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Doctors say Medicare cuts force painful decision about elderly patients

"It has definitely made my patients feel more distant from me, and I don't know how to deal with that," Weinstein said.

Financial concerns also prompted Weinstein's group to turn down a request from Chester River Hospital Center in Chestertown, Md., an hour's drive north, to do daily consultations with their mainly elderly patients.

That was disheartening news for the doctor who is currently consulting at Chester River. At 69, David Knutson is semi-retired and said he is satisfied with the payments he has been getting from Medicare. But Knutson grew animated as he spoke of all the ways he would use his time if he could find another doctor to take over coming into the hospital six days a week.

"Gardening, sailing, fishing, hunting, going to the opera," he said. "I'm almost 70. If I'm ever going to do all these things that I've been talking about I better start."

Linda Yao, of the District's Foxhall Internists, has opted for the most extreme response - pulling out of Medicare. The group prides itself on keeping the number of scheduled visits low so that patients who need a last-minute appointment can be accommodated the same day. They also offer half-hour office visits, instead of the 15 minutes on which Medicare reimbursements are predicated. It makes for a white-glove experience for patients, but high overhead for doctors.

After 11 years of serving a patient base of whom as many as half were covered by Medicare, Yao concluded the numbers were no longer adding up. As of April, seniors with Medicare must pay their entire bill out of pocket or through supplemental insurance. So far, only 100 of her approximately 1,750 Medicare patients have elected to stay on.

Could doctors see more Medicare patients if they accepted lower incomes?

Perhaps, said Yao, 42.

But, "the whole system would need to change. ... I graduated medical school $100,000 in debt. I worked 110 hours a week during my residency for $30,000 a year and sacrificed all through my 20s. And even now, you're still seeing people all day, with meetings and paperwork at night, on top of the emotional side of worrying when the patients you care for aren't doing well. This is life-and-death stuff. And I feel like that should be compensated."

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