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Seniors: How to Put Together the Right Medical Team

Philip Moeller

For anyone past the age of 60, now is the time to carefully plan for your future physician needs. You will live, on average, into your mid-80s. Who will take care of you during this period? Will your current doctors be around then? Ask them. Do they have succession plans in their practices? Ask them. If you're not satisfied with the responses, build a personal action plan to locate doctors who will best meet your needs as you age.

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Healthcare reform could add more than 30 million people to the insurance rolls beginning in 2014. Of course, the Supreme Court could invalidate some or all of this mandate. But it's already hard to get access to a primary care doctor. Imagine what it might be like in five years.

Massachusetts, which already provides near-universal health insurance coverage, had 469 doctors for each 100,000 residents in 2007, according to U.S. Census data. It ranked first in the country, with 73 percent more doctors than the national average of 271 physicians for every 100,000 people. Still, try to find a new doctor there, particularly one who is well-regarded and gets top reviews from online rating services.

The Association of American Medical Colleges maintains a summary of various studies about projected physician shortages. Its own 2008 report concludes: "Driven by such factors as U.S. population growth, aging population and doctors, and increased physician visits, the demand for doctors will outstrip the supply through at least 2025. If physician supply and use patterns stay the same, the United States will experience a shortage of 124,000 full-time physicians by 2025."

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There are roughly 850,000 doctors today. There's just no way our medical schools will be able to pump out significantly more doctors in the short run. This assumes today's high school and college students even want to go into medicine. While health reform has focused largely on patient needs, doctors are an overworked and dispirited group these days.

In recent years, many doctors have abandoned private medical practices and joined either private or hospital-affiliated group practices. They may sacrifice some income and, in theory, personal control over their practice. But they also hope to lose a lot of the paperwork, enervating reimbursement hassles and other bureaucratic burdens of dealing with private insurance, Medicare, and Medicaid. By losing some control over their professional lives, they hope to regain some control over their personal lives.

Health reform, even if it survives the high court's review, faces a very uncertain road to implementation. It does include pro-physician incentives that could, in theory, attract more people into medicine. But pressures to cut healthcare spending will intensify, regardless of the fate of health reform. Assuming doctors would improve their financial standing amidst cuts to other healthcare providers is not logical.

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Beyond a general shortage of doctors, the outlook is particularly serious for geriatricians--doctors trained to care for elderly patients. The group of people age 85 and older is the fastest-growing demographic in the country. Yet geriatricians are at the bottom of the list of desired specialties in medical school. In no small measure, this is because geriatrician pay is also at the bottom.

There were only about 7,160 certified geriatricians in the entire country last year, according to the American Geriatrics Society. That works out to one geriatrician for every 2,620 Americans age 75 and older. As the numbers of older Americans grows, the ratio is projected to rise by the year 2030 to only one geriatrician for every 3,800 people age 75 and older. The shortage of caregivers trained to deal with older patients extends to nurses, physician assistants, and pharmacists as well, the Society says. And the number of new doctors picking geriatrics for advanced training is pitifully small, totaling only 86 residents in 2009.

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