When Medicares welcome wagon rolls around the corner this year, Part B recipients are invited to take advantage of screenings, tests, shots, and referrals to other health-care providers through a one-time preventive Welcome to Medicare Physical Exam with their primary-care physician.


Thats assuming they have one.


Therein lies the rub. Too many Medicare insurance beneficiaries are being turned away by primary-care physicians offices, especially in Washington state.


Why? Threatening the infrastructure of the primary-care system is an imbalance in the distribution of doctors.


Currently, there is a big shortage of primary-care physicians in part because most medical students are not choosing this fieldno new physicians are coming into the pipeline, says Dr. Brian Seppi, medical director of Physicians Clinic, a Spokane-based internal medicine practice that also provides primary care. In part this is because primary-care physicians are paid less and get a lot more paperwork because of the gamut of conditions they deal with. Generally, it takes longer to get an appointment with a primary-care physicianor internal-medicine, family-practice, gynecology, and pediatric physiciansas contrasted to getting in to see a specialist, like a cardiologist.


Jan Monaco, CEO of the Spokane County Medical Society, says, There are many reasons the Medicare population can be challenged when seeking a physician. One is that the federal government has ratcheted down what they pay for and how much they pay Medicare physicians to fulfill their commitment to the patients.


Its a budgetary issue, Monaco contends. Congress keeps threatening to lower reimbursements to physicians, which is so frustrating to those trying to take care of the patients they already have. (The feds) pay less than 50 cents on the dollar it costs a physician to render services, and there are so many rules, regulations, and frequent changes happening, it causes physicians to want to pull their hair out. Additionally, delays in payment from Medicare serve to make the situation worse.


Citing information gathered by the American Medical Association for a bulletin titled, Impacts of Medicare Physician Pay Cuts in Washington State for 2008, Monaco says:


Washington state will lose $98 million in federal health-care funds next year due to projected decreases, and the state will lose $2.84 billion by 2015 due to eight years of cuts.


More than 760,000 Medicare patients, 336,000 TRICARE patients, and 56,000 health-care industry employees will be affected by those cuts. TRICARE is the health-care program for active duty and retired military members and their families.


Compared with the rest of the country, Washington has a below-average ratio of doctors to patientsat 250 practicing physicians per 100,000 populationeven before the cuts take effect.


45 percent of Washingtons practicing physicians are over 50, an age at which surveys have shown many of them consider reducing their patient volume.


Is a perfect storm brewing? Declining financial support for and fewer primary-care doctors, an exploding 65-plus population that makes far more visits to physicians than younger patients, as well as many current physicians in the system retiring all are unresolved challenges.


In the meantime, if you or a family member has difficulty locating a primary-care physician here who accepts Medicare patients, what action might you take?


You can get information about doctors who take Medicare patients from the county medical society, at 325-5010.


Currently, a few practices are still accepting new Medicare patients, but some of those will even open and close their practice (to those patients) depending on capacity, says Monaco. At our office we track these fluctuations so when we get queries we can advise callers of changes.


She adds, In Spokane, there are two primary-care training programsFamily Medicine Spokane and Internal Medicine Residency Spokanethat still take Medicare patients. Often these clinics are the only choice.


In planning for the future, whether moving to Spokane to retire or anticipating becoming eligible for Medicare, secure a primary-care physician well in advance so that you are established with a practice.


If you already have a primary-care doctor, but arent eligible for Medicare yet, check with your physician to determine whether you can expect to continue to receive care once you transition to Medicare. Monaco says, Most physicians who treat the Medicare-eligible population dont take any new (Medicare) patients, but do continue to see existing patients after they convert to Medicare.


Also, find out whether the medical practice where you receive care will continue to carry you as you age if your physician leaves or retires.


Seek more information about this issue overall, and once satisfied, consider reaching out to members of Congress regarding your concerns and experiences. Choose a way to exert your influence, whether via local, state, or national groups.


At a time when the nation is grappling with formidable challenges in health care, should Medicare beneficiaries of the future be optimistic?


Seppi says, It will take a while for the primary-care physician shortage to work itself out; it depends on what happens with reimbursement monies. He adds that he sees new approaches already in progress that can influence the future of an overtaxed primary care system.


To keep up with our aging population, primary care is going to be changing at a fairly fast pace over the next several years, Seppi says. Practices will need to be more team-oriented, with a focus on prevention and lifestyle changes. At our clinic, we are utilizing more mid-level providers in order to serve more patients and expanding the role of nurse practitioners who work closely with physicians in order to gain their expertise. Nurse practitioners can spend more time with patients and are likely to provide extra education in the process.


He speculates that having access to electronic medical records is key.


In Spokane, we have more electronic medical records than the national average. By accessing these, we can routinely search databases for those patients who havent been in for awhile and send a reminder like the car dealer suggesting a needed oil change, he says.


We can detect a problem before it occurs and identify target populations with similar health issues, teaming with other trained people like dietary and exercise folks to provide programs for specific issues, Seppi says. For instance, rather than have patients with high body mass come in individually for an appointment, we can search for this category and offer a weight-reduction program, he says.


By tracking medications, we can team up with other health-care providers to alert patients to medications that are identified as problematic or taken off the market.


Through time, hard work, and inspiration, solutions for the field of primary care are possibly hiding, with luck, in plain sight.


Gail Goeller co-founded Spokanes Directory for Seniors and Their Families and is the author of Coming of Age with Aging Parents.