It’s hardly news that the U.S. is suffering from a shortage of geriatricians – physicians who are board-certified experts in the health care needs of seniors. We’ve been reporting on this problem on the AgingOptions blog for many years, as this 2016 article will attest. Now comes this recent New York Times article on the same topic, written by reporter Paula Span. To us, the most important take-away from the article is the fact that, even though there are too few geriatricians to deal directly with all the patients in need, some other medical specialties are finally starting to pay attention to their age-trained peers.
Shortage of Geriatricians: a Rising Problem as Population Ages
Paula Span’s New York Times piece tells the story of a New Jersey woman, now almost 80, who had a host of medical problems. “I was not doing well emotionally,” she recalled. “Physically, I didn’t have any stamina. I was sleeping a lot. I wasn’t getting to work.” She was on anti-depressants but those weren’t helping. Finally, her family intervened and placed her in the care of a geriatrician, who got the patient into a sleep study, arranged for a physical therapy regimen, and advised a procedure that helped this woman lose almost 90 pounds. The geriatric physician also switched the patient’s medication. But perhaps most important, the geriatrician took a much different approach than most doctors do. “[The doctor] sits and talks, which a lot of doctors don’t do anymore,” the patient told the New York Times. “And she knows me. I feel very well taken care of.”
As writer Span explains, “Testimonials like this spotlight the rising need for geriatricians. These doctors not only monitor and coordinate treatment for the many ailments, disabilities and medications their patients contend with, but also help them determine what’s most important for their well-being and quality of life.” That’s the good news. The bad news is that geriatricians are in short supply, and the problem is getting worse. “As the nation’s older population surges, the gap between need and supply has steadily widened, and a persistent shortage of geriatricians has troubled the medical profession for years,” Span says.
Shortage of Geriatricians: U.S. has Barely One-Fifth of the Number Needed
According to the Times article, geriatrics has been a board-certified medical specialty since 1988, and there are now more than 200 U.S. graduate fellowship programs, underwritten by Medicare, that train geriatricians. But the number of programs, while increasing slowly, is barely keeping up with population growth (one Harvard geriatrician said the program to train geriatric specialists is in a state of “stagnation”). On top of that, young doctors are not entering the field. “Geriatrics fails to attract enough young doctors to the graduate fellowships it does offer,” says Span. She quotes this infographic from the American Geriatrics Society that warns about the growing shortage and says that more than one-third of the 384 graduate-level fellowships offered each year go unfilled.
Simple math helps explain the problem. “If one geriatrician can care for 700 patients with complicated medical needs, as a federal model estimates, then the nation will need 33,200 such doctors in 2025,” the New York Times reports. “It has about 7,000, only half of them practicing full time.” Part of the problem may be financial: an analysis of average salary and benefits shows that geriatricians earn less than half of what anesthesiologists, radiologists or cardiologists might earn. There are also subjective reasons why young, aspiring medical students steer clear of geriatric medicine: the field doesn’t offer what the Times calls “much glamour or the prospect of medical heroics,” unlike other, higher-profile specialties. On the positive side, the article says geriatricians report better-than-average job satisfaction compared with their better-paid, more highly-stressed peers.
Shortage of Geriatricians Means Doctors Need to Try a New Strategy
We here at AgingOptions generally advocate that anyone 65 and older can benefit from seeing a geriatrician, but the federal government’s recommendations are more conservative, suggesting that about one senior in three should be seeing a geriatric specialist. The older the patient and the more health problems they have, the greater the need. Geriatricians will often start by taking their patients off some prescription drugs and reducing the number of specialists they are seeing, since older patients often get conflicting advice from multiple doctors and end up with too many medications. “It’s less of ‘Let’s order this med, let’s order that procedure,’ more of a holistic approach,” one woman told the Times. Sometimes a geriatrician will arrange for a geriatric nurse to visit the patient at home, something almost unheard of in this day and age.
As the geriatric community continues to try to grow their numbers, they’ve also shifted their tactics. “Dr. Mary Tinetti, chief of geriatrics at the Yale School of Medicine, has called for geriatricians to serve as ‘a small, elite work force’ who help train whole institutions in the specifics of care for older adults,” Paula Span writes. The goal is to ensure that other specialists – nurse-practitioners, physician assistants, therapists and pharmacists – understand the needs of senior patients. This approach is starting to bear fruit with the rise of age-friendly emergency rooms (something we wrote about on our blog in April 2019) and other initiatives to better accommodate the growing elderly population.
Ultimately, demographics are going to force the issue. The New York Times says, “Health professionals increasingly recognize that if they’re not in pediatrics, they will be seeing lots of seniors, whatever their specialty. A 2016 American Medical Association survey, for example, found that close to 40 percent of patients treated by internists and general surgeons were Medicare beneficiaries.” One geriatrician had this blunt statement for the physicians of tomorrow: “If you don’t like taking care of older people, find another career.”
Don’t Let Lack of Planning Undermine the Health of Your Retirement
Fortunately, here at AgingOptions, we have established relationships with geriatric care physicians in our area, and we’ll be happy to refer you to a health care professional who will treat you with the respect and understanding you deserve. But remember, there’s much more to planning for your retirement than picking a good physician. When we work with our clients, we help them develop a comprehensive retirement plan, called a LifePlan, that includes not only their medical needs but also their legal protection, their housing options, their financial security, and their communication strategy with those closest to them. We would love to do the same for you.
You can start the discovery process and take steps toward creating a LifePlan of your own by attending one of our free information-packed Life Planning Seminars with Rajiv Nagaich. We hold these popular events at locations throughout the area. Space at our LifePlanning Seminars is limited, so we invite you to visit our Live Events page and select the date and time that works best for you. We’ll see you soon – and meanwhile, “Age on!”
(Originally reported at www.nytimes.com)