Considering GERIATRICS?

[gioia]

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Who is accepted/applying to medical school with the long term goal of practicing Geriatrics?

 

[DireWolf]

Geriatrics was at the top of my list before entering med school. When I found out they are one of the least-paid specialists, I had to scratch it off. D.O. schools are not good for allowing primary care careers. $200K+ is a lot to pay off making $100K/year.

 

[Chronotropic]

Thats strange, I would think that thanks to the high volume geriatrics would have pretty good pay.

 

[DireWolf]

Thats strange, I would think that thanks to the high volume geriatrics would have pretty good pay.

Logic would lead to this conclusion. However, all the salary surveys (some more reliable than others) have geriatrics at the bottom along with pediatrics. Of the few geriatric docs I know in St. Louis, they all make around 100K in private practice, working their tails off. The reason = ALL of their patients are Medicare/Medicaid. Needless to say, these reimbursements are horrible. They also don't do a lot of procedures.

 

[DrMom]

The reason = ALL of their patients are Medicare/Medicaid. Needless to ay, these reimbursements are horrible.

Exactly. Add to that all of the limitations & regulations of Medicare. So basically, geriatrics is low-reimbursement/high-government-red-tape.

 

[Chronotropic]

Well that explains it right there. Ironic since Ophos serve the same type of population and make out quite well.

 

[DrMom]

Well that explains it right there. Ironic since Ophos serve the same type of population and make out quite well.

But they don't soley see geriatric patients (so they don't rely soley on Medicare payments) and they do procedures.

 

[DireWolf]

Well that explains it right there. Ironic since Ophos serve the same type of population and make out quite well.

True to a certain extent- but remember that many Ophthos do tons of surgery. Procedures are better-reimbursed by Medicare. Also, there are many ophtho diseases that are prevalent among the younger population. My Grandpa's ophtho caters mostly to elderly/medicare patients. He's a retina specialist that deals with a lot of cataracts and macular degeneration. He makes bank.

 

[haldane3]

They make their money on Lasik/elective procedures also do they not? Those are 100% paid by the patient without insurance coverage remember. And they are 500-1000 a pop.

 

[gioia]

Exactly. Add to that all of the limitations & regulations of Medicare. So basically, geriatrics is low-reimbursement/high-government-red-tape.

But we will also be servicing a new generation of the aged: the Baby Boomers....

If 50 billion dollars were spent out of pocket last year on alternative medicine, then I think they will be willing to pay for expert health care in the coming years. They don't want to age the way their parents are (who, being the silent generation, were not willing to pay for themselves anyway).

I think we underestimate the power of marketing: If we sell a good product (expert aging CARE) then the money will come. The money is there and is currently being spent on: DERMATOLOGY, ALTERNATIVE MEDICINE, CHIROPRACTIC CARE.

 

[gioia]

I am indirectly saying that we, as physicians, should care less about insurance red-tape and more about marketing and word of mouth (of course my theory has yet to be proven but I will try it).

 

[DORoe]

Do you think that reimbursment will increase because of a rising elderly population and a decrease in doctors that specialize in geriatrics?

 

[DireWolf]

I think you misunderstand the point that most elderly Americans live at or below the poverty line. Pensions and social security are simply not enough to survive anymore. This is going to be a SERIOUS problem very soon. Most of the elderly's "available" money is usually spent on expensive medications. Watching my grandparents and their friends, who all worked their tails off for 50+ years at good jobs, struggle to pay the bills is extremely painful. A lot of these people rely solely on Medicare for their health care. My Grandpa's Blue Cross/Blue Shield supplemental insurance (which barely covers anything) costs $450/month. These people would love to pay for quality health care, but they simply can't.

But we will also be servicing a new generation of the aged: the Baby Boomers....

If 50 billion dollars were spent out of pocket last year on alternative medicine, then I think they will be willing to pay for expert health care in the coming years. They don't want to age the way their parents are (who, being the silent generation, were not willing to pay for themselves anyway).

I think we underestimate the power of marketing: If we sell a good product (expert aging CARE) then the money will come. The money is there and is currently being spent on: DERMATOLOGY, ALTERNATIVE MEDICINE, CHIROPRACTIC CARE.

 

[DireWolf]

Do you think that reimbursment will increase because of a rising elderly population and a decrease in doctors that specialize in geriatrics? It seems that it would make good economic sense to me.

There has been and currently is a HUGE shortage of geriatric physicians. CBS did a story on it last year. However, because of the way Medicare reimburses, these docs are STILL making ~100K/year. Supply and demand does not necessarily apply to Medicare. Also, other docs are trained to care for geriatric patients. IM, EM, FP, Surgeons, Specialists, etc. It's not like elderly patients are required to seek care from physicians trained in geriatric medicine.

 

[DireWolf]

On a side note, I hope that you and others will decide to pursue geriatric medicine. The need is obvious and it takes special people to fulfill this role. The geriatric docs that I know who were SLU-trained are all first-class people with huge hearts. I commend those strong enough to fight through the red-tape and low reimbursements to help a very needy population.

 

[gioia]

I think you misunderstand the point that most elderly Americans live at or below the poverty line. Pensions and social security are simply not enough to survive anymore. This is going to be a SERIOUS problem very soon. Most of the elderly's "available" money is usually spent on expensive medications. Watching my grandparents and their friends, who all worked their tails off for 50+ years at good jobs, struggle to pay the bills is extremely painful. A lot of these people rely solely on Medicare for their health care. My Grandpa's Blue Cross/Blue Shield supplemental insurance (which barely covers anything) costs $450/month. These people would love to pay for quality health care, but they simply can't.

DIRE,

I specifically mentioned Baby Boomers. There are EXTREME demographic variances between the group you are referring to and the one I am referring to. The group you mention will almost be the frail elderly by the time most of us are in practice - and yes, that is a desperate scene.

I am projecting: We need to see the Boomer diffs. and spending/marketing power before we kick back and assume that we are prisoners to low reimbursing insurance thieves.

If you offer quality care, I believe, the money will come. Naive? Maybe. But I don't think we should shortchange the income potential of the Geriatric specialty because of current policy and current demographics.

When you look at how much money is still spent by ALL of Americans (yes, including the older ones) on retail and entertainment and out of pocket health alternatives, I think the field of Geriatrics has alot of potential.

The problem I see is allocation.

Thank you for posting, this is thought provoking 🙂

 

[Celestron2000]

I'm defiantely thinking about geriatrics. I don't actually expect to or need to make tons of money (although I will have mega student loans to pay off.) Inspite of the low pay and redtape geriatricians are among the happiest/ most satisfied of doctors... I think that says alot right there. The more "procedural" specialties are among the least satisfied (although they tend to make the big bucks).
I just bumped-up a thread about geriatrics in pre-allo, so check that one out too.

 

[Robz]

I think you misunderstand the point that most elderly Americans live at or below the poverty line. Pensions and social security are simply not enough to survive anymore. This is going to be a SERIOUS problem very soon. Most of the elderly's "available" money is usually spent on expensive medications. Watching my grandparents and their friends, who all worked their tails off for 50+ years at good jobs, struggle to pay the bills is extremely painful. A lot of these people rely solely on Medicare for their health care. My Grandpa's Blue Cross/Blue Shield supplemental insurance (which barely covers anything) costs $450/month. These people would love to pay for quality health care, but they simply can't.

good point....rememeber that social security was suppose to the the THIRD leg of a retirement plan when it was conceived.

It was suppose to be
1/3 Pention
1/3 Retirement Savings
1/3 Social Security

As you can tell businesses stopped doing a lot of pentions
People don't save much money anymore....
People feel its the governments responsibility to take care of them in their old age.

I dunno how many people here have ever been into or spent time in a nursing home but thats a great example of the care that medicaid gives as you get older. It sucks in a way and yes...the system is going to crash and crash HARD. Not in our kids future...but in our present ....near.... within 15 years future.....

 

[gioia]

Remember that last year alone, 50 billion dollars were spent - out of pocket- on alternative medicine.

Do you know what group spent most of it? The Baby Boomers. When we start practicing medicine, the bulk of our clients will be the retiring Baby Boomers - like it or not. They are the largest demographic and American businesses spend a considerable amount of money marketing to them.

Watch TV: Look at the number of grey-haired actors selling everything and the products being marketed.

This is all to say that the geriatrics of today will not be the geriatrics of tomorrow. They are two different-minded generations of people.

So, I think geriatrics will be a rewarding future. There is currently a shortage of physicians practicing geriatrics... just think of the desperate need in 10 years.*

*for the sake of conversation, I ommitted the frail elderly topic 🙂

 

[shawred]

With the aging population, it is inevitable that the reimbursement policies will have to change. The government will only be able to limit funding to a certain degree. Otherwise, the medical system will begin to fail (quality will suffer to unacceptable levels). I also have no idea what the solution will be. However, I do believe one possibility will involve the forgiving of loans incurred by physicians who agree to practice geriatrics. I understand that most doctors receive training in treating the elderly, but I can tell you that geriatricians, as a whole, provide care that exceeds those of other specialties. Just ask yourself, "Why do many parents generally send their children to a pediatrician rather than a family doc?"

Shawred
Master of Clinical Gerontology--Baylor '01

 

[gioia]

I agree w/ Shawred's expertise 🙂

In add'n the future of geriatrics will also be a bit diff. because those patients are actually willing to spend pocket money on their health care unlike the Silent Generation who is extremely mentally (and otherwise) dependent on health care plans to care for their needs.