diagnoses, the technology exploded as well as specialists and sub-specialists, further driving up cost. So about 1972 those "wise" men in DC decided to "capitate" medical schools---pay them $$$$ to increase total medical school class size from about 9,000 to over 17,000. Remember, our population was only about 210 million back then. So with tons of taxpayer money on the table, almost all 100+ medical schools double their class size. But just like major league pitchers on a 5 day rotation and 20 expansion teams, this was the first dilution of the talent pool. The theory was that more doctors would drive competition up and cost down. However, it turns out, that more doctors just make more work for more doctors, particularly higher cost specialists. Then, technology exploded----ultrasound, CTs, MRIs, endoscopy, cardiac catheterizations, bypass surgery. And every new procedure was dumped into Medicare part B at an exorbitant starting cost, diluting the $$$ pool for routine primary care. The litigation forced doctors to order these expensive imaging procedures and refer to specialists, mostly unnecessarily just out of self preservation.

So now the next phase: When I applied to med school, there were 125,000 American graduate applications for 17,000 seats. Between lower physician compensation, increased regulation and increased litigation, our best candidates decided to get an MBA in 2 years and get better salaries rather than spend 7+ more years to start a medical career. That, plus the huge amount of student loans incurred. So once again the talent pool was diluted. Our teaching hospital can no longer fill their programs with American graduates, so they had to turn to FMGs for bodies to fill the space. Some are very good, some are dreadful. My residency program had 14 positions for 3 year Internal Medicine candidates and received 10,000 applications. Nine thousand were from FMGs and went immediately into the garbage. The remaining 1000 were easily pared down to 200 from which 14 were chosen. Now, 45 years later, I recently had reason to look at the staff of that program----much to my surprise I couldn't even pronounce the names of over 1/2 of them.

So now, fast forward to our situation in TV: Diluted talent pool due to the reasons listed above as well as a population that is now 330 million, residency programs filling with FMGs, and a less than desirable area of Florida for young physicians with a young family. Of course medical care is less than spectacular compared with Boston or NY. That doesn't mean it is horrible either. Remember, let's just assume there are 35,000 cardiologists in the US---only one of them is the best---and he can't keep all 120,000,000 appointments with cardiologists---somebody gets second best, and third, and down the line.

Hope this helps

Thank you. Great summary. Had no idea that an MBA was so valuable. I guess I don't hear that much about salaries these days, but had gotten the impression that plenty of science Ph.D.s weren't getting much for their efforts. Had gotten the same sense for engineers. But, I'm very "out of the loop". I've certainly known of a significant number of lawyers who weren't bringing in bucks proportional to the effort involved in acquiring the degree. Have *never* had much of an idea of how the world works, coming up in a less than blue collar environment. When I've seen published average incomes of various medical specialties in "relatively" recent times, nothing was close to 500K. Just checked. Looks like the numbers have nearly doubled since I last took a look. Wow. Physician Starting Salaries by Specialty: 2022 vs. 2021 (https://www.amnhealthcare.com/blog/physician/perm/physician-starting-salaries-by-specialty-2022-vs-2021/)

[blueash]

And I found sources that support my position previously. Maybe I was wrong in the actual number, my source might have been in error. No matter. So, using the numbers you posted above, of the "increase" in applicants from 36,000 to 52,000, how many are Americans who attended American Universities and how many are learning English as a second language?

https://www.aamc.org/media/6116/download?attachment

Less than 2% of successful applicants to US Medical Schools are not US citizens or non permanent resident. Some of those, perhaps many are primary speakers of English. Many others speak English better than those born here. The data does not answer your question as to what undergraduate school these non citizens attended. Would University of Toronto, or McGill, or Oxford be a problem? How about Jamaica.. an English speaking country.

Tell us how you feel about a US citizen attending a non US undergraduate school then applying to a US medical school. Is that a problem for you? You asked about that situation as if it is one. It apparently is not for US medical schools as per the last report I found looking at that exact issue, a higher percentage of US citizens who attended school abroad were admitted to medical school than those that stayed in the USA.

https://www.aamc.org/media/5961/download?attachment

If you want data, the AAMC has a button you can click and they will produce any data set you request if they are able.
Data & Reports | AAMC (https://www.aamc.org/data-reports/topic/admissions#data)

[golfing eagles]

https://www.aamc.org/media/6116/download?attachment

Less than 2% of successful applicants to US Medical Schools are not US citizens or non permanent resident. Some of those, perhaps many are primary speakers of English. Many others speak English better than those born here. The data does not answer your question as to what undergraduate school these non citizens attended. Would University of Toronto, or McGill, or Oxford be a problem? How about Jamaica.. an English speaking country.

Tell us how you feel about a US citizen attending a non US undergraduate school then applying to a US medical school. Is that a problem for you? You asked about that situation as if it is one. It apparently is not for US medical schools as per the last report I found looking at that exact issue, a higher percentage of US citizens who attended school abroad were admitted to medical school than those that stayed in the USA.

https://www.aamc.org/media/5961/download?attachment

If you want data, the AAMC has a button you can click and they will produce any data set you request if they are able.
Data & Reports | AAMC (https://www.aamc.org/data-reports/topic/admissions#data)

I'll just leave that one alone. Clearly, when it comes to these types of issues, we are never going to agree. That's OK, we'll just chalk it up to "diversity".

[Escape Artist]

Village Health will not accept our State Government Medicare Advantage plan, and our Primary Physician of 20 plus years has retired. Ironically, the doctor recommended by our retiring physician left for “greener pastures” before we could even get into to see him. Makes you wonder what is happening to our medical system that has such a shortage of doctors, nurses and other medical technicians. We would prefer an internal medicine doctor where we could develop a patient/doctor relationship but we have already found it challenging to find any doctor taking on new patients in the surrounding area. Perhaps the Walk-in emergency clinics with doctors and physician Assistants are the only solution now available for medical care in the area. Unless you are having a heart attack, we have marked off the hospital’s E.R. as a place of very last resort.

Poor medical care and/or lack of good doctors is the biggest downside of The Villages for me. It’s something I noticed almost immediately after moving here. I had to wait over two months to see a primary care physician then a couple of weeks before my appointment I was informed she had left. Back to square one!

I’ve seen a lot of praise for The Villages, and the Morse family and their genius in planning such a place and the continued expansion but one thing they lacked foresight on was that a predominantly senior population needs a lot of medical care, hospitals, clinics, doctors, nurses, medical technicians, etc. A doctor told me that central Florida just isn’t a place that attracts the best and brightest and those doctors with families don’t relish living amidst a senior community of 125,000 and growing. No, they did not think this aspect through, nor the fact that most seniors are living longer now, many well into their 90’s, and there would not be the “turnover” they anticipated when they made their best laid plans.

[ewstanley]

Poor medical care and/or lack of good doctors is the biggest downside of The Villages for me. It’s something I noticed almost immediately after moving here. I had to wait over two months to see a primary care physician then a couple of weeks before my appointment I was informed she had left. Back to square one!

I’ve seen a lot of praise for The Villages, and the Morse family and their genius in planning such a place and the continued expansion but one thing they lacked foresight on was that a predominantly senior population needs a lot of medical care, hospitals, clinics, doctors, nurses, medical technicians, etc. A doctor told me that central Florida just isn’t a place that attracts the best and brightest and those doctors with families don’t relish living amidst a senior community of 125,000 and growing. No, they did not think this aspect through, nor the fact that most seniors are living longer now, many well into their 90’s, and there would not be the “turnover” they anticipated when they made their best laid plans.

We have been here for almost twenty years.
It has gotten worse in the last several years.
The Villages advertised a new hospital, but now there is no hospital.
Our doctors have all left and was just told that that four radiologists have left the area.
It isn't getting any better and I'm sure it will get worse.

[ThirdOfFive]

We have been here for almost twenty years.
It has gotten worse in the last several years.
The Villages advertised a new hospital, but now there is no hospital.
Our doctors have all left and was just told that that four radiologists have left the area.
It isn't getting any better and I'm sure it will get worse.
"If you build it, they will come".

This shortage is not just in The Villages but in Florida as a whole. Checking the data, no part of Florida has what could be called adequate physician care. The entire state has a shortage of primary physicians and specialty care physicians: no part of the state is expected to have adequate specialist care by 2035 with most of the state having at best 80%. Primary care physician availability outlook is a bit better, but only the southern tip of the state:: Miami, Ft. Lauderdale, etc. are expected to have 100% of adequate primary care physician coverage but this does not extend to the rest of the state. ("Florida’s physician shortage: It’s not just primary care and rural areas", Jarrod Fowler, MHA FMA, Florida Medical Association Website, April 21, 2022).

Why? Who really knows? A couple of things that we DO know however is that people with money and the wherewithal to relocate are fleeing their high-tax, high-crime states like deranged lemmings in search of friendlier surroundings, and for most, those "friendlier surroundings" happens to be spelled FLORIDA. According to data I've read Florida has FOUR TIMES the influx of new people than does the next state in the row, Texas (might be wrong about Texas). These folks are also taking their money, their toys, and most importantly their spending power with them. It has led to some monumental problems at both ends: influx AND outflux. My home state of Minnesota for example as a stable population if you're just counting heads, but the people with the money are the ones scurrying south. They're being replaced mainly by third-worlders, recent immigrants who are steered toward Minnesota by Federal authorities as well as migrant farmhands, in addition to the more-than-sizeable resident population currently on welfare. This is not new: as far back as 2004 there was an article in one of the Twin Cities publications that put a financial value to it and even then it was multiple billions leaving the state every year. Today, with the multiple COVID messes and economic upheaval I'm sure it is far worse.

Second (conjecture on my part) it is probably a lot harder for a doctor to leave his/her practice than it is for a couple of retirees to pack up and skedaddle. Took us maybe three months after we made the decision but we had no notices to give, interviews to arrange, etc. etc. I'm pretty sure that with all that money leaving, the people who were formerly PAID with that money will be leaving as well, just a lot more slowly.

I don't know. That whole COVID thing blindsided a lot of people and the influx of folks to Florida overall, not just TV, has been unprecedented and could not have been planned for. I'm sure the medical situation will improve; maybe not fast enough for some, but it will. After all the money is here.

[retiredguy123]

Try a family nurse practitioner.
Or PA.
My personal belief you can’t go wrong with either.
I don't agree with that at all. I would much prefer to see a medical doctor than a nurse or a physicians assistant.

[GoRedSox!]

"If you build it, they will come".

This shortage is not just in The Villages but in Florida as a whole. Checking the data, no part of Florida has what could be called adequate physician care. The entire state has a shortage of primary physicians and specialty care physicians: no part of the state is expected to have adequate specialist care by 2035 with most of the state having at best 80%. Primary care physician availability outlook is a bit better, but only the southern tip of the state:: Miami, Ft. Lauderdale, etc. are expected to have 100% of adequate primary care physician coverage but this does not extend to the rest of the state. ("Florida’s physician shortage: It’s not just primary care and rural areas", Jarrod Fowler, MHA FMA, Florida Medical Association Website, April 21, 2022).

Why? Who really knows? A couple of things that we DO know however is that people with money and the wherewithal to relocate are fleeing their high-tax, high-crime states like deranged lemmings in search of friendlier surroundings, and for most, those "friendlier surroundings" happens to be spelled FLORIDA. According to data I've read Florida has FOUR TIMES the influx of new people than does the next state in the row, Texas (might be wrong about Texas). These folks are also taking their money, their toys, and most importantly their spending power with them. It has led to some monumental problems at both ends: influx AND outflux. My home state of Minnesota for example as a stable population if you're just counting heads, but the people with the money are the ones scurrying south. They're being replaced mainly by third-worlders, recent immigrants who are steered toward Minnesota by Federal authorities as well as migrant farmhands, in addition to the more-than-sizeable resident population currently on welfare. This is not new: as far back as 2004 there was an article in one of the Twin Cities publications that put a financial value to it and even then it was multiple billions leaving the state every year. Today, with the multiple COVID messes and economic upheaval I'm sure it is far worse.

Second (conjecture on my part) it is probably a lot harder for a doctor to leave his/her practice than it is for a couple of retirees to pack up and skedaddle. Took us maybe three months after we made the decision but we had no notices to give, interviews to arrange, etc. etc. I'm pretty sure that with all that money leaving, the people who were formerly PAID with that money will be leaving as well, just a lot more slowly.

I don't know. That whole COVID thing blindsided a lot of people and the influx of folks to Florida overall, not just TV, has been unprecedented and could not have been planned for. I'm sure the medical situation will improve; maybe not fast enough for some, but it will. After all the money is here.The US Census Department's American Community Survey just came out, and Florida is, indeed, the top destination for domestic migration with over 740,000 people moving in. However, what is far less discussed is that almost 500,000 people moved out of Florida, and the state is one of the top outbound states as well as inbound. It's still a net domestic migration of about 250,000, but that is still a lot of people leaving. Interestingly, medical care is one of the primary reasons given for leaving, along with high cost of living and insurance premiums.

[Blueblaze]

Obamacare didn't ruin medical care in America. It just drove the last nail in the coffin.

The road to ruin started in WW2 when the gooberment enacted wage and price controls when all the labor was off fighting a war. Business used the only tool in the toolshed to attract workers -- free hospitalization insurance. To this day, we remain the only country in the world where most people get their health insurance through their employer.

... Which meant that the moment someone retired, they lost their medical insurance, right at the moment when they needed it most. So the gooberment stuck a bandaid on it and created Medicare. Like all other medical insurance at the time, it only covered hospitalization.

Then, in the 80's the bright boys at Blue Cross came up with a brilliant scheme to sell everybody on the lunatic notion that we should buy insurance to cover ordinary doctor visits. It was like buying insurance for groceries, but like the rubes in any scam, we all bought into the idea of "free stuff" and joined an HMO.

...Which, in addition to driving the paperwork costs through the ceiling, caused doctors to notice the deep pockets of the insurance companies. Prices were adjusted accordingly, and now NOBODY could afford a doctor without a "healthcare" plan. For instance, the "well baby" appointments for my 1981 daughter prior to the invention of the HMO was $15. Once we were forced to join "Prucare", it still cost $15 -- but now the doctor billed Blue Cross another $100, which was equivalent to about $500 in the 80's.

"Heathcare" became so outrageously expensive that Bush expended Medicare to include doctors visits -- and started charging seniors the cost of a doctor's visit every month for the privilege.

Then, Obama noticed that the average "healthcare" policy in America was over $15,000, and about half the people in America couldn't afford it unless they worked for a fortune-500 company who could. So he nailed the last nail, and created Obamacare, to "insure" that every home in America was forced to pay at least $5000 a year (or a $500 fine) for a $10,000 deductible and a "network" of the worst doctors in America.

Now, everybody's gotten into the act. I just paid $3000 to a vet to remove a splinter from my dog's throat, because I don't carry pet "health" insurance. My Dentist just charged United $450 to clean my teeth and presented me with a $5000 "treatment plan" to replace a bridge that hasn't caused me a moment's problem in 40 years.

Boy, I can't wait for some moron to suggest that we need insurance for groceries in this high-inflation environment that our googerment created. How about you?

[GoRedSox!]

Obamacare didn't ruin medical care in America. It just drove the last nail in the coffin.

The road to ruin started in WW2 when the gooberment enacted wage and price controls when all the labor was off fighting a war. Business used the only tool in the toolshed to attract workers -- free hospitalization insurance. To this day, we remain the only country in the world where most people get their health insurance through their employer.

... Which meant that the moment someone retired, they lost their medical insurance, right at the moment when they needed it most. So the gooberment stuck a bandaid on it and created Medicare. Like all other medical insurance at the time, it only covered hospitalization.

Then, in the 80's the bright boys at Blue Cross came up with a brilliant scheme to sell everybody on the lunatic notion that we should buy insurance to cover ordinary doctor visits. It was like buying insurance for groceries, but like the rubes in any scam, we all bought into the idea of "free stuff" and joined an HMO.

...Which, in addition to driving the paperwork costs through the ceiling, caused doctors to notice the deep pockets of the insurance companies. Prices were adjusted accordingly, and now NOBODY could afford a doctor without a "healthcare" plan. For instance, the "well baby" appointments for my 1981 daughter prior to the invention of the HMO was $15. Once we were forced to join "Prucare", it still cost $15 -- but now the doctor billed Blue Cross another $100, which was equivalent to about $500 in the 80's.

"Heathcare" became so outrageously expensive that Bush expended Medicare to include doctors visits -- and started charging seniors the cost of a doctor's visit every month for the privilege.

Then, Obama noticed that the average "healthcare" policy in America was over $15,000, and about half the people in America couldn't afford it unless they worked for a fortune-500 company who could. So he nailed the last nail, and created Obamacare, to "insure" that every home in America was forced to pay at least $5000 a year (or a $500 fine) for a $10,000 deductible and a "network" of the worst doctors in America.

Now, everybody's gotten into the act. I just paid $3000 to a vet to remove a splinter from my dog's throat, because I don't carry pet "health" insurance. My Dentist just charged United $450 to clean my teeth and presented me with a $5000 "treatment plan" to replace a bridge that hasn't caused me a moment's problem in 40 years.

Boy, I can't wait for some moron to suggest that we need insurance for groceries in this high-inflation environment that our googerment created. How about you?As I was reading through your post, I began thinking of how much it costs for Vet expenses each year for our dogs and sure enough, you mentioned it later in your post. Our dog had a bout with a auto-immune disorder called IMPA last year, and I am happy he recovered but 3 days in the pet hospital and testing, treatment and medicine cost about $9,000. Even if they stay healthy, the annual cost of checkups, vaccines, heartworm, flea and tick prevention....we honestly spend more on our dogs' healthcare than we do our own (knock on wood).

I worked in the health insurance business for 25 years. In my opinion, there are too many profit centers in the health care delivery universe. I am not anti-capitalist, and anyone who has invested in health insurance companies in this century has made a lot of money. But it is simply a fact that when so many publicly-traded companies such as drug companies, durable medical equipment, ambulance, even for profit hospitals and many more all have a fiduciary responsibility to their shareholders, patient care cannot be the number one priority. So many physician groups are being bought up by hospital systems and conglomerates. We are not headed in the right direction.

You are 100% right, in my opinion, about tying health insurance to your job. It shouldn't be and in 2023, there is no logical reason for that.

[ThirdOfFive]

The US Census Department's American Community Survey just came out, and Florida is, indeed, the top destination for domestic migration with over 740,000 people moving in. However, what is far less discussed is that almost 500,000 people moved out of Florida, and the state is one of the top outbound states as well as inbound. It's still a net domestic migration of about 250,000, but that is still a lot of people leaving. Interestingly, medical care is one of the primary reasons given for leaving, along with high cost of living and insurance premiums.
Reasonable, considering how insurance premiums for the most part are off the charts and doctors, especially specialists, are indeed scarce.

We were lucky: after a particularly bad experience with an overbearingly arrogant third-worlder who seemed to have graduated from the Josef Mengele school of doctor-patient relations, we found one who we are satisfied with, at least for the primary physician stuff. We see an NP, whose work is overseen by the doctor, and are quite satisfied thus far. Not so happy with the specialists but I've been seen by Mayo Clinic cardiologists for the past two decades and Jacksonville isn't that far away.

Sometimes though it seems we ignore answers that are right under our noses. Many other countries have doctor shortages but some don't, at least to the extent that we do. The government of Thailand for example will assist outstanding students who otherwise couldn't afford medical school, paying tuition and expenses. The payoff is that such students, once they attain their M.D., must work for the government in government-run hospitals and clinics for a certain period of time before setting off on their own. Such doctors are free to set up their own practices during the time-periods when they're not working for the government, and many do, moving into their established practices full-time once their obligation to the government is fulfilled. It has resulted in what is essentially a two-tier health care system there, with day-to-day care for those who otherwise could not afford it available at the government-run hospitals and clinics. That does NOT mean bad care however. Personal experience: my wife and I were partying with some of her friends one night. Hot over there in April and a lot of the guys, me included, shed our shirts. Next morning we were scheduled to go on a van trip upcountry to some park or other. I woke up that morning with a whole lot of red pinprick-looking things from the waist up and knees down. Didn't think much of it, but by 10:00 AM they were the size of dimes. At noon they were quarter-sized and itched like hell. The crew decided to stop at a small government hospital near the town we were going. It was a Saturday so there were quite a few people waiting, but they moved me to the front of the line. I was examined by a doctor who prescribed a salve and a drug. Turned out I had been bitten the night before by an insect too small to see, one that Thais are not affected by but we foreigners are. He said that the itching would be gone by evening and the splotches would be gone in 3-4 days. Right on both counts. We stopped and paid the bill on the way out. E.R., Doctor exam, and meds came to a total of 112 baht. About $4 American.

Why couldn't something like that work here, on a national or state level, or both?

[kingofbeer]

Obamacare didn't ruin medical care in America. It just drove the last nail in the coffin.

The road to ruin started in WW2 when the gooberment enacted wage and price controls when all the labor was off fighting a war. Business used the only tool in the toolshed to attract workers -- free hospitalization insurance. To this day, we remain the only country in the world where most people get their health insurance through their employer.

... Which meant that the moment someone retired, they lost their medical insurance, right at the moment when they needed it most. So the gooberment stuck a bandaid on it and created Medicare. Like all other medical insurance at the time, it only covered hospitalization.

Then, in the 80's the bright boys at Blue Cross came up with a brilliant scheme to sell everybody on the lunatic notion that we should buy insurance to cover ordinary doctor visits. It was like buying insurance for groceries, but like the rubes in any scam, we all bought into the idea of "free stuff" and joined an HMO.

...Which, in addition to driving the paperwork costs through the ceiling, caused doctors to notice the deep pockets of the insurance companies. Prices were adjusted accordingly, and now NOBODY could afford a doctor without a "healthcare" plan. For instance, the "well baby" appointments for my 1981 daughter prior to the invention of the HMO was $15. Once we were forced to join "Prucare", it still cost $15 -- but now the doctor billed Blue Cross another $100, which was equivalent to about $500 in the 80's.

"Heathcare" became so outrageously expensive that Bush expended Medicare to include doctors visits -- and started charging seniors the cost of a doctor's visit every month for the privilege.

Then, Obama noticed that the average "healthcare" policy in America was over $15,000, and about half the people in America couldn't afford it unless they worked for a fortune-500 company who could. So he nailed the last nail, and created Obamacare, to "insure" that every home in America was forced to pay at least $5000 a year (or a $500 fine) for a $10,000 deductible and a "network" of the worst doctors in America.

Now, everybody's gotten into the act. I just paid $3000 to a vet to remove a splinter from my dog's throat, because I don't carry pet "health" insurance. My Dentist just charged United $450 to clean my teeth and presented me with a $5000 "treatment plan" to replace a bridge that hasn't caused me a moment's problem in 40 years.

Boy, I can't wait for some moron to suggest that we need insurance for groceries in this high-inflation environment that our googerment created. How about you?


Medicare Part B covers doctor's visits and this was part of the Medicare act passed in 1965. Not sure which President Bush you are referring to. You seem to be ranting IMHO.

[mntlblok]

Obamacare didn't ruin medical care in America. It just drove the last nail in the coffin.

The road to ruin started in WW2 when the gooberment enacted wage and price controls when all the labor was off fighting a war. Business used the only tool in the toolshed to attract workers -- free hospitalization insurance. To this day, we remain the only country in the world where most people get their health insurance through their employer.

... Which meant that the moment someone retired, they lost their medical insurance, right at the moment when they needed it most. So the gooberment stuck a bandaid on it and created Medicare. Like all other medical insurance at the time, it only covered hospitalization.

Then, in the 80's the bright boys at Blue Cross came up with a brilliant scheme to sell everybody on the lunatic notion that we should buy insurance to cover ordinary doctor visits. It was like buying insurance for groceries, but like the rubes in any scam, we all bought into the idea of "free stuff" and joined an HMO.

...Which, in addition to driving the paperwork costs through the ceiling, caused doctors to notice the deep pockets of the insurance companies. Prices were adjusted accordingly, and now NOBODY could afford a doctor without a "healthcare" plan. For instance, the "well baby" appointments for my 1981 daughter prior to the invention of the HMO was $15. Once we were forced to join "Prucare", it still cost $15 -- but now the doctor billed Blue Cross another $100, which was equivalent to about $500 in the 80's.

"Heathcare" became so outrageously expensive that Bush expended Medicare to include doctors visits -- and started charging seniors the cost of a doctor's visit every month for the privilege.

Then, Obama noticed that the average "healthcare" policy in America was over $15,000, and about half the people in America couldn't afford it unless they worked for a fortune-500 company who could. So he nailed the last nail, and created Obamacare, to "insure" that every home in America was forced to pay at least $5000 a year (or a $500 fine) for a $10,000 deductible and a "network" of the worst doctors in America.

Now, everybody's gotten into the act. I just paid $3000 to a vet to remove a splinter from my dog's throat, because I don't carry pet "health" insurance. My Dentist just charged United $450 to clean my teeth and presented me with a $5000 "treatment plan" to replace a bridge that hasn't caused me a moment's problem in 40 years.

Boy, I can't wait for some moron to suggest that we need insurance for groceries in this high-inflation environment that our googerment created. How about you?

What an edifying post. I was a ware of parts of it, but that ties it all together nicely for me. Not picturing a lot of ways out of it though, especially given the record of those making the rules. :-(

Gooberment. I like that. Except that it maybe leans a little too heavily towards incompetence when corruption would seem, to me, to be the greater driver.

[Blueblaze]

Medicare Part B covers doctor's visits and this was part of the Medicare act passed in 1965. Not sure which President Bush you are referring to. You seem to be ranting IMHO.

You're right. Bush's contribution was part "D" -- drugs.

Don't see how that changes much, though.

What I can't understand is why everyone is not ranting about this. Must be all that "free stuff"we got.

[golfing eagles]

Obamacare didn't ruin medical care in America. It just drove the last nail in the coffin.

The road to ruin started in WW2 when the gooberment enacted wage and price controls when all the labor was off fighting a war. Business used the only tool in the toolshed to attract workers -- free hospitalization insurance. To this day, we remain the only country in the world where most people get their health insurance through their employer.

... Which meant that the moment someone retired, they lost their medical insurance, right at the moment when they needed it most. So the gooberment stuck a bandaid on it and created Medicare. Like all other medical insurance at the time, it only covered hospitalization.

Then, in the 80's the bright boys at Blue Cross came up with a brilliant scheme to sell everybody on the lunatic notion that we should buy insurance to cover ordinary doctor visits. It was like buying insurance for groceries, but like the rubes in any scam, we all bought into the idea of "free stuff" and joined an HMO.

...Which, in addition to driving the paperwork costs through the ceiling, caused doctors to notice the deep pockets of the insurance companies. Prices were adjusted accordingly, and now NOBODY could afford a doctor without a "healthcare" plan. For instance, the "well baby" appointments for my 1981 daughter prior to the invention of the HMO was $15. Once we were forced to join "Prucare", it still cost $15 -- but now the doctor billed Blue Cross another $100, which was equivalent to about $500 in the 80's.

"Heathcare" became so outrageously expensive that Bush expended Medicare to include doctors visits -- and started charging seniors the cost of a doctor's visit every month for the privilege.

Then, Obama noticed that the average "healthcare" policy in America was over $15,000, and about half the people in America couldn't afford it unless they worked for a fortune-500 company who could. So he nailed the last nail, and created Obamacare, to "insure" that every home in America was forced to pay at least $5000 a year (or a $500 fine) for a $10,000 deductible and a "network" of the worst doctors in America.

Now, everybody's gotten into the act. I just paid $3000 to a vet to remove a splinter from my dog's throat, because I don't carry pet "health" insurance. My Dentist just charged United $450 to clean my teeth and presented me with a $5000 "treatment plan" to replace a bridge that hasn't caused me a moment's problem in 40 years.

Boy, I can't wait for some moron to suggest that we need insurance for groceries in this high-inflation environment that our googerment created. How about you?

Unfortunately, I think your wish has already come true. There is an ad on TV for insurance that you are only eligible for if you have BOTH Medicare and Medicaid. It puts $164/mo back in your SS check and gives a monthly allowance for groceries, OTC meds, diapers, vitamins and the like. Guess who must be paying for all that "free stuff"?

[margaretmattson]

I have never been in the medical profession. However, I am quite aware the baby boomers are 20% of the US population. The generation behind us is nearly as large. With these percentages, it is easy for me to understand the shortage in medical professionals. It is not going to get better. The percentage of elderly is too high to make that possible.

In the past few years, I have seen more and more proclaimed frogs forced to leave the Villages for medical reasons. Within ten years, the population of the Villages is going to double. My husband and I have taken note and have made plans to move back to our less populated hometown, when needed. Like those who have left, we do not see how moving back can be avoided. Unless, of course, we both die in our early seventies.

Our country is approaching nearly 1 in 5 retired. Some of us may live to see 1 in 4. It appears medical personnel are carefully scrutinizing the numbers before coming to the Villages. The new hospital is a no go. IMHO, The developer should have used the same thought process before attempting to double the size and population. We will never have enough medical professionals to meet the rapidly rising demand. Call me a pessimist but the numbers speak for themselves. Time will tell.

[Avista]

Interesting that we all live here and have different takes. I've not had any problems with Drs here. I get into my Dr. easily and if he's booked up longer than I care to wait then I am perfectly happy with either of the PAs. My husband switched to Medicare Advantage and loves it. Has seen every Dr. he has wanted to. The plan pays for his gym membership, it pays him to get a 6 month check up, it pays him to have routine screenings...so far it's been very good. About 6 months ago a specialist I regularly saw discharged me because the entire practice was switching over to accepting only Medicare Advantage and I don't have it.

We have been very pleased with our Villages Health and United Medicare Advantage. Have had it for years. We also have an excellent dentist through network.

[kingofbeer]

You're right. Bush's contribution was part "D" -- drugs.

Don't see how that changes much, though.

What I can't understand is why everyone is not ranting about this. Must be all that "free stuff"we got.
I think the medicare premium taken out of Social Security should be eliminated. Premium should be zero for all even for those with high income. Personally, I don't have much confidence in doctors that go to medical school outside of the US. My understanding is that the rate of pay for medical doctors in our area is low and that explains why doctors do not want to work here. I had a long conversation with someone in the medical field who works in Virginia because they are paid twice as much there.

[mntlblok]

My understanding is that the rate of pay for medical doctors in our area is low and that explains why doctors do not want to work here. I had a long conversation with someone in the medical field who works in Virginia because they are paid twice as much there.

I wonder how much the rate of pay for, say, a Villages Health doctor would have to increase in order to entice more of them to come and stay. I also wonder who makes the pay rate decision and on what it is based. Guess I don't even know who "owns" Villages Health. If it is the developer, then I suspect they've thought it through and war gamed it to no end and probably have contingency plans for all scenarios. Reckon they read this TOTV stuff? :-)

[Pugchief]

My understanding is that the rate of pay for medical doctors in our area is low and that explains why doctors do not want to work here. I had a long conversation with someone in the medical field who works in Virginia because they are paid twice as much there.

That's bc the cost of living in VA is much higher than in central FL. The rate of reimbursement in PPOs even varies between the central business district of a large city (where the rent is high and you have to pay staff more) and the distant suburbs of that same city.

[OrangeBlossomBaby]

Obamacare didn't ruin medical care in America. It just drove the last nail in the coffin.

The road to ruin started in WW2 when the gooberment enacted wage and price controls when all the labor was off fighting a war. Business used the only tool in the toolshed to attract workers -- free hospitalization insurance. To this day, we remain the only country in the world where most people get their health insurance through their employer.

... Which meant that the moment someone retired, they lost their medical insurance, right at the moment when they needed it most. So the gooberment stuck a bandaid on it and created Medicare. Like all other medical insurance at the time, it only covered hospitalization.

Then, in the 80's the bright boys at Blue Cross came up with a brilliant scheme to sell everybody on the lunatic notion that we should buy insurance to cover ordinary doctor visits. It was like buying insurance for groceries, but like the rubes in any scam, we all bought into the idea of "free stuff" and joined an HMO.

...Which, in addition to driving the paperwork costs through the ceiling, caused doctors to notice the deep pockets of the insurance companies. Prices were adjusted accordingly, and now NOBODY could afford a doctor without a "healthcare" plan. For instance, the "well baby" appointments for my 1981 daughter prior to the invention of the HMO was $15. Once we were forced to join "Prucare", it still cost $15 -- but now the doctor billed Blue Cross another $100, which was equivalent to about $500 in the 80's.

"Heathcare" became so outrageously expensive that Bush expended Medicare to include doctors visits -- and started charging seniors the cost of a doctor's visit every month for the privilege.

Then, Obama noticed that the average "healthcare" policy in America was over $15,000, and about half the people in America couldn't afford it unless they worked for a fortune-500 company who could. So he nailed the last nail, and created Obamacare, to "insure" that every home in America was forced to pay at least $5000 a year (or a $500 fine) for a $10,000 deductible and a "network" of the worst doctors in America.

Now, everybody's gotten into the act. I just paid $3000 to a vet to remove a splinter from my dog's throat, because I don't carry pet "health" insurance. My Dentist just charged United $450 to clean my teeth and presented me with a $5000 "treatment plan" to replace a bridge that hasn't caused me a moment's problem in 40 years.

Boy, I can't wait for some moron to suggest that we need insurance for groceries in this high-inflation environment that our googerment created. How about you?

So what's your solution?

And why is it so difficult for you to spell the word government?

[Blueblaze]

So what's your solution?

And why is it so difficult for you to spell the word government?

The solution is the same one that was working pretty well 30 years ago when a doctor's visit was $15 and if you had insurance to pay for it, you had to file for it.

In other words, CAPITALISM.

The solution is for Americans to wake up from their fantasy that "free stuff" exists, that gooberment is the solution to every problem, and that the gooberment's money comes from somewhere other than their own pocket. It would also be a big help if people weren't so stupid as to believe that insurance can possibly work to pay for every day expenses rather than catastrophes.

On the day that stupid people quit being stupid, here's how I would unwind the current farce.

1. Add the cost of employer medical benefits to employee income and tax it at the same rate, to end the idiotic link between employment and insurance that the gooberment created.

2. Outlaw as insurance fraud the scam of selling insurance policies for ordinary, everyday expenses, such as doctor visits, car repairs, roof replacements, and groceries.

3. Make it illegal for a practitioner of any sort to deal directly with an insurance company. Require the insured to file their claims AND PAY THE BILLS, to restore their interest in containing the costs.

3. Disband the doctor's union (AMA) to defeat their primary purpose, which is to limit the number of practitioners (the same as any union). Or at least, forbid them from engaging in that practice. Create a federal agency to monitor and publish the complaints and outcomes, to enable the market to remove incompetent doctors.

4. Require all medical facilities and practitioners to publish a complete list of their rates and fees, easily accessible to all patients.

5. Prohibit lawyers from advertising. Pass meaningful tort reform that limits punitive damages and requires plaintiff to pay the cost of frivolous claims.

6. Overhaul the Patent Office. Restore patents to 7 years, as originally intended, and prevent it from allowing patents on new uses for an old drug, or other such ruses for artificially increasing the monopoly period for new discoveries.

7. Overhaul the FDA. Eliminate the FDA's ability to ban anything. It should merely test and publish results, and should be required to complete that testing within one year. Prescriptions should be advisory, not mandatory, as they are in most other countries. You should not need buy a doctor's permission every 6 months for your asthma medicine.

9. End Obamacare, Medicare, and Medicaid. Pay back with interest the money that was confiscated from retirees for Medicare over their working lives, so they can use that money to purchase their own catastrophic major medical insurance on the open market.

10. In order to reduce the cost of becoming a doctor, prohibit any educational institution that receives federal funding from raising their tuitions and fees beyond the federally-published inflation rate.

And, by the way, I'll quit spelling it that way when it goes back to governing instead of goobering.

[margaretmattson]

The solution is the same one that was working pretty well 30 years ago when a doctor's visit was $15 and if you had insurance to pay for it, you had to file for it.

In other words, CAPITALISM.

The solution is for Americans to wake up from their fantasy that "free stuff" exists, that gooberment is the solution to every problem, and that the gooberment's money comes from somewhere other than their own pocket. It would also be a big help if people weren't so stupid as to believe that insurance can possibly work to pay for every day expenses rather than catastrophes.

On the day that stupid people quit being stupid, here's how I would unwind the current farce.

1. Add the cost of employer medical benefits to employee income and tax it at the same rate, to end the idiotic link between employment and insurance that the gooberment created.

2. Outlaw as insurance fraud the scam of selling insurance policies for ordinary, everyday expenses, such as doctor visits, car repairs, roof replacements, and groceries.

3. Make it illegal for a practitioner of any sort to deal directly with an insurance company. Require the insured to file their claims AND PAY THE BILLS, to restore their interest in containing the costs.

3. Disband the doctor's union (AMA) to defeat their primary purpose, which is to limit the number of practitioners (the same as any union). Or at least, forbid them from engaging in that practice. Create a federal agency to monitor and publish the complaints and outcomes, to enable the market to remove incompetent doctors.

4. Require all medical facilities and practitioners to publish a complete list of their rates and fees, easily accessible to all patients.

5. Prohibit lawyers from advertising. Pass meaningful tort reform that limits punitive damages and requires plaintiff to pay the cost of frivolous claims.

6. Overhaul the Patent Office. Restore patents to 7 years, as originally intended, and prevent it from allowing patents on new uses for an old drug, or other such ruses for artificially increasing the monopoly period for new discoveries.

7. Overhaul the FDA. Eliminate the FDA's ability to ban anything. It should merely test and publish results, and should be required to complete that testing within one year. Prescriptions should be advisory, not mandatory, as they are in most other countries. You should not need buy a doctor's permission every 6 months for your asthma medicine.

9. End Obamacare, Medicare, and Medicaid. Pay back with interest the money that was confiscated from retirees for Medicare over their working lives, so they can use that money to purchase their own catastrophic major medical insurance on the open market.

10. In order to reduce the cost of becoming a doctor, prohibit any educational institution that receives federal funding from raising their tuitions and fees beyond the federally-published inflation rate.

And, by the way, I'll quit spelling it that way when it goes back to governing instead of goobering.Most of your solutions, I agree with. However, by law, medical help cannot be denied to anyone. I have been told those who have insurance pay for the costs of those who cannot afford it. Another issue are patients who need long term or extensive care. I believe it is much more complicated than any of us can understand.

[Viperguy]

Medicare Advantage is really named incorrectly, it should be named Medicare Disadvantage. I’ve heard that 30% of all claims are routinely denied. If your doctor prescribes 12 treatments, they might only approve 8 treatments. You are also restricted to going to clinics that you probably wouldn’t have chosen on your own.

One of the worst things about Medicare Advantage is after one year of switching to Medicare Advantage, you have to medically qualify to switch back to Original Medicare. If you’re health declined, then you could be stuck with Medicare Advantage for life. The best option is to stay on Original Medicare with a good supplement.
Is this true? Qualify? How? I was under the impression that I can go back to original anytime in open season. Tell me more.

[Blueblaze]

Most of your solutions, I agree with. However, by law, medical help cannot be denied to anyone. I have been told those who have insurance pay for the costs of those who cannot afford it. Another issue are patients who need long term or extensive care. I believe it is much more complicated than any of us can understand.

Requiring a doctor to provide medical help to someone who can't pay is an unconstitutional confiscation of private property. The fact that a law exists does not make that law constitutional or even right. Charity must be voluntary or it corrodes the humanity of both the recipient and provider, not to mention the society that confiscated the means to provide it. Theft does not become moral just because it's "legal".

There is nothing complicated about reality. Reality only becomes "complicated" when it is in conflict with your notion of "how things oughta be".

[tophcfa]

Is this true? Qualify? How? I was under the impression that I can go back to original anytime in open season. Tell me more.

You can not be denied Medigap (original Medicare Supplement Plan) when you turn 65 and sign up for Medicare based on preexisting conditions. Medigap costs more per month than Advantage plans, but provides way better catastrophic coverage if you have serious and expensive health issues. With most good Medigap plans, you pay a higher monthly premium, but after that you are only required to pay a small annual deductible (about $250) and 100% of everything else is covered (except prescriptions (part D,), hearing, vision, and dental). If you originally sign up for an Advantage plan because you are healthy, and don’t anticipate any significant health expenses, then you can be medically underwritten for preexisting conditions if you want to later switch to a Medigap plan.

Think about it, if there was no medical underwriting for switching, everyone who is healthy would sign up for an Advantage plan to save money. As people age and begin to develop expensive health issues they would simply switch to a Medigap supplemental plan to again save money. That’s not how insurance is designed to work, it’s to cover catastrophic costs. Allowing people to switch, without medical underwriting, would drive up the price of supplemental plans ridiculously high.

Plus, with Medigap, there is no network. You can see any doctor in the USA that accepts original Medicare without a referral. They should rename Medigap, “Snowbird insurance”. Birds don’t need to be worried about being out of network regardless of which of their homes they are currently at. Somehow, which I can’t understand, the Villages Health has managed to only accept Advantage plans. The only way I can figure how they get away with that is that they don’t accept original Medicare (parts A & B). This practice is extremely rare, and is shady at best for a region that theoretically caters to the best interest of senior citizens!

People need to be very careful about properly planning for the long term when turning 65 and not simply think about what their monthly premiums will be immediately. Deciding to go the Advantage plan route, versus a Medigap supplemental plan, can have negative long term financial implications as health needs change over time. There are several very well written books available that go into great detail about the Medicare decision tree one must navigate and how to maximize one’s benefits as well as minimize their risks. I highly recommend anyone nearing the age of Medicare eligibility read a couple of these books and very carefully consider the long term implications of their initial enrollment decision. Hope this helps.

[Caymus]

You can not be denied Medigap (original Medicare Supplement Plan) when you turn 65 and sign up for Medicare based on preexisting conditions. Medigap costs more per month than Advantage plans, but provides way better catastrophic coverage if you have serious and expensive health issues. With most good Medigap plans, you pay a higher monthly premium, but after that you are only required to pay a small annual deductible (about $250) and 100% of everything else is covered (except prescriptions (part D,), hearing, vision, and dental). If you originally sign up for an Advantage plan because you are healthy, and don’t anticipate any significant health expenses, then you can be medically underwritten for preexisting conditions if you want to later switch to a Medigap plan.

Think about it, if there was no medical underwriting for switching, everyone who is healthy would sign up for an Advantage plan to save money. As people age and begin to develop expensive health issues they would simply switch to a Medigap supplemental plan to again save money. That’s not how insurance is designed to work, it’s to cover catastrophic costs. Allowing people to switch, without medical underwriting, would drive up the price of supplemental plans ridiculously high.

Plus, with Medigap, there is no network. You can see any doctor in the USA that accepts original Medicare without a referral. They should rename Medigap, “Snowbird insurance”. Birds don’t need to be worried about being out of network regardless of which of their homes they are currently at. Somehow, which I can’t understand, the Villages Health has managed to only accept Advantage plans. The only way I can figure how they get away with that is that they don’t accept original Medicare (parts A & B). This practice is extremely rare, and is shady at best for a region that theoretically caters to the best interest of senior citizens!

People need to be very careful about properly planning for the long term when turning 65 and not simply think about what their monthly premiums will be immediately. Deciding to go the Advantage plan route, versus a Medigap supplemental plan, can have negative long term financial implications as health needs change over time. There are several very well written books available that go into great detail about the Medicare decision tree one must navigate and how to maximize one’s benefits as well as minimize their risks. I highly recommend anyone nearing the age of Medicare eligibility read a couple of these books and very carefully consider the long term implications of their initial enrollment decision. Hope this helps.

I think I remember the SHINE person tell me that in Massachusetts you can switch without underwriting. That could help some snowbirds.

[golfing eagles]

Requiring a doctor to provide medical help to someone who can't pay is an unconstitutional confiscation of private property. The fact that a law exists does not make that law constitutional or even right. Charity must be voluntary or it corrodes the humanity of both the recipient and provider, not to mention the society that confiscated the means to provide it. Theft does not become moral just because it's "legal".

There is nothing complicated about reality. Reality only becomes "complicated" when it is in conflict with your notion of "how things oughta be".

Almost. A private medical practice does not have to accept anyone as a patient, as long as it is not on the basis of race, religion, sex ,etc. On the other hand, a public facility such as an ER or urgent care facility is bound by COBRA 1987 regulations. They must see any patient, regardless of ability to pay, and can only transfer them to another facility if "stable". The paperwork is Draconian and the penalty for violations even more Draconian.

[kkingston57]

Regarding the ACA, I don't think the costliest increase was the elimination of pre-existing conditions...because if the plans are affordable, many people will buy them and not have pre-existing conditions. But the elimination of the individual mandate ensured that the population on ACA plans were sicker and costlier individuals. If everyone was required to have a plan, the costs would be spread over more plans with healthier/younger people.

I know some people will say that the healthy are subsiding the unhealthy. While this may be true, none of us really knows when we may go from being healthy to not as healthy.

So much of the total medical spend in this country is for people in the final year of life. So no matter what, we all pay for that.

As for Florida, I believe that there is a math problem which manifests itself in several ways, and one of them is health care. There are so many people moving here and the growth has been so fast that medical care can't keep up with population growth. The same percentage of physicians would have to be moving here as the rest of the population, but I don't think physicians are as likely to give up a job or location they have been in as the rest of the population so this is one of several areas FL has to play catch up.

I am stating my opinion, not claiming to know it all or stating hard facts or statistics. As always and as my wife will happily verify, I could be wrong.

Well reasoned rationale. In addition, I bet statistics will show that Floridians seek more medical care than the average populace due to fact that there are more older patients in Florida.

[retiredguy123]

The solution is the same one that was working pretty well 30 years ago when a doctor's visit was $15 and if you had insurance to pay for it, you had to file for it.

In other words, CAPITALISM.

The solution is for Americans to wake up from their fantasy that "free stuff" exists, that gooberment is the solution to every problem, and that the gooberment's money comes from somewhere other than their own pocket. It would also be a big help if people weren't so stupid as to believe that insurance can possibly work to pay for every day expenses rather than catastrophes.

On the day that stupid people quit being stupid, here's how I would unwind the current farce.

1. Add the cost of employer medical benefits to employee income and tax it at the same rate, to end the idiotic link between employment and insurance that the gooberment created.

2. Outlaw as insurance fraud the scam of selling insurance policies for ordinary, everyday expenses, such as doctor visits, car repairs, roof replacements, and groceries.

3. Make it illegal for a practitioner of any sort to deal directly with an insurance company. Require the insured to file their claims AND PAY THE BILLS, to restore their interest in containing the costs.

3. Disband the doctor's union (AMA) to defeat their primary purpose, which is to limit the number of practitioners (the same as any union). Or at least, forbid them from engaging in that practice. Create a federal agency to monitor and publish the complaints and outcomes, to enable the market to remove incompetent doctors.

4. Require all medical facilities and practitioners to publish a complete list of their rates and fees, easily accessible to all patients.

5. Prohibit lawyers from advertising. Pass meaningful tort reform that limits punitive damages and requires plaintiff to pay the cost of frivolous claims.

6. Overhaul the Patent Office. Restore patents to 7 years, as originally intended, and prevent it from allowing patents on new uses for an old drug, or other such ruses for artificially increasing the monopoly period for new discoveries.

7. Overhaul the FDA. Eliminate the FDA's ability to ban anything. It should merely test and publish results, and should be required to complete that testing within one year. Prescriptions should be advisory, not mandatory, as they are in most other countries. You should not need buy a doctor's permission every 6 months for your asthma medicine.

9. End Obamacare, Medicare, and Medicaid. Pay back with interest the money that was confiscated from retirees for Medicare over their working lives, so they can use that money to purchase their own catastrophic major medical insurance on the open market.

10. In order to reduce the cost of becoming a doctor, prohibit any educational institution that receives federal funding from raising their tuitions and fees beyond the federally-published inflation rate.

And, by the way, I'll quit spelling it that way when it goes back to governing instead of goobering.
I would add that the patient should always be required to make a copay for any medical treatment, to encourage competition among medical providers. Under the current system, patients don't care how much the treatment costs when it is covered 100 percent by insurance.

[kkingston57]

"If you build it, they will come".

This shortage is not just in The Villages but in Florida as a whole. Checking the data, no part of Florida has what could be called adequate physician care. The entire state has a shortage of primary physicians and specialty care physicians: no part of the state is expected to have adequate specialist care by 2035 with most of the state having at best 80%. Primary care physician availability outlook is a bit better, but only the southern tip of the state:: Miami, Ft. Lauderdale, etc. are expected to have 100% of adequate primary care physician coverage but this does not extend to the rest of the state. ("Florida’s physician shortage: It’s not just primary care and rural areas", Jarrod Fowler, MHA FMA, Florida Medical Association Website, April 21, 2022).

Why? Who really knows? A couple of things that we DO know however is that people with money and the wherewithal to relocate are fleeing their high-tax, high-crime states like deranged lemmings in search of friendlier surroundings, and for most, those "friendlier surroundings" happens to be spelled FLORIDA. According to data I've read Florida has FOUR TIMES the influx of new people than does the next state in the row, Texas (might be wrong about Texas). These folks are also taking their money, their toys, and most importantly their spending power with them. It has led to some monumental problems at both ends: influx AND outflux. My home state of Minnesota for example as a stable population if you're just counting heads, but the people with the money are the ones scurrying south. They're being replaced mainly by third-worlders, recent immigrants who are steered toward Minnesota by Federal authorities as well as migrant farmhands, in addition to the more-than-sizeable resident population currently on welfare. This is not new: as far back as 2004 there was an article in one of the Twin Cities publications that put a financial value to it and even then it was multiple billions leaving the state every year. Today, with the multiple COVID messes and economic upheaval I'm sure it is far worse.

Second (conjecture on my part) it is probably a lot harder for a doctor to leave his/her practice than it is for a couple of retirees to pack up and skedaddle. Took us maybe three months after we made the decision but we had no notices to give, interviews to arrange, etc. etc. I'm pretty sure that with all that money leaving, the people who were formerly PAID with that money will be leaving as well, just a lot more slowly.

I don't know. That whole COVID thing blindsided a lot of people and the influx of folks to Florida overall, not just TV, has been unprecedented and could not have been planned for. I'm sure the medical situation will improve; maybe not fast enough for some, but it will. After all the money is here.

The problem is happening now and getting worse. It does appear that nobody wants to address it now so that it does not get worse. Not every professional person wants to move to hot, central, minimal culture central Florida. People moving here come mostly for 1 reason, lower costs of living.

[kkingston57]

The US Census Department's American Community Survey just came out, and Florida is, indeed, the top destination for domestic migration with over 740,000 people moving in. However, what is far less discussed is that almost 500,000 people moved out of Florida, and the state is one of the top outbound states as well as inbound. It's still a net domestic migration of about 250,000, but that is still a lot of people leaving. Interestingly, medical care is one of the primary reasons given for leaving, along with high cost of living and insurance premiums.

Most of those moving out are coming from the real higher cost of living areas of Florida, near the coast. We moved out 3 years ago along with many other S. Floridians

[retiredguy123]

Almost. A private medical practice does not have to accept anyone as a patient, as long as it is not on the basis of race, religion, sex ,etc. On the other hand, a public facility such as an ER or urgent care facility is bound by COBRA 1987 regulations. They must see any patient, regardless of ability to pay, and can only transfer them to another facility if "stable". The paperwork is Draconian and the penalty for violations even more Draconian.
Don't those rules only apply to public facilities that accept Medicare?

[kkingston57]

So what's your solution?

And why is it so difficult for you to spell the word government?

Had the same ?. Only alternative I could think of was a single payer system, which is used by 99% of the developed world.

[Blueblaze]

Had the same ?. Only alternative I could think of was a single payer system, which is used by 99% of the developed world.

Would you like to hear about my personal experience with "single payer" in London?

I sat with an employee all night, writhing and moaning, on a gurney in a ward with about 50 other people writhing and moaning in their little 8x8 cloth cubicals -- while my staff back home tried to raise someone in the middle of the night to get her transferred from the public NHS hospital to the private hospital across the street that the Queen uses.

During all that time, she never did see a doctor. When we finally got her transferred, we learned that she had a ruptured tubal pregnancy and peritonitis. She nearly died, and it was three weeks before she was well enough to travel. She lost the ability to have any future children.

When it comes to "free stuff" from your gooberment, be very, very careful what you wish for -- particularly "free heathcare". They're just liable to give it to you. You won't like it.

[golfing eagles]

Don't those rules only apply to public facilities that accept Medicare?

All patients. In fact, these regulations came about because a pregnant illegal alien in Southern Texas came to the ER of a private hospital and was sent to a public hospital without proper evaluation. For whatever reason she died en route and so the s**tstorm began. Of course, there were so few violations that the "powers that be" started calling improperly filled out paperwork a violation and fined accordingly. As a result, ERs all across the country were reluctant to accept patients from other facilities. The only time we even tried was when we could not provide a needed service or patient request.

[OrangeBlossomBaby]

I would add that the patient should always be required to make a copay for any medical treatment, to encourage competition among medical providers. Under the current system, patients don't care how much the treatment costs when it is covered 100 percent by insurance.

Yeah - a poor person with an infectious disease, who can't afford a co-pay, should be turned away. Let them infect everyone else, that's fine since everyone else can just pay the co-pay when they get sick.

[OrangeBlossomBaby]

Had the same ?. Only alternative I could think of was a single payer system, which is used by 99% of the developed world.

My solution would be a hybrid of commercial for-profit insurance and medicare.

BASIC health care would be covered 100%, no co-pay, no deductible, no max, courtesy of tax dollars. By basic I mean:

Annual physical and routine yearly bloodwork to support the physical and consultation with the patient to go over the results and make recommendations for treatments, if any are needed.

Minor wound care - cuts and scrapes, antibiotic ointments, bandages, and the like.

Prostate exam, mammography, pap smear, routine vaccines (flu, MMR for kids, for example), a full-body skin cancer exam every other year, routine eye test, routine hearing test, one regular dental cleaning per year, one fluoride treatment per year for kids. All of this would be covered - no one would be required to get all this done but if they chose to, it'd cost them nothing out of pocket with no insurance necessary.

Then everything else can be commercial, and people can pick how they pick now, with various types of coverage at various premiums, various deductibles and out of pocket limits, and so on. The 80/20 plans from before the ACA can return if the insurance companies want it again. Employers can benefit from group coverage for their employees, but they can pass on the premium costs to those employees and not have to pay for the coverage unless they want to (or negotiate it into a union contract if applicable).

[Randall55]

Small part of the problem. In meantime developers including others in the area are building homes for retirees and very little is being developed for the worker bees including professionals. A good new doctor(except for geriatrics) has 0 incentive to work here.Great point. My son bought a home in Middleton because of the schools. He is a professional who commutes to Orlando everyday while his wife works a clerical job in the Villages. Many like him. The professionals live in the Villages but do not work here. The area does not pay enough. As you stated, zero incentive.

[mntlblok]

My solution would be a hybrid of commercial for-profit insurance and medicare.

BASIC health care would be covered 100%, no co-pay, no deductible, no max, courtesy of tax dollars. By basic I mean:

Annual physical and routine yearly bloodwork to support the physical and consultation with the patient to go over the results and make recommendations for treatments, if any are needed.

Minor wound care - cuts and scrapes, antibiotic ointments, bandages, and the like.

Prostate exam, mammography, pap smear, routine vaccines (flu, MMR for kids, for example), a full-body skin cancer exam every other year, routine eye test, routine hearing test, one regular dental cleaning per year, one fluoride treatment per year for kids. All of this would be covered - no one would be required to get all this done but if they chose to, it'd cost them nothing out of pocket with no insurance necessary.

Then everything else can be commercial, and people can pick how they pick now, with various types of coverage at various premiums, various deductibles and out of pocket limits, and so on. The 80/20 plans from before the ACA can return if the insurance companies want it again. Employers can benefit from group coverage for their employees, but they can pass on the premium costs to those employees and not have to pay for the coverage unless they want to (or negotiate it into a union contract if applicable).

That doesn't sound particularly unreasonable to me. What are the forces working against such "hybrids". I remember reading gripes about a "two tier" health system decades ago. Never really understood the gripes.

Blueblaze's NHS story is scary and believable, but I coincidentally spoke with my western Canada peer last evening about his new, premature twin granddaughters. I was blown away both by what their system can still offer *and* by the amazing skill and expertise that *any* NICU can apparently pull off *anywhere*. Them's some sharp folks. Guess I don't really know if that level of "service" is available to the "average" Canadian. He *did* mention that the NICU in Red Deer would not accept a transfer of the babies from the apparently fancier place in Edmonton.

Really makes me wonder what kind of spread there is out there amongst "bad" doctors and the elite - and the likely "in between" majority. Reminds me that I had a cardiologist *lie* to me, apparently in order to justify additional, more "profitable" testing. I had enough "medical" background to be suspicious and to ultimately get to the bottom of it, but how does the guy on the street figure any of that kind of stuff out??

So, does a "doctor type", PA, NP and such come out and declare her "tier" level for such a system? Does the legal profession have too much to lose to allow such a system to exist in this country? After all, aren't a majority of legislators trained in said profession - the fox guarding the hen house?

And, why is it so rare in a forum such as this to see an offer of a reasonable suggestion for a "solution"? Guess it *does* sorta go against human nature - least from what *I's* observated. . .