When I moved to Oregon in 2010, and needed a new physician, I used the internet to track down the geriatricians in my area. About half the listings included a note that the doctor was not taking new patients.
When I telephoned the remaining names on my list, each one told me they were not taking new patients.
So much for finding healthcare that actually relates to my stage of life and needs.
FACT: In 2014, there were 46.2 million people 65 and older in the U.S.
FACT: In 2030, there will be about 71.4 million people in the U.S. 65 and older
FACT: Currently, there are about 7,000 geriatricians in the U.S. - about one for every 6600 people.
As The New York Times reported in January,
”The American Geriatrics Society estimates that to meet the demand, medical schools would have to train at least 6,250 additional geriatricians between now and 2030, or about 450 more a year than the current rate.”
In case you are misinformed – many people are - the Times article also includes a good, short explanation of what a geriatrician is:
”...a physician already certified in internal or family medicine who has completed additional training in the care of older adults. In addition to providing clinical care, geriatricians are skilled in navigating the labyrinth of psychological and social problems that often arise in the aging population.”
Some people, even some physicians, believe that primary care doctors can delivery the same-quality care to elders as geriatricians. Elizabeth Eckstrom, a geriatrician who happens to practice right near me in Portland, Oregon, refutes that:
”If primary care doctors were providing optimal care to older adults, polypharmacy would not be one of the leading killers in that population. Fifty percent of dementia would not be missed in primary care practices. Many patients with delirium would not be missed by physicians in our hospitals.
“Recent evidence about care provided by geriatrics teams shows that hospital length of stay is about one day shorter, costs less, and has fewer complications, including falls, pressure ulcers, and catheter-associated urinary tract infections.”
Dr. Eckstrom also says not every elder needs a geriatrician but has called for additional training of all types of health care providers (except pediatricians).
Many residencies in geriatrics go empty. The biggest reason is that geriatricians are paid much less than other specialists. They can expect an annual income of about half that of other specialties - $200,000 versus $400,000. Their insurance reimbursement is usually less that other physicians because elder care just takes more time than other specialists require.
”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, reports U.S. News and World Report.
“...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.
American surgeon, Atul Gawande, wrote the best, most eloquent explanation of the complexities of geriatric care I've ever read. It is a long story in the 30 April 2007 issue of The New Yorker magazine titled “The Way We Age Now.”
For the story, Dr. Gawande shadowed a geriatrician through his day seeing patients and recounts in detail the entire examination and the many questions the geriatrician asks one 85-year-old woman who lives on her own. Then -
”In the story of Jean Gavrilles and her geriatrician, there’s a lesson about frailty. Decline remains our fate; death will come. But, until that last backup system inside each of us fails, decline can occur in two ways.
“One is early and precipitately, with an old age of enfeeblement and dependence, sustained primarily by nursing homes and hospitals. The other way is more gradual, preserving, for as long as possible, your ability to control your own life.
“Good medical care can influence which direction a person’s old age will take.
“Most of us in medicine, however, don’t know how to think about decline. We’re good at addressing specific, individual problems: colon cancer, high blood pressure, arthritic knees. Give us a disease, and we can do something about it.
“But give us an elderly woman with colon cancer, high blood pressure, arthritic knees, and various other ailments besides—an elderly woman at risk of losing the life she enjoys—and we are not sure what to do.”
This is what geriatricians are for – to “think about decline” and to preserve, “for as long as possible, your ability to control your own life.”
And bless every one of them for doing so.
Unfortunately, most of us will not have that kind of care and will need to educate ourselves in our own care to work with the kind of physicians we have.
From an article last week in Kaiser Health News:
”[Dr. Todd] Goldberg also teaches at the Charleston division of West Virginia University and runs one of the state’s four geriatric fellowship programs for medical residents. Geriatric fellowships are required for any physician wanting to enter the field.
“For the past three years, no physicians have entered the fellowship program at WVU-Charleston. In fact, no students have enrolled in any of the four geriatric fellowship programs in West Virginia in the past three years.
“'This is not just our local program, or in West Virginia,' said Goldberg. 'This is a national problem.'
“The United States has 130 geriatric fellowship programs, with 383 positions. In 2016, only 192 of them were filled.”
One more problem in our world for which there seems to be no solution.