Is care for senior citizens at risk?
At the very least, the threat of growing limitations in the availability of care is, depending on your point of view, being suggested as a possibility or wielded as a threat.
At least two organizations have provided information in the past month to suggest that there won’t be enough physicians to provide care for aging Americans.
It’s the dollar, you see. There are just not enough of them in caring for old folks.
The American Medical Association has unveiled the opening salvo in its fight to get Congress to overturn the expected cuts in Medicare payments coming as a result of the Sustainable Growth Rate formula. The nation’s physicians got a reprieve late last year when an anticipated 5 percent reduction was avoided in session-ending legislation. Payback may come this year if Congress doesn’t act – the SGR-based payment cut is set for 10 percent in 2008.
The AMA contends its survey of 9,000 physicians found that 60 percent of physicians will “be forced to limit the number of new Medicare patients they will be able to care for next year, when Medicare cuts physician payments.” SGR-based cuts could total as much as 40 percent over nine years, and 77 percent of physicians say they’ll limit new Medicare patients if payments fall that much.
“As physicians brace for nine years of steep payment cuts, it will be extremely difficult for them to continue accepting new Medicare patients,” said AMA Board Chairman Cecil B. Wilson, MD. “The baby boomers begin entering the program in 2010, and the Medicare cuts increase the likelihood that there may not be enough doctors to care for the huge influx of new Medicare patients.”
Additionally, it appears that fewer medical students are considering specializing in geriatrics because of low reimbursements.
The Geriatrics Workforce Study, conducted by the Association of Geriatric Academic Programs and the University of Cincinnati, indicates that the number of medical students pursuing careers in geriatric medicine is declining, with fewer than 4 percent entering the specialty. The study estimates that, if current trends continue, there will be only one geriatrics specialist for every 7,665 older adults by 2030.
Other specialties promise bigger paychecks, and because of the high cost of medical training, that’s funneling students away from geriatrics, contends the American Geriatric Society.
“When students look at their student loans and bills accrued from years of medical school and training, and then look at the average salary of a geriatrician compared with other specialties such as gastroenterology or urology, which offer twice and sometimes three times the yearly income, the choice of specialty is often decided on that factor alone,” said Jane Potter, MD, board chairman of the AGS.
The AGS and several other associations are working with the Institute of Medicine to examine workforce readiness to care for the nation’s aging population. The AGS is also proposing potential incentives, such as absolving a percentage of student loans, to encourage more students to choose the geriatric specialty. Whatever you feel about the motives behind these reports, they indicate areas for concern as the nation enters a period in which a substantial portion of its population is aging and expecting to get the healthcare coverage that their parents enjoyed. Meanwhile, the main program to pay for seniors’ care will soon start burning through the Medicare Trust Fund’s reserves to pay its bills.
Some recently proposed solutions, such as the patient-centered medical home that we cover in this issue, offer the promise of giving physicians new incentives that will enable them to modernize and automate their practices, while providing personalized care that could head off patients’ expensive care episodes.
It’s disingenuous to expect physicians to shoulder the blame for healthcare expenses and then ask them to take on the burdensome cost of reforming the system – for example, by paying to implement electronic medical records – without taking a fresh look at the economic incentives we’re providing.