[Sadie1313]

Originally Posted by jrandall

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.

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.

[Villages PL]

Originally Posted by gomoho

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.

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.

[skyguy79]

Originally Posted by jrandall

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.

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!

[skyguy79]

Originally Posted by Villages PL

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.

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.

[Villages PL]

Originally Posted by jrandall

I have one of the great "Marcus Welby" doctors and she is terrific.

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

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.

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.

[ilovetv]

Originally Posted by Villages PL

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.

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.

[Number 6]

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.

[ilovetv]

Originally Posted by Number 6

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

[Villages PL]

Originally Posted by skyguy79

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.

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.

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.

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.

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.

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.

[Villages PL]

Originally Posted by ilovetv

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

[ilovetv]

Regarding:

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.

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.

[Avista]

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.

[Buckeye Girl]

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.

[Villages PL]

Originally Posted by ilovetv

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.

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.

[Villages PL]

Originally Posted by Avista

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.

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?