Walking away from Medicare

About a year and a half ago, Dr. Leslie Kernisan, 37, a geriatrician in San Francisco, decided she couldn't stand her medical practice any longer. Every day, she felt she was shortchanging her older patients. "What I had in the way of time and resources to meet patients' needs was so inadequate that it felt almost grotesque," she told me recently. At the time, Dr. Kernisan was working at a community clinic filled with caring, committed professionals. They weren't the problem. What was wrong, she felt, was a dysfunctional system of health care for seniors — and at the center of that was Medicare, the government's insurance program for seniors.