As It Ages, U.S. Faces a Shortage of Geriatricians

WASHINGTON — As the baby boom generation reaches old age, Americans will face a serious shortage of doctors specially trained to treat the elderly.

That's the warning of the American Geriatrics Society, which predicts that by 2030, when there could be nearly 80 million people over 65, the nation will need roughly 26,000 more geriatricians than are likely to be available.

Geriatricians are family care physicians or internists who have received advanced training in the care of the elderly.

Unlike other doctors, whose primary goal often is to find and treat a disease, geriatricians aim at improving their patients' quality of life, allowing them to function independently as long as possible.

The typical patient likely to see a geriatrician is at least 75 years old — often 85 or more — with multiple physical disabilities and often mental and functional ones as well, said Dr. Ken Brummel-Smith, head of the Florida State University Department of Geriatrics and a former president of the American Geriatrics Society.

While an elderly patient may see many specialists who order specific treatments, the geriatrician monitors the various treatments and prioritizes the care. Geriatricians also are likely to have a different approach to palliative care and end-of-life treatment.

"Geriatricians treat the individual as a whole," said Dr. Jane Potter, chief of geriatrics and gerontology at the University of Nebraska Medical Center and immediate past president of the American Geriatrics Society.

"If you ask people what they fear about growing old, it's that they won't be able to take care of themselves. And that's really where we focus," Potter said.

The problem for the future is that only about 230 new geriatricians are certified each year, Potter said. Meanwhile, many current geriatricians, who entered the field when it was considered a hot commodity in the 1970s and '80s, are now at or nearing retirement age.

Low pay and a perception that working with the elderly is not as glamorous as being a surgeon are among the reasons so few geriatricians are produced each year, Potter said.

Also, "the way Medicare has allocated the reimbursement ... the higher the tech thing you do, the greater the reimbursement and payment," Potter said.

Brummel-Smith noted that while family physicians and internists — also expected to be in short supply in the future — can combine payments from private and public insurers, geriatricians receive the bulk of their payments from Medicare and Medicaid, both of which historically pay lower rates than private insurance.

The American Geriatric Society is pushing for congressional passage of a bill introduced last May that would create a pilot Medicare program to pay for a "geriatric assessment" of an elderly patient's condition and development of a plan to keep the patient healthy. The bill also would boost payments for doctors, mostly geriatricians, who coordinate the care of patients with multiple chronic conditions, including dementia.

So far, it has little support in either house of Congress, and among the major presidential candidates, only Sen. Hillary Clinton, D-N.Y., has endorsed it.

Potter said the nation's obsession with youth and its abhorrence of aging also plays a role in the shortage of geriatricians.

"We all fear aging, and I think what most of us would prefer to do is ignore it," Potter said. "We say, 'Well, that geriatrics is for someone else, its not for me.' "

That "translates into a message to physicians that this is an undesirable thing for you to specialize in. But let me tell you, this is an enormously gratifying field," Potter said.

Potter to a recent independent survey of about 12,000 doctors that found geriatrics was the most satisfying of all medical specialties.

"We have this contradiction, that it's an enormously satisfying field and we're the worst reimbursed," she said.