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WATSONVILLE - For the greater part of 2008, Dr. Chris O'Grady closed his doors to new Medicare patients.

He was already caring for so many elderly patients in his Watsonville-based family practice that he was often going home at 10 p.m.

Medicare paid him far less than he considered fair - and now the government was threatening to cut the rates again.

Many of the county's primary care doctors have struggled before reaching the same conclusion.

On the one hand, they know Santa Cruz's elderly and disabled Medicare patients are in critical need of primary care. On the other hand, they feel Medicare reimburses them far too little to see those patients.

In Dr. O'Grady's case, this conflict was rendered more acute because of his special training: geriatrics.

The 44-year-old, silver-haired doctor says treating elderly patients carries lots of unique rewards, but also comes with complications. Older patients generally have more complex ailments - ranging from dementia to osteoporosis to hypertension. They need more frequent and longer appointments. They often land in the hospital, and doctors have to leave behind other patients to go check on them.

By last spring, Dr. O'Grady was overwhelmed with new elderly patients who thought they had nowhere else to turn. Add to that the low reimbursement rate - Medicare pays poorly in Santa Cruz County compared to neighboring Santa Clara - and last summer, Congress was threatening to cut the rates by an additional 10 percent. (A federal funding formula calls for cutting doctors' pay when Medicare costs grow faster than the national gross domestic product. Congress can override that requirement).

Dr. O'Grady decided he'd had enough. As president of the Santa Cruz County Medical Society, he'd grown tired of Congress turning a deaf ear to pleas from him and other local providers.

If enough doctors shut their doors on new patients, and that made those patients angry, then maybe, just maybe, Congress would do something.

"Until the patients complain, nothing's going to happen," O'Grady said. "If nobody on Medicare can get in to see a doctor, the politicians have to respond to that."

But Dr. O'Grady never felt 100 percent comfortable with this method of protest. Many of his colleagues who've closed their doors to new Medicare patients share this ambivalence, he said.

"We're at this uncomfortable point," he said. "The patients are kind of stuck in the middle. It's a standoff between doctors and Congress."

On Jan. 1 of this year, Dr. O'Grady reopened his practice to new Medicare patients, on a limited basis. If the reimbursement rates don't change in the next year, though, he plans to close it to new Medicare patients again, this time for good.

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