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U.S. Lacks Doctors to Care for Seniors
April, 27, 2004 -- The U.S. does not have enough geriatric specialists to treat its rapidly aging population, according to a report released by a physicians' group Tuesday.
The report warns that the nation's 7,600 geriatric specialists make up only about one-third of the number needed to provide care to the elderly now. Those requirements are expected to become dire as the baby boom generation begins to retire later this decade, leading to an expected doubling of the aged population by 2050.
In fact, the number has declined steadily since the mid 1990s, when about 9,200 doctors were certified to deliver specialized care to the elderly, according to the report.
Experts speaking to reporters blamed low Medicare payments and a widespread lack of enthusiasm among young doctors who can make far better livings in other areas of medicine.
"The result is that we can't even replace people who are retiring," says Greg Warshaw, MD, director of geriatric medicine at the University of Cincinnati College of Medicine. The 127 geriatric medicine programs at U.S. medical schools are relatively poorly attended and produce only 250-300 new specialists each year, says Warshaw, a past president of the American Geriatric Society, which produced Tuesday's report.
Internists and family doctors care for the majority of elderly patients and bill Medicare for their services. Geriatric experts argue that specialized care is needed for about 15% of older patients. Those are patients with multiple illnesses who may be taking 12 or more different medications and who often receive unnecessary or risky treatments ordered by doctors unaware of risks in frail patients. -->
"We can't take care of all the older people in this country," says Meghan Gerety, MD, a professor of medicine and a geriatrician at the University of Texas Health Science Center in San Antonio. "We are never going to be taking care of all 15% of those people."
The report points to a shortage of specialists who teach at medical schools, where future primary care doctors can learn the basics of caring for complex elderly patients. Currently, schools have little incentive to fund training in geriatric medicine when other specialties are in higher demand by doctors, Warshaw says.
Part of the problem is that young doctors see little incentive to enter the field since Medicare generally pays doctors for services rendered in the office or hospital, Gerety says. It does not pay for time spent coordinating care among family members, social service agencies, pharmacies, and other doctors -- services that experts say are essential to providing care to the frailest patients.
"Obviously Medicare reimbursement is a huge problem for us," Gerety says.
The Medicare reform law passed last year includes a pilot project designed to improve care for beneficiaries with chronic conditions. The report is critical of the effort, saying it focuses only on patients with single conditions like diabetes and does not do enough to improve care for those with multiple diseases.
Congress is considering a measure that would give financial incentives to medical schools that promote geriatric training. Lawmakers have yet to act on the proposal.
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