The U.S. geriatrician population has been hovering around 7,000 for several years without much change. At the same time, the elder population grows by about 10,000 a day. You see the problem.
One reason is that geriatrics is at the bottom of the pay scale for doctors and one reason for that is the time-consuming nature of the field wherein patients' needs are more complex than younger adults. As U.S. News reported in 2015:
”Unlike other physicians who might specialize in one organ system or disease, geriatricians must be adept at treating patients who sometimes are managing five to eight chronic conditions...
“Geriatricians also 'pay special attention' to a person’s cognitive and functional abilities, including walking, eating, dressing and other activities of daily living, McCormick says. 'Geriatricians take a holistic approach. We look at how we can help patients to be as functional as possible and exist in the community in the best way possible,' he says.
“For example, older adults may have a hearing or visual deficit that impacts their physical health and quality of life. Something as simple as eye glasses or hearing aids can make a world of difference.
“'We look for little things that can improve quality of life and surprisingly enough you can often make things quite a bit better,' McCormick says.”
Because there are far too few geriatricians to go around, most elders, like me, wind up with a family physician or internist for their primary care. These men and women do their best to help but they are hindered by time constraints and by the less than adequate education they receive in medical school about old people's health issues:
”Despite the diverse range of knowledge and skills required to appropriately care for older adults, the median time devoted to geriatric education in medicine in 2005 was still only 9.5 hours,” according to a 2012 report published in The Gerontologist.
“A survey of medical schools in the United States revealed that less than half (41%) of responding schools have a structured geriatrics curriculum and less than a quarter (23%) require a geriatric clerkship.”
(As you can see in the quotation, these statistics are dated which is due, according to the report, to “an absence of more contemporary information” - common in healthcare related to elders – we are too often not included in studies or, as in this case, the studies are not conducted frequently enough.)
Eighteen years ago, Dr. Edward Ratner, a geriatrician and associate professor in the University of Minnesota’s Department of Medicine in Minneapolis started a senior mentoring program that had medical students spend a series of afternoons with older people as their mentors.
That worked well enough but students were reporting a lot of loneliness and isolation among the elders. So, according to an article at Next Avenue, he changed the program:
”Students moved into the Augustana Apartments in downtown Minneapolis, where their mentors lived — some of them very independently, some with a few support services. Augustana residents got new neighbors and companionship.
“The building, run by the senior housing and services nonprofit Augustana Care, filled several apartments that were standing empty. Augustana’s social services director got volunteer help from students with recreational activities and other needs that residents had.
“And the students gained more learning time with elders, a place to live near the university and a discount on rent in exchange for their volunteer work.”
Dr. Ratner goes on to explain the problem with the limited amount of geriatric study in medical schools – which is so bleeding obvious once someone says it:
”The trouble with traditional medical education isn’t just that it gives students only episodic glimpses of older adults or that it leaves out all the context of seeing them in their homes and communities. It’s also that every older adult the students see is sick, Ratner says.
“'That’s a terribly negative stereotype because most elderly aren’t sick most of the time,' he explains. 'If students think that elderly are always sick and disheveled and confused — because that’s how they look when they see them — they won’t appreciate that [older adults] can be a lot better after treatment and they’ll discount the value of even trying.'”
I've been thinking about elder medical care all week as an appointment with my primary care physician, not a geriatrician, was scheduled for this morning.
We are to check up on the “mystery malady” that is still with me, though less so than a few months ago, and I want to discuss with him why I am not taking his recommendation for a certain, well-known drug to treat osteoporosis or, in my case, osteopenia.
My physician is young – there are reasons this is good. But he also has little experience with the medical issues of old people yet so since I first met him late last year, I have made myself a mentor to him.
I haven't told him this and I probably won't. But I speak with him differently than physicians I had when I was younger and in the past decade of my elderhood because I believe we share responsibility for my wellbeing.
I know a lot more about my body than all the tests he schedules can reveal and because of what I do (this blog), I read a great deal more about the health and medical needs of old people than he has time for.
So gently, carefully and as it pertains to what is on our schedule on any given visit or phone call, I share my knowledge, my life experience as an old person and sometimes what I have learned from you, TGB readers, over the years.
It's not a lecture or a lesson; I make sure it is a conversation – short, to the point and not to get in the way of the expertise he has that I need to know.
This doctor is a good guy, I like him. But given the medical school deficiencies in geriatrics and, as we have discussed here many times over many years, no one really knows what it's like to be old until they get here.
So maybe my little project will help my physician not just with me but with future elder patients.