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Where Have All the Geriatricians Gone?

With more Americans living past 100 than ever before, Terry Fulmer, president of the John A. Hartford Foundation, points to a growing need to “have all the supports in place to assure not just a long life but a high quality of that long life.”

Unfortunately, the field of medicine dedicated to caring for the elderly is suffering severe shortages.

A recent New York Times article, reporting from Oregon, cites approximately one geriatrician for every 3,000 people over 75. This shortage will only grow more acute as the state’s population continues to age.

Census data predicts that about 31 million Americans will be 75 or older by the year 2030, the largest elderly population in American history. There are only about 7,000 geriatricians in practice today. We need to almost double that number to meet the demand, says the American Geriatrics Society. In other words, 450 more geriatrics students per year would need to graduate into the field.

A shortage of doctors might seem to put geriatrics in high demand, but the opposite is actually true. The field is shrinking because of extremely low incentives. Older patients tend to have more incurable health issues, so the focus must turn to increased functionality. Geriatrics requires additional training after an internal medicine or family practice degree. Once a doctor has completed the extra training, salaries are dismally less than those of other fields. A geriatrician can expect to make about $220,000 per year, which is less than half of a cardiologist’s income and 20,000 less even than a general internist.

It’s true that geriatrics is less appealing than specialties with experimental new drugs or more exciting technologies. Medicare, also, represents an obstacle to growth, only paying what’s necessary for medications and procedures but doling out next to nothing for care planning. Geriatrics also is not, as many believe, a simple variation on general medicine. Aging patients contend with a whole different set of psychological and social issues that those across elder care health sectors must be trained to help treat.

Some are optimistic for change as new payment and accountability models emerge. Ideas for restructuring the field include combining geriatrics and palliative care, offering geriatrics training within medical disciplines (cardiology, urology, emergency medicine), and training across professional sectors (nursing, pharmacy, physical and occupational therapy).

It’s clear that the landscape will need to change, both to ensure quality care for aging citizens and to continue attracting students to geriatric fields.