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Yet Another Article Demonstrating The Deleterious Effects Of Our Reimbursement Structure

August 6, 2008

Another article demonstrating how high reimbursement for procedure-centered medicine is creating a shortage in vital areas of care.

Our aging population needs more geriatricians.  Yet, there is a current shortage with no relief in sight.  Geritricians go through additional training, but are paid dramatically less than specialists in procedure-oriented practices.  Why, as a medical student, would you extend your training to receive less pay?

Brandeis professor Dr. Stuart Altman reveals the reason: the insurance system is biased against doctors–like geriatricians–who concentrate on preventive medicine. “The way the health system pays the workers in it, it has a very strong bias in favor of high-tech services, highly specialized services and primarily services for acute care.” Time-intestive, non-procedure based primary care is not as highly compensated. In fact, geriatricians make a quarter to a third less than other specialists.

Within the geriatric medicine community there is a great debate regarding whether current geriatricians should be training family med and internal med docs in geriatric care or spend their time actually providing care for older adults.  On one hand, training doctors currently in their residency for family medicine or internal medicine in the proper care of older adults would produce a crop of physicians with at least some training in geriatric specific conditions.  However, this leaves a gap in the continuum of care–current geriatricians are pulled away from treating their own patients to provide this training.  Emerging research is also showing that simply adding additional education into already packed curriculum is not effective.

This is a problem that is only going to get worse as our population ages and people live longer with more complex chronic conditions.  Until we fix the way we pay physicians, problems like this will only get worse.

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