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Geriatrician shortage threatens aging population


Is there a doctor in the house? How about a geriatrician? If you are age 65 or older, chances are you could benefit from the expert medical advice and care of a geriatrician, yet a severe shortage of doctors serving the aging population may make that a difficult goal.

Since 2000, the number of geriatricians in the United States has declined by 22 percent. Today there are approximately 7,100 geriatricians and several thousands more physicians who list geriatrics as a specialty. The future doesn’t look very promising either: given the present outlook, there will be only 8,000 geriatricians in practice by 2030, even though the older population in the United States will need at least 36,000, according to a 2008 study in the American Journal of Medicine.

Geriatricians are internal medicine or family physicians who have completed extra training in aging and geriatric medicine. Much of a geriatrician’s function is to manage, rather than cure, chronic conditions such as diabetes, dementia, and osteoporosis; assess the risks and benefits of multiple medications; help older adults cope with issues such as memory problems, depression, and incontinence; and coordinate long-term care as well as activities of daily living issues.

Monitoring multiple medications is an especially critical task of geriatricians. A significant number of older patients do not take their medications as ordered, either because they cannot afford them, they do not understand how to take them, they are experiencing debilitating side effects, or they simply forget. Proper coordination of medications can have a life-altering impact on a patient’s ability to function.

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Perhaps the biggest reason for the geriatrician shortage is Medicare’s fee-for-service system, which is followed by most private insurers as well. This approach assigns a far greater value on procedures than on the type of care geriatricians often provide. That is, doctors get reimbursed if they remove a mole or give a breathing treatment but not if they talk with patients about nutrition or how to improve incontinence issues.

Thus geriatricians typically make much less than other specialists, averaging $150,000 per year. They also are more likely to spend time visiting nursing homes, calling families, and coordinating care programs with other doctors. These are activities for which they do not get compensated.

Geriatrics also is not a “glamour” specialty for doctors, like oncology or cardiology. This attitude is reflected in how geriatrics is taught in medical school - or not taught. Of the 145 medical schools in the United States, only nine have a geriatrics department, and few of the schools require geriatric courses at all.

Still looking for a geriatrician? Several free online websites can help you locate a geriatrician in your area, including Revolution Health and Health Grades. You can also ask for a referral from your local hospital, senior center, or general practitioner.

Cravens et al. Fam Med 2000 Jan; 32(1): 34-41.
Hirth VA et al. Am J Med 2008 Mar; 121(3):247-51
Warshaw GA et al. J Am Geriatr Soc 2008 Oct; 56(10): 1796-1801.