Hi Kevin,
As I built my practice, I was selective about who we let in.
There is a big demand for PCP's in Maine. So I have no Medicaid and little Medicare. However the 17% Medicare generates about 30% of my office visits, because they are older and require the Q3 month followups and hospitalizations, etc.
I look at medicine, as should most of us in primary care these days, from a business model. Supply and demand. We are in short supply, therefore our demand is great. In coming years, the demand will only INCREASE. Therefore we will gain more control over certain things.
While we may not be able to dictate what insurance pays us, we will increasingly be able to dictate our fees and give up on accepting insurance.
As the nation nears the 100,000 doctor shortage that is expected soon, we will have greater power to take on the patients that we want and discard the ones we don't want.
In my region, I have built an excellent reputation and people are screaming to get in. We only take family members of existing patients, and only those who are insured or cash pay, and only those who have a GOOD referrence from the family already established. I tell patients that "if your mother is a pain in the a**, I'm not only firing her but I'm going to fire you too." I say this jokingly, but they get the point. I don't want bad patients.
