Challenging Doctor Shortage
 

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.

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.

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.

Good point
 

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.

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?

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.

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.

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.

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.

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.

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

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/202...cal-prices.pdf

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.

Thanks for writing this.

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.

Health Care
 

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.

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

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:

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.

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????

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.

No problem with traditional Medicare and a supplement

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.

Better compensation elsewhere?
 

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. . .

Starting
 

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

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

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.

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

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.

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

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.

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.

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.

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.

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.

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.

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

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