By Paul Bass

A study by Yale Medical School researchers confirms that it's getting harder and harder for elderly Americans on Medicare to find a doctor who'll accept them as patients. The research team, led by http://info.med.yale.edu/intmed/geriatrics/pages_faculty/cooney.htm">Dr. Leo Cooney, a noted expert on geriatric care, called 900 randomly selected doctors' offices across the country to ask whether they accept new Medicare patients. About 40 percent said no.

More than half of those weren't accepting new patients, period. But around 17 or 18 percent specifically said they weren't taking Medicare patients, according to Cooney.

In addition, 6 to 7 percent said the doctor would have to see the patient before saying yes or no. That raises fear of "cherry-picking"â€"of doctors waiting to see just how old and sick patients are before taking on their cases. That's an especially big problem for people on Medicare: The frail elderly take more time to treat. But Medicare doesn't reimburse doctors more for treating them. So doctors become more reluctant to take them on.

The overall numbers were better in the Northeast than in other parts of the country, but the problem's growing here as well, Cooney observes. He says the answer lies in fixing how doctors are reimbursed, not in blaming the doctors.

"We think of doctors having a ton of money and being able to do whatever they want," Cooney says. But "it's hard to get people to go into primary care. It's a tremendous amount of work. The reimbursement is not a lot. So they're all going into dermatology and other [specialties] where the reimbursement is a lot better.

"So I'm a little hesitant to say these people are doing horrible things. They're working their tails off. They have to support an office. My concern is not so much to make them do something, but to put incentives in place so it would be reasonable for doctors to care for frail elderly."

Cooney's team hasn't finished its study yet. When it does, Cooney says, he hopes to use the findings to alert medical associations and activists groups to the problem in the hope of bringing about change.

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