Geriatric Specialist

[Bkworm]

Several months ago, I started seeing ads in my FB feed about new doctors' groups who were Geriatric Specialists. Now I am seeing ads for doctors who specialize in treatment of 65+ patients with Medicare.

Can anyone advise me of advantages and/or disadvantages with such groups. I have been going to the same PCP for about 25 years at least (I believe it is actually closer to 35 years) However, even though I still like her in many ways, she has started pushing for all the preventative tests. We seem to be at loggerheads. Would these other specialists push as much or would they accept my decisions for my body?

I have the feeling that the PCP is about to ask me to leave her care. At my last appointment, she advised she can only treat me as long as the insurance covers me and they will probably stop because I am not going for the preventative tests. When I said I could change to Medicare coverage she quickly pointed out that Medicare won't cover some of the tests at age 75. I am currently 72 and my husband is 74. He says he will retire next February but I will believe it when it happens. Our medical insurance is through the hospital where my husband has been employed for going on 46 years. Her practice is actually owned by the hospital corporation so I know all this pushing is actually coming from the hospital corporation procedures to bring in more money for their machines and bottom line.

Any guidance would be appreciated.

[Daydream]

Bkworm,

My husband and I both have the Original Medicare plan so that we can go to any doctor or hospital that takes Medicare (if we ever need to see a specialist). We also have to buy supplemental insurance such as prescriptions and dental. I am 68 and my husband is 69. I will say this...Medicare has paid better than any medical insurance my husband has ever had throughout all his working career.

My primary care physician has recommended that I get all the various tests such as mammogram, colonoscopy, etc. and I have refused them and he has respected my decision.

You asked if Geriatric specialists would push the preventative tests and my guess is that they probably would however the bottom line is how pushy of a personality your PCP is. My PCP has been very nice about it and has recommended the tests but has not been threatening or angry with my decision not to have those tests. I hope that helps!

[Bkworm]

Thank you, Daydream,

It does answer some questions. I also appreciate the info on your Medicare experiences. We don't yet know what we are going to do once my husband retires. Have researched enough to know we won't go with one of the Advantage plans. Too many people have been burned when it comes to serious illnesses.

Eleven years ago, my PCP seemed to be very supportive of my change to the WFPB lifestyle. But now she just keeps pushing for the tests and wanting me to schedule the tests. I guess I know where she is coming from on one hand. She lost her mother to breast cancer when the PCP was in her teens. But, I believe this is my body, my life, and my decision.

I started this lifestyle to control RA and have gained so many other benefits since. I am not doing this to live to be 100. I just want to live as independent as possible as long as possible. Aging in the US is not easy or pretty. At 72, I believe it is time to allow nature to follow its own path but that is my belief. I am not trying to make others follow that same path but let me be in control of my path, not a hospital corporation.

In Central Florida, there are very few medical practices, if any, left that aren't owned by a hospital corporation, either Advent Health, HCA, or Orlando Health. Between the three corporations, they own just about everything medical in this area - pharmacies, labs, medical practices, assisted living and nursing homes, brace companies, fitness gyms, physical therapy practices, etc. How this is allowed and is not considered a conflict of interest and a monopoly I don't know. It is all a huge business and gets bigger every day.

Thanks again, Daydream

[DynoDan]

‘Marketing’. The engine that drives capitalism.
Likely, doctors that may have started out idealistic, have all ‘thrown up their hands’, given in, & boarded the gravy train (not very attractive advertising for our USA society, when the majority of broadcast TV commercials push products that can only be purchased with physician collusion). Some might have initially tried convincing their patients (customers) that the drugs/tests they request aren’t actually proven to be effective (or safe), but then, if that wasn’t futile, there would be no trillion dollar advertising industry. Those that do buck the system, soon find their medical practice & years of expensive educational investment threatened by the pharma/media economic megalith. So much easier to just take the money, and learn to cultivate self-justification. Honest/independent doctors have most all gone the way of politicians with a similar bent (along with the Dodo birds).

[Bkworm]

Thanks for your input DynoDan,

Marketing in our area for all three medical corporations is extremely intense - TV, FB, YouTube, Radio, Mailimgs, magazines, newspapers, sponsorship at NASCAR, etc., etc.,etc., You can’t get away from it. Due to our insurance through my husband’s employment, we can only receive services through their approved providers for any medical needs. Just in our area north of Orlando, all three have stand alone ERs within no more than a two to three mile area at most. In just a quick overview in other surrounding areas, there is at least the same situation in six other areas in Central Florida.

I personally find it alarming but no one else seems to even question it at all.

I truly believe this is what is now pushing all the requests for the testing. I really don’t believe changing doctors would help. So I guess I will keep fighting the good fight for now with the same PCP. Unless she finally asks me not to return.

Thanks again, DynoDan.

[coleman876]

You have my sympathy. We are 76 and 83 and we are being pressured to take tests. We are on no medications at this point and they are very eager to get us into the money making system. I made the mistake going to the ER because of a stomach issue I have been having. I have followed Dr. McDougall for 17 years but had covid and it attacked my stomach and caused me digestive problems. Anyway, the ER doctor was standing there recommending every test he could think of and I just kept saying no, no, no. He finally talked me into a covid test and a EKG. Don't think I will go back until I am on my way out! You can just see them thinking about how they can run up the bill. So disappointing you can't trust anything anymore. I feel they care nothing about your health just racking up the bill so they can all make a lot of money. My great grandmother lived to be 103 and she said even then that the only reason she had lived so long was because she wouldn't go to doctors. I'm starting to believe her! Best of luck to you and stay strong and stubborn!

[VeggieSue]

Can anyone advise me of advantages and/or disadvantages with such groups. I have been going to the same PCP for about 25 years at least (I believe it is actually closer to 35 years)

I may be forced to switch docs soon myself and have been looking into them. The state of healthcare today is alarming! It's nearly impossible to find "a" doctor - it's all groups consisting of doctors, nurses, PA's and APNs. You make an appointment and it's not for an individual person, it's for "the group" and you see whichever person is on duty that day. People in the same practice can have vastly different philosophies on health care and treatments. I see it in my husband's oncology group and my sister in law saw it in her gerontology/geriatric group.

However, even though I still like her in many ways, she has started pushing for all the preventative tests. We seem to be at loggerheads.

I've been so lucky with the family practice our family has been going to for over 40 years now, starting with the grandfather and now down to a distant nephew. Only one really pushed for the testing but he retired decades ago. The docs I've had since then all asked at each visit but never pushed.

Would these other specialists push as much or would they accept my decisions for my body?

You never know ahead of time. If your city has a local Facebook group or message board you can ask there if anyone had seen those docs and what their opinions of them are. Maybe set up a "fact finding" appointment - no exam, just Q&A stuff, but you'll most likely have to pay out of pocket. Maybe his staff can answer your questions over the phone?

I have the feeling that the PCP is about to ask me to leave her care. At my last appointment, she advised she can only treat me as long as the insurance covers me and they will probably stop because I am not going for the preventative tests.

Doctors lie to scare you into doing as they demand. My current doc keeps refusing to order my thyroid and asthma meds for more than 6 months at a time, telling me both the state of NJ and our insurance won't allow yearly prescriptions. Uh, yes they do. All my husband's Rx are written for yearly, as is my brother's BP med. When I had my yearly stuff done 2 weeks ago I told him to his face I want my meds written for the year, not 6 months, that I KNOW it is legal and in fact our insurance company encourages yearly. He said OK, that's how he'll have his nurses call them in. Of course, it was once again a 3 month supply, renewable only once. When I called the office they refused to change it, saying it's doctor's orders to only give 6 month prescriptions.

Our medical insurance is through the hospital where my husband has been employed for going on 46 years.

Are you keeping that insurance when he retires? My husband was able to when he retired so when we were each eligible for Medicare we only got Part A at the time, but now with his leukemia and kidney failure journey all the docs he's dealing with encouraged him to get Part B ASAP because that would cover more than what coverage he already has. They said I should do it, too, because who knows what's going to happen in the future. Now that Part B has kicked in for both of us, our regular insurance company says Medicare is now Primary, BUT anything they don't cover his BCBS *will*.

My brother got Medicare Parts A&B when he turned 65 and also signed up for an Advantage Plan. He chose the one offered by BCBS because after doing weeks of research he saw they covered just about everything Medicare didn't. Luckily he hasn't had to use any of it yet, so we can't say for sure if they were telling the truth or not. LOL

Any guidance would be appreciated.

(sigh) All I can suggest is to ride it until it crashes but do your research now while you have the time. Ask around for doctor suggestions from anyone you can. Try the phone call to each office and ask about mandatory testing.

Florida has been horrible for doctors for decades. When we moved there for a year back in 1999 the only way we even *had* a primary care doc is because he's the brother in law of the doctor I had then (A cousin of the doc I see now). His office also gave me the hard sell and line that certain tests were mandatory above a certain age as per "state law" and I had my first mammo in maybe 25 years, and it'll be my last ever because of the damage it did to me at the time. I never saw the doctor himself the entire year, only one of the PAs. I never did have any of the other tests they wanted me to have aside from the x-ray when I hurt my back and got diagnosed with degenerative disc disease. The doctor my father had refused to take us as patients because his practice was already overbooked. One of the few things I liked about moving back to NJ was getting my old doctors back.

[DynoDan]

I have to laugh whenever I hear the inevitable TV pharma ad refrain: “ask your doctor”. Good luck, unless you schedule an office visit (often several hundred dollars out-of-pocket). Nowadays, physicians have their nurse/office manager screen all calls. Some won’t even accept messages or emails, unless you book an appointment.
I usually get my medical care at a distant VA hospital. They don’t really have a monetary incentive for excessive testing, but their doctors still do maintain a knee-jerk ‘CYA’ attitude. I sometimes use a local surgeon (for medical-technical reasons or cosmetic work the VA won’t authorize, and especially to avoid excessive/unnecessary driving). I wanted to offer him the opportunity recently to perform some minor work I had already scheduled with the VA, but didn’t want to waste a lot of money unnecessarily. I also didn’t want to pressure him into accepting low-paying medicare work if he was especially busy. His nurse wouldn’t even give me an office email address, let alone his private phone #.