Sotile is the author of The Medical Marriage: Sustaining Healthy Relationships for Physicians and their Families and The Resilient Physician: Effective Emotional Managementfor Doctors and their Medical Organizations. Boise is also the first stop on Sotile's tour to launch his new book on Thriving with Heart Disease.

Dinner will be served and the event is open to physicians from throughout the state.

Sotile has spoken at the AMA Leadership Conference and many other venues. Watch this space for more information and prices for the event.

Winter Clinics: February 14-17, 2003, Sun Valley, Idaho - For more information call Dawn at 336-2930 or Marie at 331-1478.

As I approach medicare age the thought struck me - Who will care for me? Having recently closed my office I needed to change my billing address with medicare since I continue doing some part-time work. Rather than a simple change of address or a phone call this necessitated filling out a Federal Health Care Provider/Supplier enrollment application... all 10+ pages. Having spent the better part of 30 years caring for medicare patients, it seemed a bit much! Of course, no payment can be received until the paperwork is done.

The paper problem is only one of many facing medicare. The reimbursement issue, especially in primary care, is critical. It is simply not possible in a fee for service setting to make a living if a large proportion of patients are on medicare. The complicated rules re documentation result in excessive dictation, much of it unnecessary. The discrepancy of payments for similar services between geographic areas is unfair. Patients frequently are confused re benefits. Billing statements made to them make the physicians look like crooks. Many patients would have paid me my usual and customary fee and were stunned when told this was illegal and my fees were set by the government. If these problems aren't addressed access to care will continue to be a problem. I understand why some physicians choose not to care for medicare patients though I disagree with their decision. Who cares for their elderly family members?

The adversarial position medicare places physicians in with patients, hurts the trust so necessary to good patient care. Encouraging patients to report their physicians only undermines this trust. We do have doctors who abuse the system and they must be weeded out but the vast majority of physicians are true to their calling.

Americans have an insatiable appetite for medical technology and as our population ages this will further the already strained medicare budget unless society places some limits. It's wrong to expect physicians to make rationing decisions at the bedside. Open and honest discussion is needed. Good medical care should be available to all but the idea that government can provide everything to everyone without raising more revenues is naive.-Some sort of means testing may be necessary. We humans tend to take advantage of things that are free. Entitlements, once in place, are difficult to change.

By the way, my doctor does take medicare patients.

John J. Mohr, M.D.