Columns

It wouldn’t hurt if we all became more defensive in our relationships with medical practitioners. If Senior Power were a meaningful concept. 

Practitioners of defensive medicine diagnose or prescribe therapies as protection against malpractice liability. Fear of legal action motivates defensive medicine. Another motive may be increase of services ipso facto increased revenue. Defensive medicine is widespread in the United States, particularly in such high-risk medical specialties as emergency medicine and obstetrics. 

Does your primary care physician practice defensive medicine of either type? How physicians of various ages, specializations, locations, and sex/genders view what is euphemistically referred to as compensation is worth considering.  

Medscape (Medscape, Inc.) is a web resource for physicians and other health professionals, available free, with required registration, to them and to consumers. Founded in 1995 by SCP Communications, Inc., by 1999 it was trading on NASDAQ. Medscape’s annual Physician Compensation Report of 2012 is based on responses from United States physicians in 25 specialty areas. With a few personal comments interspersed, here are some of the Report’s relevant findings. 

Physician income declined, although top-earning specialties remain the same as in the previous year’s survey. In 2012, radiologists and orthopedic surgeons top the list at $315,000, followed by several gists -- anesthesiologists, cardiologists, urologists. The bottom-earning specialties are family medicine, internal medicine, pediatrics. Physicians are nearly evenly split about whether or not they feel fairly compensated. A majority of primary care physicians say they are not being fairly compensated. Senior citizens’ primary care physicians tend to be specialized in family medicine and internal medicine. 

About 42% of the physicians who responded to this survey were under age 45. Two thirds were male; one third, female. Male physicians across all specialties earn about 40% more than female physicians. In primary care, men earn 23% more. In some specialties the gap in income is narrower, e.g. male obstetricians/gynecologists earn about 12% more than their female counterparts. Why do you think this is so? 

Female physicians continue to spend more time with each patient than do male physicians. Roughly 45% of both sexes/genders spend 13-20 minutes per patient visit. Medscape’s commentator rationalizes that "Female physicians tend to concentrate in obstetrics and primary care, where doctors naturally spend more time with patients than do other specialists… Often, they are part-time employees for lifestyle reasons, and their main priority isn't on maximizing revenue for the practice. So, they are able to spend more time with patients." Naturally? Lifestyle? 

Apparently, it is worth the time and money required to become board certified. The majority of the 24,216 survey participants are board certified. Board certified physicians earned 89% more than non-board-certified. Board certification impacts more than just compensation. It is often required for inclusion in health plans and for hospital privileges. More and more patients are researching physicians' backgrounds, which is a good thing. 

Although decreased reimbursement (by Medicare, Medicaid, insurance companies) has been the recent buzz-phrase, some specialists surveyed saw modest gains, while others saw significant declines. Partners in private practice far out-earned physicians in any other work environment. The greatest income increases were in nephrology, oncology, ophthalmology, pediatrics, rheumatology. A buzz-phrase or word is connected with a specialized field or group and usually sounds important or technical; it is used primarily to impress laypersons and becomes nonsense through endless repetition. 

The 13-16 minutes patient visit is still most common, especially in the primary care specialties of family medicine and internal medicine. Dermatologists, emergency physicians, ophthalmologists, and radiologists spend the least time -- a mean of 9 -12 minutes per encounter. The hospital E.R. physician spent exactly 9 minutes determining that the cervical neck collar could be removed, thus enabling the paramedics to retrieve their equipment and get out; I was billed by him as well as the E.R. . 

More than half of these physicians spend 4 hours or less a week on paperwork and other administrative activities. Few family physicians, internists, and pediatricians spend that much time on administrative activity. Medscape proffers the explanation that more documentation is being required than ever before.  

The 2012 survey shows far more dissatisfaction among doctors across all specialties. 

Just over one half of all physicians would choose medicine as a career again. Only one quarter would choose the same specialty. The most frustrated with their specialties are family physicians and internists. Despite lower incomes, 46% of pediatricians would still choose their specialty. The most satisfied specialty is dermatology.  

Three percent of physicians have cash-only practices, although that percentage is higher for plastic surgeons (15%) and psychiatrists (11%). A dermatologist of whom I am aware has notified patients that she no longer accepts any insurances, i.e. it’s cash up front in one form or another. Many senior citizens do not have credit cards. 

“Physician frustration is growing,” reports Medscape. Their comments on the frustrations of the profession include "The regulatory environment and the onerous paperwork involved are making the current situation untenable, " and "I love being a physician, but I hate what is happening to medicine. Too many people are coming between me and the care I provide to my patients." 

Despite the interest in “alternative patient-care delivery models,” only a small percentage of physicians are currently involved. About 3% participate in Accountable Care Organizations (ACOs), but some say they plan to become involved. An ACO is a type of payment and delivery that ties provider reimbursement to quality evaluation and reduction in the total cost of care for a given patient population.  

Only 1% of physician respondents practice concierge medicine, also known by some people as direct care, a relationship between a patient and her/his physician which the patient pays an annual fee or retainer that may or may not be in addition to other charges. In exchange, it is thought that doctors provide enhanced care. If you’re laid up with influenza, and your doctor doesn’t deem it worth a house call, or you can’t get an appointment with her/him, your care and your wallet would seem to lack enhancement.  

While all concierge medicine practices share similarities, they vary widely in their structure, the level of service provided, and the amount of the fee charged. It is estimated that 800-5,000 U.S. doctors practice concierge medicine. 

Healthcare reform entails treatment and quality guidelines set by insurers and by Medicare, but physicians are clearly skeptical (Medcape’s adjective) that guidelines will improve patients' quality of care. Physicians perceive guidelines as a greater loss of autonomy. Almost half of physicians surveyed said these measures will have a negative impact; 29% said they will have no impact on quality. Between 26% and 31% of internists, family physicians and pediatricians say that quality measures and treatment guidelines will have a positive effect. Only 25% of physicians believe health care reform will lead to better-quality care. Guidelines and health care reform apparently equate in many physicians’ perceptions.  

In the past, most doctors did not discuss treatment costs with patients. Now, less than half of the physicians surveyed said they occasionally discuss cost of care issues if patients raise the subject. Occasionally? If…? One in seven doctors say they never discuss the issue, either because they themselves do not know the cost of the treatments, or they do not believe it is appropriate to do so. Specialists most likely to participate in cost-related conversations are the dermatologists, family physicians, psychiatrists, rheumatologists. 

As more physicians become employees, they feel that it is their responsibility to treat the patient's problem, rather than worry about the payment issues. For them, the cost issue is a secondary concern. Names, please.  

The healthcare reform goal of reducing "unnecessary care" faces challenges. The vast majority of physicians said they will not reduce the number of tests, procedures and treatments they perform, either because the guidelines are not in their patients' best interests, or because of the need to practice defensive medicine. 

xxxx 

NEWS 

“A Museum Visit For Art Lovers With Alzheimer's” played on the morning edition of National Public Radio, May 17, 2012. It can be read on the Internet; a print transcription will be available. The Kreeger Museum in Washington, D.C., once the residence of former GEICO chairman David Kreeger and his wife, it was designed in 1967 by Philip Johnson. It is one of several museums in the country that have a special program designed for people with Alzheimer's. 

The Berkeley Commission on Aging is: “Charged with identifying the needs of the aging, creating awareness of these needs, and encouraging improved standards of services to the aging. Council shall appoint one of its members as liaison.” The Commission’s May 16, 2012 meeting agenda included Adoption of a Mission Statement for the Commission on Aging. “To actively promote older adults health, safety, independence and participation in our community; to enhance quality of life for people 55 years and older; to increase public awareness of their contributions and needs.” [sic] The Commission’s next meeting is scheduled for Wednesday, June 20. But confirm. 510-981-5178. 

xxxxx 

MARK YOUR CALENDAR: Be sure to confirm. Readers are welcome to share by email news of future events and deadlines that may interest boomers, seniors and elders. Daytime, free, and Bay Area events preferred. pen136@dslextreme.com.  

Until June 30. Gallery Hours: Tuesday - Friday, Noon - 5:30pm; Saturday, Noon - 4:30 P.M. Kala Gallery, 2990 San Pablo Avenue: Visions from the New California. The Visions from the New California award is an initiative of the Alliance of Artists Communities and is supported by the James Irvine Foundation. Each year the awards program celebrates six outstanding California visual artists from diverse communities. The awardees are artists whose work may as yet be unfamiliar to a wide audience, but whose compelling visions help define California. Free. 510-841-7000.  

Until August 31. Environmental Education Center in Tilden Regional Park. North End Central Park Drive. Tuesday through Sunday, and Memorial Day (May 28) 10:00 A.M.-4:30 P.M. Tilden Exhibit Celebrates Conservation Successes. Art exhibit celebrating the successes of conservation in the region, state and nationally. Show features works by 60 artists portraying plants and animals no longer listed as endangered species due to conservation efforts. The exhibit calls attention to the successful strategies of land managers, volunteers and rangers throughout the state and local parks. Includes both two-dimensional and three-dimensional works, including pastels, watercolors and oil paintings, as well as carved sculptures and mixed-media creations. Some of the featured species include the brown pelican, the tiger salamander, the salt marsh harvest mouse, and tule elk. Exhibit sponsors include the East Bay Regional Park District and the Merritt College Environmental Management and Technology Dept. Free. www.ebparks.org 

Until Sept. 2. Berkeley Arts Festival Gallery presents a new exhibition of the work of creative visual artists. Robert Brokl, paintings/prints. Mark Bulwinkle, painted steel screens. Art Hazelwood, linocuts. Roberta Loach, prints. Mari Marks, encaustic paintings 2133 University Av. Free. 510-644-6893. www.berkeleyartcenter.org 

Until Sept. 29. Thursdays, Fridays and Saturdays, 1-4 P.M. Joanna Gewertz Harris, Ph.D, Bay Area dancer, dance historian and author of Beyond Isadora: Bay Area Dancing 1915-1965, will discuss the history of East Bay performers, choreographers and pioneers of today’s dance community. The exhibit explores dance in the East Bay and includes a video by Margaretta Mitchell, an interview with Frank Shawl, and archival footage of Hanya Holm. Jeanine Castello-Lin and Tonya Staros, Co-Curators. Wheelchair accessible. Berkeley History Center, 1931 Center St. Free. 510-848-0181 

Sunday, May 27. 1:30-4:30 P.M. Book Into Film: Betty Smith’s A Tree Grows in Brooklyn at Central Berkeley Public Library, 2090 Kittredge. Read the book at home. Watch the movie together. Discuss the book, film and adaptation as a group. Registration required- call 510-981-6236 to sign up. 

Wednesday, May 30. 12 Noon-1 P.M. Playreaders at Central Berkeley Public Library.  

2090 Kittredge. Meets weekly to read aloud from great plays, changing parts frequently. Intended for adult participants. 510-981-6100. 

Thursday, May 31. 1:30 P.M. UC Botanical Garden Docent Tour. With paid admission, free docent-led tours year-round on Thursdays, Saturdays and Sundays at 1:30 PM. Plants of the World - General Tour of the Garden. Explore the Garden’s incredible diversity of plants from six continents, including environments as diverse as deserts, tropical forests, redwood forests, and wetlands. Each tour is a unique experience focused on plants at their seasonal best, a variety of themes, and your interests. Event Contact: garden@berkeley.edu, 510-643-2755. 

Saturday, June 2. 10 A.M. – 4 P.M. Berkeley Public Library, 2090 Kittredge St. Semi-annual Book Sale. Books sold for 50 cents each. 510-524-8378 or berkeleylibraryfriends.org. 

Monday, June 4. 6:30 P.M. "Castoffs" - Knitting Group. Kensington Library, 61 Arlington Ave. An evening of knitting, show and tell, and yarn exchange. All levels are welcome and help will be provided. Free. 510-524-3043. 

Wednesday, June 6. 12 Noon-1 P.M. Playreaders at Central Berkeley Public Library.  

2090 Kittredge. Meets weekly to read aloud from great plays, changing parts frequently. Intended for adult participants. 510-981-6100. 

Wednesday, June 6. 6-8 P.M. Lawyer in the Library. Albany Library, 1247 Marin Av. Free 15 minute consultation with an attorney who will clarify your situation, advise you of your options, get you started with a solution, and make a referral when needed. Sign up in person at the Reference desk or call 510-526-3720 ext. 5 during library hours. 

Also August 1, Sept. 5, Oct. 3, Nov. 7 and Dec. 5.  

Thursday, June 7. 3:00-5:P.M. At the Rockridge Library in Oakland, 5366 College Avenue. 51A, 605 bus lines stop in front of the library; walk 5 blocks south from Rockridge BART station. "Explore Your Future" workshops for people age 50+, sponsored by Coming of Age: Bay Area (a national nonprofit initiative.) 4-session series of classes. For Coming of Age members, the charge is $49 for all 4 sessions; for nonmembers, it is $89. But becoming a Coming of Age member is free, and people can sign up on the website at www.comingofage.org/bayarea and get the discounted rate for the workshop and other activities. Meet with a group of people and a skilled counselor to really think about and envision your next steps. 888-308-1767 or 415-474-7787. 

Thursday, June 7. UC Botanical Garden. Tour and Open House – first Thursday of every month. Parking is limited. Docent-led tours for groups are not available on Free Thursdays. In order to minimize the impact on the plant collection, ensure the safety of visitors, and to provide your group with the best educational experience groups larger than 18 students (+3 chaperones) on our “First Free Thursdays” not admitted. See http://botanicalgarden.berkeley.edu/education/tours.shtml for group admission information. Free. Event Contact: garden@berkeley.edu, 510-643-2755. 

Sunday, June 10. 2 P.M. Blue Suede Jews. Central Berkeley Public Library, 2090 Kittredge. Local rock historian Richie Unterberger presents lecture/footage of Jewish musicians in the golden age of rock roll, including Bob Dylan, Carole King and many more. 510-981-6100.  

Wednesday, June 13. 12 Noon-1 P.M. Playreaders at Central Berkeley Public Library.  

2090 Kittredge. Meets weekly to read aloud from great plays, changing parts frequently. Intended for adult participants. 510-981-6100. 

Thursday, June 14. 8:45 P.M. Cafe Literario. West Berkeley Public Library, 1125 University Av. Facilitated Spanish language book discussion. June title: Margarita, Está Linda la Mar by Sergio Ramirez. 510-981-6270. 

Saturday, June 16. 5 P.M. Claremont branch, Berkeley Public library, 2940 Benvenue Av. Melanie O’Reilly will perform original music inspired by Joyce’s writings. 510-981-6280. 

Monday, June 18. 7 P.M. Art historian Michael Stehr will discuss Gian Lorenz Bernini, the Michelangelo of the Baroque. He will also present a slide show. Kensington Library, 61 Arlington Avenue. Free. 510-524-3043. 

Wednesday, June 20. 12 Noon-1 P.M. Playreaders at Central Berkeley Public Library.  

2090 Kittredge. Meets weekly to read aloud from great plays, changing parts frequently. Intended for adult participants. 510-981-6100. 

Wednesday, June 20. 1:30 P.M. Berkeley Commission on Aging regular meeting. North Berkeley Senior Center, 1901 Hearst. 510-981-5178. Be sure to confirm. 

Monday June 25. 7 P.M. Kensington Library Book Club: The Chosen by Chaim Potok. 61 Arlington Av. Free. 510-524-3043. 

Tuesday, June 26. 3-4 P.M. Tea and Cookies. Central Berkeley Public Library. 2090 Kittredge. A book club for people who want to share the books they have read. 510-981-6100.  

Wednesday, June 27. 12 Noon-1 P.M. Playreaders at Central Berkeley Public Library.  

2090 Kittredge. Meets weekly to read aloud from great plays, changing parts frequently. Intended for adult participants. 510-981-6100. 

Wednesday, June 27. 1:30-2:30P.M. Great Books discussion group. July’s People by Nadine Gordimer. Rosalie Gonzales, group facilitator. Albany Library, 1247 Marin Av. 510-526-3720.  

Sunday, July 8. 1 – 4:30 P.M. The 2012 Berkeley Rent Board Convention will be held in the main meeting room of the downtown, central Berkeley Public Library, 2090 Kittredge, corner of Shattuck. A slate of candidates for the November 2012 election will be chosen. Contact: www.berkeleyrentboard.org 510-981-6100. 

Wednesday, July 11 6-8 P.M. Lawyer in the Library. Albany Library, 1247 Marin Av. Free 15 minute consultation with an attorney who will clarify your situation, advise you of your options, get you started with a solution, and make a referral when needed. Sign up in person at the Reference desk or call 510-526-3720 ext. 5 during library hours. 

Also August 1, Sept. 5, Oct. 3, Nov. 7 and Dec. 5.  

Wednesday, August 1. 6-8 P.M. Lawyer in the Library. Albany Library, 1247 Marin Av. Free 15 minute consultation with an attorney who will clarify your situation, advise you of your options, get you started with a solution, and make a referral when needed. Sign up in person at the Reference desk or call 510-526-3720 ext. 5 during library hours. 

Also Sept. 5, Oct. 3, Nov. 7 and Dec. 5.  

Wednesday, August 22. 1:30-2:30P.M. Great Books discussion group. Selections from The Bhagavad Gita. Rosalie Gonzales, group facilitator. Albany Library, 1247 Marin Av. 510-526-3720.  

Wednesday, Sept. 5. 6-8 P.M. Lawyer in the Library. Albany Library, 1247 Marin Av. Free 15 minute consultation with an attorney who will clarify your situation, advise you of your options, get you started with a solution, and make a referral when needed. Sign up in person at the Reference desk or call 510-526-3720 ext. 5 during library hours. 

Also Oct. 3, Nov. 7 and Dec. 5.  

Wednesday, Sept. 26. 1:30-2:30P.M. Great Books discussion group. Things Fall Apart by Chinua Achebe. Rosalie Gonzales, group facilitator. Albany Library, 1247 Marin Av. 510-526-3720.  

Wednesday, Oct. 3. 6-8 P.M. Lawyer in the Library. Albany Library, 1247 Marin Av. Free 15 minute consultation with an attorney who will clarify your situation, advise you of your options, get you started with a solution, and make a referral when needed. Sign up in person at the Reference desk or call 510-526-3720 ext. 5 during library hours. 

Also Nov. 7 and Dec. 5.  

Wednesday, October 24. 1:30-2:30P.M. Great Books discussion group. Troth, by Gregor von Rezzon. Rosalie Gonzales, group facilitator. Albany Library, 1247 Marin Av. 510-526-3720.  

Wednesday, Nov 7. July 11 6-8 P.M. Lawyer in the Library. Albany Library, 1247 Marin Av. Free 15 minute consultation with an attorney who will clarify your situation, advise you of your options, get you started with a solution, and make a referral when needed. Sign up in person at the Reference desk or call 510-526-3720 ext. 5 during library hours. Also Dec. 5.  

Wednesday, November 28. 1:30-2:30P.M. Great Books discussion group. Sunday Morning, by Wallace Stevens. Rosalie Gonzales, group facilitator. Albany Library, 1247 Marin Av. 510-526-3720.  

Wednesday, Dec. 5. 6-8 P.M. Lawyer in the Library. Albany Library, 1247 Marin Av. Free 15 minute consultation with an attorney who will clarify your situation, advise you of your options, get you started with a solution, and make a referral when needed. Sign up in person at the Reference desk or call 510-526-3720 ext. 5 during library hours. 

An invitation. Candidates for election are welcome to share statements of their accomplishments and plans vis a vis senior citizens and elders. Please email them to me at pen136@dslextreme.com.