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.