. . . . . Access Issues . . . . . The Journal of Rural Health 224 Vol. 22, No. 3 Physicians Who Treat the Elderly in Rural Florida: Trends Indicating Concerns Regarding Access to Care Anne Gunderson, ARNP, GNP; 1 Nir Menachemi, PhD, MPH; 2 Ken Brummel-Smith, MD; 1 and Robert Brooks, MD 2 ABSTRACT: Context: Rural elderly patients are faced with numerous challenges in accessing care. Additional strains to access may be occurring given recent market pressures, which would have significant impact on this vulnerable population. Purpose: This study focused on the practice patterns and future plans of rural Florida physicians who routinely see elderly patients. Additionally, we examine those who provide services to a high volume of Medicare (HVM) patients. Methods: A self-administered mailed survey was sent to rural physicians who identified themselves as practicing family medicine, internal medicine, psychiatry, general surgery, a surgical specialty, or a medical specialty. Questions examined changes in services offered by all rural physicians and among them, the HVM physicians. Impact of the professional liability insurance situation, satisfaction with current practice, and future practice plans on changes in service availability was also examined. Results: Overall, 539 physicians responded for a participation rate of 42.7%. Two hundred eighty eight (54.9%) of all physicians in the study indicated a decrease or elimination of patient services in the last year. HVM physicians, compared to low volume of Medicare providers, were significantly more likely to decrease or eliminate services overall (66% vs 45%, P = .001). Mental health services (47% vs 18%, P = .001), vaccine administration (39% vs 16%, P = .008), and Pap smears (41% vs 13%, P = .008) were more likely to be eliminated among the HVM physicians. HVM physicians were also significantly more likely to be somewhat or very dissatisfied (40% vs 23%, P = .012) with their practice. Conclusions: Physicians in rural Florida report dissatisfaction with their practice and are decreasing or eliminating services that are important to the elderly. Given the aging population and increasing need for health care services, these trends raise concern about the ability for these patients to receive necessary care. T he state of Florida has the nation’s highest proportion of elderly residents, 1 many of whom live in rural areas and rely on Medicare for their health care needs. These rural residents are more likely to be sicker, poorer, and older than their urban counterparts. 2,3 Rural residents are also more likely to be suffering from chronic conditions and lack health insurance coverage. 4 Compounding these facts, rural residents typically experience limited access to care, 5,6,7 particularly because of a shortage of physicians 8 and challenges involving transportation to health care facilities. 9 Rural Medicare patients receive health services primarily in physician offices. Despite recent documented changes in service availability associated with the medical malpractice crisis in Florida 10 and in other states, 11 and a general reduction in Medicare reimbursements, 12 few studies have specifically examined the cohort of physicians whose practice is made up of a high percentage of Medicare patients. These doctors, whom we refer to in this study as “high volume of Medicare (HVM) physicians,” are in many cases the only providers accessible to these patients. Any changes in physician practice patterns, and HVM practice patterns, could potentially have devastating effects on the already constrained access faced by this vulnerable population. Given the vulnerabilities of this population and recent market pressures on physicians, 1 Department of Geriatrics, Florida State University College of Medicine, Tallahassee, Fla. 2 Division of Health Affairs, Department of Family Medicine and Rural Health, Florida State University College of Medicine, Tallahassee, Fla. This study was funded in part by a grant from the Florida Department of Health, Office of Rural Health. For further information, contact: Anne Gunderson, ARNP, GNP, University of Illinois at Chicago, 845 South Damen Avenue, Chicago, IL 60612-7350; e-mail agunders@uic.edu.