As more members of the Baby Boomer generation start to age and will number 70 million nationally in the year 2030 when the last of them reach 65, a decades-old shortage of geriatric physicians still looms large, threatening their prospects for senior long-term and short-term care, university researchers and professional trade association leaders in the field say.
The American Geriatrics Society (AGS), a New York-based nonprofit focusing on the quality of life of seniors, reports that, with this evolving medical and sociological phenomenon, aging Boomers most in need of medical assistance and service are projected to have less access to the expertise of geriatricians than previous generations.
In fact, AGS’ leaders and other institutions such as the University of Maryland School of Nursing add that this trend may be taking place in the present as fewer medical school students have elected to enter this field over the years.
This translates into longer delays for service among seniors by medical specialists such as geriatricians, they say.
Experts point out that this medical specialty has always experienced a gap but the next overwhelming round of aging Baby Boomers will require more health care than in eras past and the current crop of geriatricians won’t be able to meet the need in terms of funding or technical resources.
More specifically, researchers at Duke University School of Medicine in Durham, N.C. say the country simply is not ready to serve the growing tide of Boomer seniors who will need medical attention. The current national medical infrastructure lacks the adequate equipment, structure and technical assistance to provide the most comprehensive health care for patients with several chronic illnesses or physical and mental limitations.
Low Geriatrician Numbers
Even with the predicted increase in the number of seniors, medical school students are opting out of geriatrics, which endangers the future of the field. The AGS reports that, in 2010, all of 75 medical interns in internal medicine or family practice medicine enrolled in geriatric medicine fellowship programs.
Currently, the field holds over 7,500 certified geriatric physicians nationally. However, the AGS states that the country needs at least 17,000 geriatricians to care for 12 million seniors.
The organization finds that 30 percent of the senior population and their families will need a geriatric physician and one geriatrician can serve 700 seniors — a development that researchers say may not materialize in the future.
Additionally, researchers with the division of geriatrics and general internal medicine at Stony Brook University Medical Center in New York and the Association of Directors of Geriatric Academic Programs reveal that the year 2009 saw 7,300 geriatricians in senior long-term care and short-term care facilities, hospitals, clinics, universities and medical centers. This represents a decrease of 5.4 percent from 2000.
As of 2007, they add, about 264 medical school graduates selected to enter the specialty of geriatrics nationally. If this development continues, by 2030 with the final tier of Boomers aging, the nation’s health infrastructure will be short of 24,000 geriatric physicians.
Throughout the country, more adults are living longer, thus necessitating medical care to handle a wide range of chronic illnesses such as cardiovascular disease, arthritis, diabetes, bone disease and dementia.
For example, the presence of centenarians is not new, researchers with the University of Washington’s division of gerontology and geriatric medicine at Harborview Medical Center in Seattle say. By 2030, one in 5 residents nationwide will qualify for Medicare with those aged 65 and older comprising 20 percent of the country’s population at that time.
Experts say that the main reason a shortage of geriatric physicians exists is that the field itself does not provide medical school students with incentives to explore it with its lack of renown, low salary and overall compensation scale and problems with Medicare and Medicaid reimbursement for senior long-term care and short-term care.
As a result, medical school students weighing their options and eying the future prospects of internal medicine, family practice medicine and primary care medicine as well as some specialties may not believe that they can enjoy a reasonable standard of living with the field of geriatrics.
Geriatric physicians generate more of an income from being reimbursed for such medical procedures as cardiac bypass surgery. Researchers say aging is not centered on medical specialties but actually involves discussion with families about hospice care. This is an essential part of geriatrics but it is not reimbursed.
Additionally, medical school students are exhibiting less interest in primary care medicine, which touches on the field of geriatrics. Researchers say that it only follows that, if medical students are not interested in primary care medicine, they won’t be interested in geriatrics either.
Geriatrician Skill Requisites
Geriatric physicians must be able to treat patients with five to eight chronic illnesses as compared with medical specialists who focus on one type of illness. Experts say geriatricians must understand a patient’s set of circumstances and objectives and not focus so much on the treatment of all of the illnesses. If not, a geriatrician won’t be able to create a plan of care that suits the patient.
These physicians focus on a senior patient’s intellectual and physical functions such as walking, eating, dressing and other activities of daily life. They are expected to take a holistic outlook on a patient’s health and ensure that they are able to reunite with their communities as much as possible.
Geriatricians tend to work in different categories of health care facilities as part of a multi-specialty team with medical specialists, nurse practitioners, registered nurses, physical therapists, occupational therapists, social workers, mental health professionals and ancillary healthcare staff in general, experts say.
Categories of facilities include the patient’s home, hospitals, nursing homes, assisted living centers, rehabilitation centers, community clinics and hospices.
Because of the multiplicity of solutions available to resolve the shortage of geriatricians, medical experts say they are excited from a scientific and educational standpoint about the development of the field.
Economics is one consideration in dealing with the shortage: medical school students may not be interested in geriatrics if it is low-paying and they must bear a high school tuition burden after they graduate. Most geriatric physicians treat seniors on Medicare and Medicaid, government programs that have paid lower reimbursements than private insurers.
Researchers point out that geriatrics is the only specialty in which doctors will glean less income even as they’ve completed more years of training. Part of the solution of closing the geriatric medicine practice gap is to re-design the reimbursement system so that medical school students are not turned off by this field.
Developing Geriatric Skill Sets
The AGS says that it will continue to lobby for extra funds to train future geriatric physicians. At the same time, it will also make an effort to educate a current healthcare workforce to prepare to serve senior patients.
The organization’s program the Geriatrics-for-Specialists Initiative will help medical specialists in fields other than geriatrics create the tools and knowledge base needed to provide for seniors.
Last year, the program trained surgeons to release guidance on post-surgical delirium. Emergency medicine doctors launched a program to describe the elements of a geriatrics-oriented emergency department. This program resulted in the gathering of 100 such specialists nationally with most researching the aging factors of their fields, the group’s leaders say.
Experts add that medical school and internship programs known as residencies are also called upon to include the field of geriatrics to their curriculum — just as all medical students are expected to study pediatrics even if they are not embracing that specialty.
Ancillary health care fields such as nursing, physical therapy, occupational therapy, home health care and clinical social work — all of which form part of the medical teams for senior patients — mandates extra training, too.
The following universities, hospitals, clinics and medical centers have been identified by leaders in the field to be the best institutions to study geriatrics: Mount Sinai Medical Center in New York; Ronald Reagan UCLA Medical Center in Los Angeles; Johns Hopkins Hospital in Baltimore; Massachusetts General Hospital in Boston; Mayo Clinic in Rochester, Minn.; Duke University Medical Center in Durham, N.C.; NewYork-Presbyterian University Hospital of Columbia and Cornell; UPMC-University of Pittsburgh Medical Center; Yale-New Haven Hospital in New Haven, Conn., and; the Cleveland Clinic.
Researchers and professional trade association leaders have identified a variety of solutions to address the geriatric physician shortage.
The first solution involves raising direct reimbursement rates for geriatricians. AGS has begun by petitioning Congress for reform in the manner in which geriatric physicians are paid.
Other organizations are lobbying for providing scholarships or tuition debt forgiveness for students who elect to study geriatrics, a practice already started in some states in the country.
Additionally, the AGS has put forth a new policy that will mandate all physicians and medical specialists to be exposed to geriatrics. This has already begun in several medical universities nationwide.
Experts tout the plusses of such geriatric requirements. First, they say, such education enables medical school students to understand the healthcare needs of seniors and guarantees that all doctors obtain training in geriatrics.
Secondly, the policymakers make sure that the skills, specialties and mindsets of physicians from all fields improve in terms of caring for seniors, researchers with the University of Pittsburgh’s geriatric psychiatry and care department say.
After implementing such a policy, the University of Maryland’s medical school has already found improvement among medical schools who said they would not have considered geriatrics had they not been trained in long-term care and assisted living classes. At the school, geriatricians have trained doctors of other specialties in their field.
Another school that has seen similar progress in advancing in geriatrics among medical school students is Stony Brook in New York. Instructors report making geriatrics the center of physical training and holding workshops and retreats to teach junior residents/medical school students in the field.
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