Dr. Marcus Welby clinics
 

Have we been lulled into complacency by those who would model themselves after a fictional doctor and say, "trust us, we know what's best for you?"

In last Sunday's Daily Sun there were about 12 questions or points that the new doctors had to measure up to. Things like, "were they good students in medical school and would they relate or interact well with other doctors and patients." Do they enjoy or love their work? It seemed as though the questions covered all the bases.

But there's no indication that anyone is asking this all important question: Do you (or will you) like working with patients who are old and sickly. How do you feel about old people in general? Do you value them? Would you look upon a 90 year old patient as having a future, or would you look upon that person as having lived long enough already? As a family doctor, what do you know about the special needs of the elderly? You haven't specialized in Geriatrics, so what makes you think you will know everything that you need to know to provide the best possible care?

A doctor could have had the best grades all through medical school and that still wouldn't make him or her a geriatrician. In order to become a doctor one must have a superb memory but a GP can't remember something that hasn't been learned in the first place. Specialties exist for a reason but will we be told we can have any specialist we need as long as it's not a geriatrician?

I propose that each clinic have at least one geriatrician. We have been told that what's new about these clinics is that they will put the patient first, rather than money or the welfare of the attending GP. If they really mean it, why shouldn't they provide doctors who are specially trained to care for those who have reached an advanced age?

I believe these facilities are based on the Mayo and Cleveland clinics. So, I'm not concerned about what name they use. I would guess that any doctor considering on working in these Villages facilities would realize that the patients would be older.

By choosing internal medicine as their specialty years before this, they have chosen to specialize in the specialty that takes care of the elderly and branches out into geriatrician subspecialty, and that's why the others did not choose that specialty.

And by applying for the job in this community of 100,000 people over 55, it's quite obvious the applicants know what the patient population will be.

And by the way, I think we all know that the "Marcus Welby" label is just like the jingle, "Pop Pop Fizz Fizz Oh What a Relief it IS" that Alka Seltzer ran on television and radio in the 1960's. The point is......we REMEMBER it and what the product was/is.

I've been reading all the articles in the Daily Sun and went to most of the U.S.F. lectures and I have never heard that the clinics will be based on the Mayo & Cleveland clinics. Instead, what they have been saying is that this is going to be something totally new.

Yes, doctors can well imagine that their patients will be somewhat older but that doesn't mean that it shouldn't be part of the interview to see how they respond. There were other questions on the list where the answers could also be assumed but they still ask them to see how the applicant responds.

Do the Mayo & Cleavland clinics employ geriatricians? Maybe they do or maybe they don't, I don't know. But I'm asking about The Villages Clinics. Why has there never been any mention of hiring geriatricians?

[QUOTE=Villages PL;694553]I've been reading all the articles in the Daily Sun and went to most of the U.S.F. lectures and I have never heard that the clinics will be based on the Mayo & Cleveland clinics. Instead, what they have been saying is that this is going to be something totally new.

Yes, doctors can well imagine that their patients will be somewhat older but that doesn't mean that it shouldn't be part of the interview to see how they respond. There were other questions on the list where the answers could also be assumed but they still ask them to see how the applicant responds.

Do the Mayo & Cleavland clinics employ geriatricians? Maybe they do or maybe they don't, I don't know. But I'm asking about The Villages Clinics. Why has there never been any mention of hiring geriatricians?[/QUOTE]

This would have been an excellant question to ask at one of the "most lectures" you attended.................probably better answered there than posters guessing on TOTV.

I happen to agree with you, VillagePL. I noticed in one of the interviews the physician said he enjoys getting to know the whole family and watching them grow, etc.... my thought was , well that will not be the case in The Villages at all. There are so many differences in older people as oppossed to younger people, I hope they will be aware of those differences. One thing that comes to mind is medication dosage, what's good for a 35 year old may not be correct for a 65 year old. If I decide to go to one of the health centers I will be asking about the experience level with older people. I do think these centers are a step in the right direction, we'll have to wait and see.

I'm pretty sure that the only similarity to Mayo Clinic or Cleveland Clinic mentioned as a template for the new TV medical home clinics is: That the physicians would be paid a decent salary instead of having to try to stay solvent in private practice relying mostly on Medicare payments that are under actual cost of running a practice.

Salaried pay is where similarities would end, I think, considering the research and residents in training who treat the patients at Mayo......

"Mayo Clinic in Rochester is a 1,595-physician group practice which, along with Rochester Methodist Hospital and Saint Marys Hospital, form an integrated medical center in Rochester, Minn. offering comprehensive diagnostic and treatment services.

World-class programs in medical education and research enhance the quality of patient-care.

Facts and Figures (based on 2010 data)

Personnel
Staff physicians and scientists: 2,016
Residents, fellows and temporary professionals: 2,789
Allied health staff (clinic & hospital): 27,544
Total: 32,349

Patients
Unique patients: 334,000
Outpatient visits: 1.46 million"

Mayo Clinic in Minnesota - Mayo School of Graduate Medical Education - Mayo Clinic

I believe the "geriatric question" is legitimate and have never seen it addressed in all the blah, blah, blah that has been in he Daily Sun.

Well, of course. I was at the lecture that was given by the doctor who is now in charge of all the Villages Clinics. There were lots of questions that day and I got caught up in listening. I'm not sure if I had even thought of that question back then. That was quite a while ago. By the way, nothing was said about care for those of an advanced age....the frail elderly.

I was thinking the same thing. Many of these doctors have experience with whole families and are not from retirement communities. They may have had some older patients but how good were they at taking care of them?


That's right. There's a long long list of medications that should never be given to older patients. Gerontologists are aware of this but not all family doctors are. I read about a survey that was done to prove it but I don't remember where I read it. The dosage is another thing that's important, even for vitamins.

I first got tested for vitamin D3 because I read that most older people are deficient. Was the doctor aware of most older people being deficient? I don't think so because I was going to him for a couple of years and he never included it on my blood test. So I had to ask for it and sure enough I was very very low. 30 would be normal and I was at 8. So he suggested I take a large dosage of 50,000 IU weekly, presumably to catch up. But, thankfully, he forgot to give me a prescription for it. It was way more than I would have been able to tolerate. I bought some over the counter and found from experience that I can only tolerate about 600 IU per day. And that's the standard amount that's recommended in most vitamin books.


Yes, good for you for your willingness to ask, but I doubt they will ever admit that they don't have enough experience. And if we wait to see, all the doctors will be hired and it will be too late.

Several years ago, when my aunt was still living, I was visiting her in south florida and she asked me if I wanted to go with her to her doctors appointment. I gladly agreed to go. While we were in the waiting room we started a conversation and she started telling me how expensive her medications were ($500.00 per month). I asked, "how many medications are you taking?", and she said, "6". I was amazed to hear that.

I told her that each drug is tested separately for safety. But when you take several drugs in combination, it can be risky. There's usually a risk for liver or kidney failure, especially for an older person. And I asked her to ask her doctor if there might be a way to cut down. And she said, "Oh, he's a GOOD doctor and I trust him, he wouldn't give me anything that would hurt me. So that was the end of that conversation.

A few years later, she suffered kidney failure. When your kidneys fail, you're not allowed to take any drugs at all. And one of the drugs she had been taking was a cancer drug. So, without the cancer drug, the cancer came back and it wasn't long before she died.

This is what happens when people say, "Oh, I trust my doctor!" And they won't even consider alternatives. Her son was and still is a doctor of pharmacy living in another state. I even asked her to check with her son but she said she didn't want to bother him.

I think there would be a lot less kidney and liver failure for seniors if they were in the care of geriatricians, not to mention other conditions that may come about from drug interactions.

I have one of the great "Marcus Welby" doctors and she is terrific. Instead of being so skeptical and anticipating failure instead of success, consider either trying one of the doctors or just wait and see how others that are going to these doctors feel about their experiences. I am very satisfied with the Colony Care Center, doctors, staff, and attention I have received.

Excellent points. I find it facinating how much they promote that these doctors are salaried and not paid based on percentage of charges. What most people don't understand is salaried physicians typically receive what has been dubbed "pay for performance" bonuses. They get financial bonuses for a variety of things. Some receive financial rewards for good HEDIS (Healthcare Effectiveness Data and Information Set) scores which measures the quality of the care they deliver. Unfortunately they also often receive bonuses for keeping referrals to specialists low, keeping hospital admissions at a set number, or limiting expensive lab or diagnostic tests. Having worked in health care administration most of my career and I always ask any provider I see if they have any financial incentives to limit the number of referrals to specialists or for testing? If they say yes, I ask what is the time frame of these measures? Monthly? Quarterly? and then schedule my visits accordingly. (You'd be surprised how many more lab tests are ordered or referrals to specialists made at the beginning of the measuring period vs towards the end, when the provider knows they have exceeded or are close to exceeding their expected numbers). There are pros and cons to every system used to compensate medical providers. As a patient, I simply want to understand what system my provider is under so that I can manage my care accordingly.

and I always ask any provider I see if they have any financial incentives to limit the number of referrals to specialists or for testing?

I would be amazed if any doctor would honestly answer that question!

I agree gomoho. I can't imagine any doctor would answer this question honestly. I can't even imagine a doctor being hired to work at one of the clinics WITHOUT extensive
senior care experience. I personally would prefer a NP who specializes in Geriactrics; a specialist who loves working with seniors. I think the biggest problem with the doctors in and around TV is they expect a certain kind of "senior" and what they get is a patient who is assertive and challenges them and some just don't like working with that kind of patient. I can think of a few doc's right away - I've seen or someone I know has seen. It will be interesting to see how it plays out.

Villages health care
 

I agree with you 100 %. I can't believe how so many people are already putting down doctors in a system they haven't even been to yet. I DID ask when I went to the Colony Plaza office. I received a packet with bios of some of the docs that are working there. One of them DID mention a specialty in Geriatrics. Why decide in advance to be so negative, before these places are even opened? When I started with a doctor in The Villages, I went by his reputation, from friends & neighbors. I never even thought about his specialty in Geriatrics. There are good & bad in all fields. Just because they specialize, doesn't mean they're Kind, Compasionate, caring etc. Some docs think they "Know it all", and won't refer you to another doctor, even when they should. That's more dangerous than ever....being treated by someone who thinks he's G-D, jut because he specializes in one area, but treats you for something he doesn't know enough about. The idea of these new health care plaaces, is that if they don't know....they will refer you to someone who does. FYI, the expected openings for the offices not open yet is as follows:
Santa Barbara (near the hospital) - Oct.
Pinnelles - Nov.
Mullberry - Jan.-Feb.
Creekside - Feb.-March
It's good to "Look before you Leap", but how about the saying, "Try it You'll Like It". Hey, if you don't like it, try somewhere else. Being of a positive mind keeps us looking young. Negativity causes wrinkles.

Here's some information that might help with the "geriatric question". I called ask-a-nurse at The Village's Hospital this morning. I asked, "what's the difference between a doctor who has studied Internal Medicine and a geriatrician?"

This is the answer she gave:

Internal Medicine covers general medicine for adults (14 and older).

Geriatricians, in addition to having studied internal medicine, have special knowledge and training for the diseases and disorders of the elderly.

I would add this: It seems logical that a Geriatrician would provide better overall care if they have a better understanding of the elderly. And a better understanding would likely result in a different drug prescription.

My wife and I could have very well said exactly what you've said word for word. We too have a doctor at Colony where we feel she is terrific. Might even be the same doctor as yours.

Our doctor is a Family Doctor, which I considered the best of what choices we had, and we're happy knowing that her training includes geriatric medicine which is a sub-specialty of both family medicine and internal medicine that focuses on health care of elderly people.

Based on my past experience I'd much rather have a family doctor that doesn't necessarily know everything (who does) and will look up, research or confer on what they don't, or appropriately refer when necessary, than a specialist that will pretend that they do know everything to save face because they're, well... "a specialist."

You might say we're as happy as a cat in a catnip factory! https://www.talkofthevillages.com/fo...ons/icon10.gif

It is a reasonable deduction that a geriatrician ("might," rather than) "would" provide better overall care as you stated, but not necessarily. With all due respect for the ask-a-nurse resource, those definitions you were given do NOT quite match what information I found from more than one source when researching.

From that research I had indicated on my prior post, "a Family Doctor's training includes geriatric medicine which is a sub-specialty of both family medicine and internal medicine that focuses on health care of elderly people. Simply put, a geriatrician is essentially an extension of those two medical disciplines.

Might it just be a case of semantics here? I don't know, but in either case I just don't see it the way the ask-a-nurse put it and I'm more than happy with the qualifications of our doctor.

Good for you! I'm glad you're happy with your doctor. What is it in particular that you like about your doctor?


Of what help will it be to wait for others to say how they feel about their experiences? Everyone is different; you like your doctor but the next person may not. And 6 months to a year from now, you may change your mind if something goes wrong. Each individual has a unique set of circumstances. You might be 65 and in good health while the next person might be 85 and in poor health. Which one is more likely to put the doctors skills to the test? And if the 85 year old has a heart attack or stroke and dies, he or she is unlikely to show up here to tell us about the poor treatment. Keep in mind that we will never know about the vast majority of these individual circumstances or conditions because it's none of our business. ;)

Tell me how you think we can objectively judge the overall performance or effectiveness of the clinics. I think one way to at least get an indication of future performance is to look at who they are hiring and what types of doctors they are hiring. There are no geriatricians so far as I know. They have been featuring them in the newspaper.

PL, I'm not being confrontational in saying this, but just trying to raise awareness as you are. By insisting that these primary-care doctors be geriatricians, you are insisting that the primary-care doctor be a sub-specialist.

One of the problems with that is with all the "overhaul" and upheaval in healthcare finance right now, pretty much everybody knows that the goal is to put more money into primary care, to prevent the over-use of more costly specialist and especially sub-specialist care and treatment.

Yes, geriatricians are needed for elderly people who have chronic disease and multiple complex organ-system failures interacting and complicating each other. But people like you who take care of yourself (and there are many more like you than you appear to think) who don't have complex chronic medical problems to manage/treat, do not need a sub-specialist (geriatrician) for their primary-care needs.

Even more important in this picture: There is already an existing shortage of internists in this country in proportion of the population at, and reaching, age 65+. So if there is a shortage of internists, there is a corresponding shortage of geriatricians, because they are sub-specialists of internal medicine.

Knowing that it's going to be hard to find enough motivated and available internists to staff all the TV clinics, I'd say it's even harder to find as many geriatricians as you see as needed.

And then there is the issue of the focus by Medicare/medicaid to shift and bolster payments toward primary care for prevention purposes, and away from specialists and sub specialists.

And about your aunt having 6 prescriptions and trusting her doctor who's a "good" doctor. I don't know about her, but with many people, those 6 prescriptions could have come from 5 other specialists who were not the lady's primary doctor. That is one more reason the shift in focus of healthcare funding right now is toward the primary-care generalist who oversees and should have to approve referrals to specialists.....to both lower healthcare costs, and assure accurate, efficient treatment.

These are points to think about....I'm not arguing.

I have a friend who is a physician (Internist) who has a daughter in medical school. His advise to her is to get into a specialty that does not require a stethoscope. And you wonder why there is a shortage of primary care physicians.

No, the reason for the shortage of primary care physicians is not just higher pay as your post implies.

The biggest reason is that there are too few required residency-training slots for the number of medical-school graduates in need of them.....

"All medical students must complete residency in a field of their choosing before they can practice medicine. New medical schools are opening across the country, but strangely, the number of medical residency spots is remaining nearly constant. Most residency programs receive funding from Medicare. The number of residency positions that Medicare will pay for was set in a 1997 law called the Balanced Budget Act. No new federally funded positions have been added since then, even though the U.S. population has grown by 49 million people and the complexity of medical care has increased by orders of magnitude....

....By the end of the decade, the number of US medical and osteopathic school graduates is projected to exceed the number of residency positions (currently the extra residency spots are filled by graduates of foreign medical schools, who have historically helped provide much-needed primary care services and care in rural settings). Already many students are not able to train in the field they prefer due to a lack of available residency spots. Soon, students who have gone through the medical school admissions process and the long hours and considerable expense of medical school will not be able to continue to any residency position.."

"Medical School Enrollment Outpacing Available Residency Slots
May 20, 2013 02:47 pm Sheri Porter – New survey results released by the Association of American Medical Colleges (AAMC) show that enrollment at U.S. medical schools and schools of osteopathic medicine continues to increase at a steady pace. However, the same survey report highlights increasing concern from the nation's medical school deans about insufficient numbers of residency training positions being available to meet matriculating students' graduate medical education needs....."

And then there is the fact that a doctor who's finished with all their education and training has around $360,000 in student loan debt as our friends' son has, which is going to be almost impossible to manage on a family practice or internists' gross pay of $150,000 that has to also fund their first home purchase, funding their kids' college education that will probably cost $200,000 each, funding their self-retirement funds, etc.

And then there is the question of whether every young doctor choosing a specialty is attracted to working with patients who will probably get better and go home, or whether they work with patients who probably are only going to get worse. That is not for everyone.

The Shortage of Medical Residency Spots: A Failure of Government Control - Forbes

Medical School Enrollment Outpacing Available Residency Slots -- AAFP News Now -- AAFP

I'm not looking for a 100% guarantee of better overall care. I'm just looking for a reasonable likelyhood of better care. As I said in my opening post, why not have at least one geriatrician in every clinic. If you found different information, it may depend on the source. Ask-a-nurse seemed to be fair and unbiased. She wasn't trying to promote one or the other.

When you say "includes geriatric medicine" what exactly does that entail. All medical doctors get some schooling in nutrition but it's very little compared to someone who gets a degree in nutrition. Medical doctors, from what I have read, get just one class in nutrition. It's a tiny fraction of what a nutritionist gets.

I think a lot depends on the source. It makes me think of my father: When I was a kid I went with him to buy paint on sale at Sears. We needed several gallons to paint our house. Upon arriving at the paint department, my father asked the manager if the paint was good paint. The manager said, "Oh, yes sir! This is Sears best!" Later I asked my father if he thought there would be any possibility that the manager would have said otherwise.

I suggested (at least) one geriatrician per clinic. I didn't think that was a lot to ask for, being that these clinics will primarily serve an elderly population. If a GP thinks that someone of an advanced age, with multiple chronic conditions, could benifit from seeing a geriatrician, what will he/she do? Send that person to Ocala? Or, have they already made up their minds to just completely ignore that specialty altogether? That destroys the concept of conveinience, which was part of the reason for having neighborhood clinics in the first place.

Well, that's a good point. But I'm not suggesting the over-use of Geriatricians. Last time I checked, one would need to go to Ocala to find a Geriatrician. There were two listed in the Ocala (area) phone book. As far as I know, we have none in The Villages at this time.

People who are healthy today may eventually need a geriatrician as they get older. But perhaps these clinics envision the sickest going into nursing homes? Maybe that's the plan: Health care for those who are well enough to come in for an office visit. But how about keeping them well enough so they don't have to go to a nursing home. That should be the goal.

There is a shortage, but even so, there are 7,029 certified geriatricians in the U.S.. All we nee is 8.

Geriatricians could serve as ofice managers in the clinics. As such they would get payed more. The average GP gets an annual salary of about $122,070. The starting salary for a geriatrician ranges from $96,880. to $145,320.

In addition to being an office manager the geriatrician could take care of those older patients who have multiple chronic conditions. In other words, they could perform as a GP with salary and bonus. I know this can be done.

Regarding:

I think you'd be hard-pressed to find a physician-geriatrician who wants to be an office manager! Anybody going into geriatrics is going to be a person who loves treating patients, not doing the drudge paperwork shuffle that results in exceedingly low reimbursements from Medicare/medicaid in the end, anyway. The twisted mess of billing insurance and Medicare and Medicaid, and the huge uncollected debt the physicians assume is why primary care docs can't make it in private practice, AND why these subsidized, for-set-salary physician jobs are being created in this clinic model in the first place.

This seems like a negative discussion, I am an RN certified in Gerontology. I Have a very positive view of what is happening with The Villages Health Care Centers. When I worked in Tampa, we worked closely with those at USF who were studying aging. I have signed up and look forward to receiving my care there.

My husband and I are extremely pleased with our primary physicians @ Colony. It is good, that in The Villages we have other choices, as well. We still have our specialists.

I think you may misunderstand the meaning of office manager in the context of The Villages Clinics. When I read about it in the newspaper I believe I read that the manager would have 1,250 patients just like the others.

Why talk about medicare reimbursement when all the doctors will be on salary anyway? The GPs will be on salary and the geriatrician could be on salary too.

I'm sorry that you see it as negative. I also see The Villages Health Care Centers as moving in a positive direction. Negatives often become positives. For example, the reason for trying to find better health care solutions in the first place is because of a dissatisfaction with the status quo. That means all of the doctors involved in this project have negative feelings about health care in general. If no one ever had negative feelings, where would the impetus for innovation come from?

I think we should each find the physician here that we can trust the most and put our care pretty much in his/her hands. For instance, if he/she thinks we should have a colonoscopy, then we probably shouldn't research ourselves out of that suggestion.

Most of us do not have medical degrees. It is wise to find the person that comes closest to our idea of what an expert is and trust that person. In my view a group is better than one. I am a complex old soul.

If this "Marcus Welby" group, when it opens. in our neck of the woods, doesn't have what I am looking for than my next step may be to hike up to Gainesville and see what their medical community has to offer. I wish THEY would hike on down here. I wish there was an MD on the same level as my dentist Dr. Kathleen Williams who is now not taking any new patients.

She is a graduate of University of Florida and the best dentist I have had in my whole life.

Response
 

The main point is that anyone who moves to any new area must go through a process of research to select new doctors. Many are also limited in their selections due to their insurance coverage. So one must jump in and try and if you don't care for the one selected you go to another. All of the bios on the doctors at Colony Care were experienced and have good credentials. It was hard for me to choose. I looked each one up on the Internet looking for prior reviews of their services. Finally I chose Dr. Susan Hawley. If I didn't care for her after seeing her I would have chosen another one until I found the right fit. I didn't have too. She is a good fit.

Response 2
 

The reason I like Dr. Susan Hawley is that she listens, is attentive, and has addressed a number of my medical concerns satisfactorily. She never makes me feel rushed either.

Geriatrician coming to Promise Hospital with a training program. Not sure how it will work but mentioned in today's paper.

It is TOO late to train for me. I am already GERIATRIC. I hope I am doing it well. I have never been this old before. ;)

Yes, I read about it in the Sunday paper. They made a pledge of a few million dollars to provide geriatric training for doctors. It will be at the Promise Hospital. This type of article, as usual, doesn't fully explain how the program will work. So, it's left up to the individual reader to imagine how it might work. I imagine it will be for those doctors who work at the Promise Hospital and will have nothing to do with The Villages Clinics. They recognized a desperate need for more geriatrics but The villages Clinics have not yet addressed this issue.

Some have said there are GPs at The Villages Clinics who have studied geriatrics but I kind of doubt that it amounts to much. I saved all the articles that have come out announcing the new doctors and when it mentions their qualifications or specialty it doesn't say anything about any of them having a sub-specialty in geriatrics. And even if some of them do have it, it's not the same as being a geriatrician.