[serenityseeker]

roz, thanx for the clarification. You are entirely correct on your point of "employed " (kind of a funny term as if the rest are unemployed.. :..I am one of those and it always cracks me up) physicians, I should have been more clear in that I was referring to those in private practice or independent group settings. The rest do have a choice and are being forced into some unpleasant ones.
So many physicians that can no longer afford to keep their practices/group practices viable after even 20 or more years in practice are now working for hospitals, HMOS, the VA etc. They do in fact take all comers as defined by their employers. Intersting trend, and while likely to continue, it is not a solution to access by any means.
Your point about practices that don't file insurance and operate independently is a good one also, and in some cases the only way fiscally to continue practice. And while it does free one from the choking rules and constant battles for reimbursement, it still leaves the question of who will take care those with Medicaid, Medicare, and substandard insurance or no real financial means to otherwise afford medicines and care for ongoing conditions like diabetes, hypertension, seizures, heart disease, etc. These are a great majority of people that end up in the E.R. and subsequently hospitalized with conditions that likely could have been prevented with out patient access to maintenance care and medicines.
Your insight into the difficulties of billing, and the costs to the physician of dedicating at least employee to the task of trying to fight for the few dollars of reimbursement is also right on point but missed by most people entirely.
We really do need a "single payer" type system. The more accurate term is national health insurance. The term "socialized medicine" is used to politicize the issue and polarize people by those more concerned with their own political leanings than addressing the problems.
Make no mistake..we are not talking about "giving away more for free" nor is it a question of "where does it all stop?". When we are dealing with an issue that now em compasses 16% of our gross domestic product and affects the survival, viability, and advancement of our country, its time to take a hard long look. We already spend vast sums on a system rife with inefficiency and several different fractured programs with different rules and oversight. It is time to reexamine what we have and restructure it into something more efficient and humane. It is being done by essentially every other industrialized nation except the U.S. Until we are ready to do so the problems of access for seniors and those working people that fall through the cracks will escalate rapidly When these people are sick enough to end up in the hospital they will then get band aid treatment and be released to repeat the cycle again. its really maddening..a ridiculous cycle.

[Villages Kahuna]

I researched a lot and found a good ol' American-trained doctor in TV. It turned out that he had the bedside manner of a mole and misdiagnosed a simple skin infection so badly that it took me a couple of months to heal up.

I now have a foreign-educated but U.S.-trained internist who seems very careful and caring. What's scary is that I'm actually beginning to understand what he says with his heavy accent. I'm guessing that's not an uncommon problem just about anywhere in the U.S. these days.

Also be careful to make sure that the doctor you choose has privileges at The Villages Regional Medical Center. I know there are several locally who seem to have excellent credentials but do not have privileges at either TVRH or the Leesburg Hospital. I can't figure out why, but what good is a doctor if he/she can't see you if you need to go to the hospital?

[zcaveman]

Originally Posted by diskman

zcaveman,
no it is about a primary care physician accepting medicare patients.

Sorry. The word Medicare did not appear in the first five posts so I naturally assumed it was all primary care physicians.

[serenityseeker]

Also be careful to make sure that the doctor you choose has privileges at The Villages Regional Medical Center. I know there are several locally who seem to have excellent credentials but do not have privileges at either TVRH or the Leesburg Hospital. I can't figure out why, but what good is a doctor if he/she can't see you if you need to go to the hospital?

Kahuna, I think I can answer that question.
The shift for the last several years is for primary care physicians to concentrate their efforts on the outpatient population and keeping their practice open, and leave the inpatient medicine to Hospitalists(internists that are strictly there for inpatient medicine). It becomes primarily an issue of economic survival, but one of lifestyle also.
The last several years have had such substantial cuts via reimbursements (especially Medicare and Medicaid) that physicians have been forced to squeeze more and more patients into their day in an attempt to survive, all the while taking salary cuts each and every successive year. The amount of time it takes to round on even a few hospital patients daily(usually twice a day) does not justify the time away from the office.
Let me give you a "typical day" scenario. Get to the hospital by 6:30 A.M. or so to make rounds on patients. Track down their labs, xrays, talk to the nurses, examine the patients, then sit down and write appropriate orders, the write a note That addresses each and every thing listed above. Now repeat for each patient, hoping their are no curveballs(there always are lol) that require more time and discussion with specialists etc. This could be as few as 3 or as many as 10 or more patients.
Of course now you are probably late for the office, where there are patients scheduled every 10 minutes or so (ridiculous I know). Most of these will certainly have issues that take longer than 10 minutes to address but if you don't see enough people that day you don't pay the bills. Wait, now you have to stop and take phone calls about the sick patients in the hospital... :edit:...even more behind, people getting angry over the wait.
Struggle to "catch up" (time has to come from somewhere...now doc is rushing even more). Maybe catch a break with some easy patients and a cancelleation(that is not gonna pay the bills)and get back close to on time by working through lunch to catch up on all the other phone calls that have piled up from patients and other physicians, and insurance companies, and of course making sure all the visits from the morning are documented exactly the way the government/insurance companies say they should be.
Big deep breath and wade into the afternoon. Just staying on schedule when the hospital calls to say Mr. Smith is having shortness of breath and mental status changes. Talk to the nurse again, order appropriate tests. :edit:...behind again...natives are gettin restless in the waiting room(and I frankly don't blame them...their time is valuable too).
Back to the patients in the office, not 10 minutes later nurse calls back to say Mr. Smith looks bad and is going down hill....blast out of the office and high tail it to the hospital..take of of Mr. Smith, get things stableized and slink back into a office full of angry irritable people that have been waiting well beyond and hour or more past their appointment time (and justifiably irritated...how can they appreciate this madness if even explained to them).
Finally finish seeing the 5:00pm appointment at 6:15. Need to get back to the hospital check on Mr. Smith and the other six patients, two of which have been waiting for discharge since 3pm. The pile on the desk(phone calls, prescriptions, charts to be signed, office notes to be dictated)...all gotta wait. See the inpatients, wrap things up and head home maybe by 8pm. Now doc is on call for the rest of the night not just for his patients but for the 4 other doctors in his call group..this will mean phone calls for most of the night and almost certainly getting back up sometime and going into the E.R. to admit some patients. Remember though, tomorrow is Tuesday, and the whole process repeats itself...now with a tired and sleep deprived doc. And :edit:...there is that pile of stuff he had to leave on the desk that will have to be addressed in the morning...maybe start rounding at 5:30a.m. instead...but wait...all of the morning labs are not even back by then.
The system is so crazy that is almost impossible to do both in and outpatient and do it well. There are still dedicated and brave souls struggling to do so but they are the fast shrinking minority. Keeping the office open is a monumental struggle in and of itself. 40%cut in reimbursements over the last decade with overhead rising every year(estimated at 20% this year alone). The time it takes to follow patients in the hospital robs time and effort from an office hanging on by a thread in many cases. Physicians and their families are tired of the above type scenario, and they are making choices in an effort to survive and live in something approaching a healthy way. The docs bearing the brunt of this barely controlled madness refered to above are your Internists and Family Practice docs.

[Villages Kahuna]

...I wondered what the new speciality "Hospitalist" meant. At the same time, it is just common sense that the doctors, particularly those in internal medicine or family practice, specialize in order to optimize their shrinking income streams.

But still, even though an internist and hospitalist work together, why wouldn't the internist at least seek priveleges at one or two hospitals? Is there a cost to doing that? Are there requirements that make being on staff a disadvantage to a physician who intends to concentrate patient care only in his office? If they were on staff, at least they could make patient visits on occasional, special circumstances basis--which they can't do if they don't have a hospital affiliation.

Just asking.

[serenityseeker]

Kahuna,
I cant presume to speak for all of them but keepeng privledges does obligate you to meetings, committees and such. This is the reason for some. Only so many hours in a day.
Additionally, it is suprising how fast you can get behind in medicine. Seeing only a couple or few patients in a year definately gets you behind in the nformation/technology/practice part of things in an inpatient setting. That definately increases the liability issues.
That being said, some choose to do exactly what you describe. Privledges are not necessary though for social visits to check up on a patient.
Great questions btw.

[serenityseeker]

Thought this might be of interest.
http://bulletin.aarp.org/yourhealth/...ors_gone_.html

[zcaveman]

I go on Medicare in December. I thought that was going to open a whole new world of providers and networked hospitals. From this thread I guess that isn't so.

[rozlee]

Serenity,

I had to remember I was on this site!!! I thought I was at work!!The day you describe is right on the money although you forgot to mention Medicare D and changing all the meds you have patients on because they have now changed the formulary for their plan or patients have changed their plan and have a different formulary!! Can't blame them at the cost of meds they have to try to find the best value.

Then we have paperwork for Disability /Handicap parking plates, Releases to go to the gym, get out of jury duty, authorize special shoes, wheelchairs, scooters and the never ending list of medical supplies which all require some form, and signature from the doc.
In an office with 5 primary family docs these request take one person to research the chart fill in what they are able to and then add to the pile for signing.

[serenityseeker]

roz, your right..just didn't know how much to try to squeeze in.

Lest my point be forgotten I really just trying to give folks an accurate, even an insiders view if u will of what really goes on and why patients are seeing the problems they see. I really appreciate you adding to the effort.

The only way we can begin to get change is to first make sure people know what is really happening, how dire things are in some respects, and why they are. Knowledge is power. Unfortunately, as is often the case with human nature, the people that are "covered" for now don't always feel the need to look at the ugly parts of the system. The problem as we can tell from many of these posts is that the problems are becoming more and more apparent.

I really just want to do some small part in opening the doors to things as they are, and what they are progressing to. The more we know, the stronger we become in participating in change.

[serenityseeker]

see above for the link I think some of you were looking for