On the other side of the Atlantic - a very different picture of geriatric medicine
A letter discovered in the Los Angeles News provides an interesting perspective from the other side of the Atlantic where, in contrast to the growing popularity of geriatric medicine in the United Kingdom, there is a worrying chasm between the supply and demand for physicians specialising in geriatric medicine.
In July a ‘senior citizen’ wrote to the Los Angeles News:
‘My 77-year-old brother just moved to the South Bay and is in poor health. How do I find a good geriatrician in the area? I am sure that there are geriatricians at UCLA and USC but he can’t travel that distance on a regular basis. Additionally, we the family members cannot make the frequent drive. Also, I am 75 and may need one at some time.’
Responding to the letter writer was Helen Dennis of the ‘Successful Aging Community’ writes:
You’ve identified a challenge that may affect millions of us. Looking for a geriatrician, particularly one that is board certified, can be difficult.
Let’s first describe geriatricians: They are medical doctors trained to meet the unique health care needs of older adults. Typically they are primary care physicians who see patients in their mid-70s and older; however, this is not a steadfast rule. Most become certified in internal or family medicine and then pursue additional training to become a board-certified geriatrician.
Their niche is the diagnosis, treatment and subsequent care for patients dealing with diseases of later life. If they suspect a serious health problem, such as cancer or a neurological problem, they refer the patient to a specialist but often remain involved in the patient’s care.
Here’s the problem: The number of geriatricians is going down while the number of aging Americans in the United States is going up.
Age is a risk factor for disease and disability. Combine that with more people living longer and we have a challenge. Currently, about 80 percent of older adults require care for chronic conditions such as hypertension, arthritis and heart disease, according to the American Geriatric Society. In 2030, the need for care will increase since our 65-plus population will grow from the current 13 percent to almost 20 percent.
Today, we have a little more than 7,500 board-certified geriatricians to care for about 12 million older Americans. To meet the demand, the American Geriatric Society projects we need 17,000 more geriatricians to care for the 12 million older adults we currently have, and we will need 30,000 geriatricians in 2030. That’s not going to happen. Add to this only about 3 per cent of psychologists devote the majority of their practice to older adults and about 4 per cent of social workers specialise in geriatrics.
Few medical school graduates are pursuing advanced training in geriatrics. In 2010, only 75 residents in internal medicine or family medicine entered geriatric fellowship programs. That’s down from 112 in 2005. One problem is the medical schools. Of the 145 in the U.S., only 11 have geriatric departments. In Great Britain, every medical school has a department of geriatrics. (Emphasis added.) And then there is student debt. The Association of American Medical Colleges reports that the median education debt for medical school graduates in 2012 was $170,000; 86 percent of the graduates report having education debt, according to a RAND Corp. study.
Geriatricians are the lowest paid of any of the medical specialties according to the RAND study. In 2010, the total median annual compensation for a physician with a private practice in orthopedics was just under $500,000; for geriatrics, it was $183,523.
Not only do geriatricians earn less, they have less predictable work schedules and spend a longer time with their patients, meaning they can see fewer patients per day. That translates into fewer fees. Medicare payments also are a financial disincentive since payments often are lower than many commercial insurance rates for the same type of service.
To compensate for the shortage, many physicians are getting extra training in geriatrics. Although being board certified is ideal, we do have physicians who are treating older adults.
Thank you, I.L., for your important question. Your difficulty in finding a geriatrician is understandable. It’s a search that most of us at some time will undertake — if not for ourselves, then for a loved one.