Baby boomers and Family Medicine

[deucerp]

I'm only an MS-2 so I really don't know much, but what trickles down is that medicare is in shambles and it often doesn't pay enough to sustain a practice...what does the future look like with all the baby boomers aging and taking up more time in clinic so you can't necessarily add patients that may be private insurance that reimburse better? Or maybe I have no idea what I'm talking about...I just want to find out if it will be feasible to practice family medicine for the next 40 years. Thanks

---

Members don't see this ad.

 

[deleted87716]

medicare is in shambles and it often doesn't pay enough to sustain a practice

I don't know anyone who has a practice consisting entirely of Medicare patients. If they do, they're probably going to be taking home less than the MGMA average, unless they have incredibly low overhead, or they're "making it up on volume", as the saying goes. In order to preserve our income, most of us prefer to see a diverse mix of Medicare and other higher-reimbursing payers. IMO, it's a good idea to keep an eye on your numbers in order to avoid getting too heavily weighted towards Medicare. Personally, I try to keep Medicare at no more than 25-30% of charges.

what does the future look like with all the baby boomers aging and taking up more time in clinic so you can't necessarily add patients that may be private insurance that reimburse better?

You manage your appointments according to your practice style. I schedule patients in 15-minute slots (30 minutes for new patients and physicals). If there are too many issues to deal with in one visit, we'll take care of the most important things first, and I'll ask the patient to schedule another appointment for the rest. It's not just Medicare patients who have a lot of issues. I'll sometimes tell patients, with a smile, "I am the 'doctor for all of you', but not in one visit."

I just want to find out if it will be feasible to practice family medicine for the next 40 years.

I don't see why not. If anything, FPs are going to be in even bigger demand than they are right now.

 

[deucerp]

I don't know anyone who has a practice consisting entirely of Medicare patients. If they do, they're probably going to be taking home less than the MGMA average, unless they have incredibly low overhead, or they're "making it up on volume", as the saying goes. In order to preserve our income, most of us prefer to see a diverse mix of Medicare and other higher-reimbursing payers. IMO, it's a good idea to keep an eye on your numbers in order to avoid getting too heavily weighted towards Medicare. Personally, I try to keep Medicare at no more than 25-30% of charges.



You manage your appointments according to your practice style. I schedule patients in 15-minute slots (30 minutes for new patients and physicals). If there are too many issues to deal with in one visit, we'll take care of the most important things first, and I'll ask the patient to schedule another appointment for the rest. It's not just Medicare patients who have a lot of issues. I'll sometimes tell patients, with a smile, "I am the 'doctor for all of you', but not in one visit."



I don't see why not. If anything, FPs are going to be in even bigger demand than they are right now.

Thanks for the response. I've been around quite a few FP's and have enjoyed every minute of it. I know you're supposed to choose what you have a passion for but at the same time there are those questions about job stability and financial security, not in the sense of making a lot of money, but having a functional, efficient practice and homelife. Thanks again for the response.

 

[lateness]

I don't see why not. If anything, FPs are going to be in even bigger demand than they are right now.[/QUOTE]

i agree, the future will increase demand for Fps.

 

[gsinccom]

aren't PAs and NPs increasingly filling the role of the FP MD/DO? Aren't PharmDs even picking up some of this too?

 

[McDoctor]

aren't PAs and NPs increasingly filling the role of the FP MD/DO? Aren't PharmDs even picking up some of this too?

I'm not buying into this anxiety that MD's and DO's are being replaced by PA's and/or NP's. I do not know of any HMO or PPO that is able to reimburse a solo mid-level provider not affiliated with an MD or DO for primary care medicine provided to its members without giving the insured the option of seeing a doctor. I have not heard of any malpractice insurers who afford equal protection to PA's and NP's as MD's and DO's as if they were interchangeable. If this is happening, please provide some specifics. This fear is repeatedly raised on these forums, yet remain vague at best.

A scarier trend seen in central PA is that many PCP's are dropping or refusing to accept medical assistance HMO's due to the increasingly paltry reimbursement. This affects all ages, and is happening with medicare as well. This will be a problem if things don't improve, since as mentioned above practices will try to keep medicare patients no more than 30% or so of their practice yet the population of those over 65 will continue to grow. I suppose this bodes well for FP in that it will increase demand for new providers who will take up the overflow in medicare patients, but I think our aging population deserves better than to get pushed aside because the government lowballs the value of their medical care. I would implore the voting baby-boomers to demand more from their elected officials.

To respond to the original post I think there is tremendous stability in primary care due to the rising demand and the requirement for medical school educated physicians to manage the aging populations needs.

 

[billydoc]

I'm not buying into this anxiety that MD's and DO's are being replaced by PA's and/or NP's. I do not know of any HMO or PPO that is able to reimburse a solo mid-level provider not affiliated with an MD or DO for primary care medicine provided to its members without giving the insured the option of seeing a doctor. I have not heard of any malpractice insurers who afford equal protection to PA's and NP's as MD's and DO's as if they were interchangeable. If this is happening, please provide some specifics. This fear is repeatedly raised on these forums, yet remain vague at best.

A scarier trend seen in central PA is that many PCP's are dropping or refusing to accept medical assistance HMO's due to the increasingly paltry reimbursement. This affects all ages, and is happening with medicare as well. This will be a problem if things don't improve, since as mentioned above practices will try to keep medicare patients no more than 30% or so of their practice yet the population of those over 65 will continue to grow. I suppose this bodes well for FP in that it will increase demand for new providers who will take up the overflow in medicare patients, but I think our aging population deserves better than to get pushed aside because the government lowballs the value of their medical care. I would implore the voting baby-boomers to demand more from their elected officials.

To respond to the original post I think there is tremendous stability in primary care due to the rising demand and the requirement for medical school educated physicians to manage the aging populations needs.

Yes, it seems to be the problem all over. Many doctors, who have establshed practices, don't accept any insurances. They keep flat fee within "reasonable" range", and give their patients itemized bills for filing the claim. But that automatically excludes ppl who only stay in network.
Does anyone know what's happening with flexible/medical spending accounts?
Pre-tax system works well for retirement plans, why not health coverage?

 

[deleted87716]

Many doctors, who have establshed practices, don't accept any insurances. They keep flat fee within "reasonable" range", and give their patients itemized bills for filing the claim.

Actually, this sort of practice model is still a rarity, but is slowly garnering interest, particularly among physicians who are frustrated with the current insurance system. It's primarily attractive for patients who are uninsured, wealthy, or those with medical savings accounts.

But that automatically excludes ppl who only stay in network.

Which includes the vast majority of insured patients at this time.

Does anyone know what's happening with flexible/medical spending accounts?

The idea is slowly gaining traction with employers, for whom it can lower the costs of providing healthcare coverage (we're giving our own employees a medical savings account option this year), but employees tend to be cautious. Most of ours will probably select a traditional plan. For some reason, the American mindset is that healthcare shouldn't cost anything, at least not beyond the premium and copay. Go figure.