Many Doctors Say They Are Refusing Medicare Patients

WASHINGTON, March 16 — For the first time, significant numbers of doctors are refusing to take new Medicare patients, saying the government now pays them too little to cover the costs of caring for the elderly.

Medicare cut payments to doctors by 5.4 percent this year. The government estimates that under current law, the fees paid for each medical service will be reduced in each of the next three years, for a total decrease of 17 percent from 2002 to 2005.

For years, doctors have expressed frustration with Medicare, grumbling about reimbursement and complex federal regulations. But the latest reaction appears to be different. Doctors are acting on their concerns, in ways that could reduce access to care for patients who need it.

For example, some doctors are purposely limiting the number of their Medicare patients. The American Academy of Family Physicians says that 17 percent of family doctors are not taking new Medicare patients.

Mark H. Krotowski, 54, a family doctor in a working-class neighborhood of Brooklyn, said: "My expenses go up and up and up every year. For the government to lower what it pays me when my expenses are rising — that doesn't make sense. It's an insult."