The last thing an aging population wants to find out is there is a shortage of doctors who specialize in the health issues that are unique to older adults. Yet that’s the reality and the reason organizations like the Institute of Medicine (IOM) are focused on attracting more medical students and practitioners to the field of geriatrics.
Geriatricians are usually physicians with a background in family practice or internal medicine who specialize in the wellbeing of older adults. They work with multidisciplinary teams to holistically assess a person’s medical conditions, drug treatments, mood, cognition, ambulation and caregiver support system.
Aging into a care gap
With about 14 million older adults in the United States, the American Geriatrics Society estimates the population needs about 20,000 geriatricians. That’s about three times the number of certified geriatricians the U.S. had in 2014. A report from the IOM’s Committee on the Future Health Care Workforce for Older Americans estimates the population will need 30,000 more geriatricians by 2030.
In its report, the IOM committee described the specific needs of aging adults: “Caring for the elderly population poses a unique set of challenges. In addition to geriatric syndromes, such as falls and malnutrition, which often lead to acute health care problems, older adults also suffer from a range of cognitive impairments that can impact their ability to perform as active participants in their own care. Moreover, older adults are complex because they often suffer from a range of ailments, including chronic conditions such as hypertension and congestive heart failure, which require ongoing care and active management from multiple providers simultaneously.”
1,500 geriatricians would have to be trained a year for the next 14 years to care for the expected increase of older adults in the future
Given the need for medical expertise in aging, why aren’t more doctors going into geriatrics? Two factors may be at play: this specialty pays less and the field requires additional training. To offset the gap, the Institute of Medicine has made three recommendations to increase the number of geriatricians in the U.S.
More people might consider this field if they knew how satisfying it can be. In one study, geriatrics was second only to pediatric emergency care in terms of career satisfaction. The Institute of Medicine suggests more clinicians and caregivers should be exposed to the specific clinical conditions unique to geriatrics. More training opportunities would also allow health care professionals to share best practices for caring for older adults and broaden awareness of common geriatric challenges.
Increase exposure for doctors-in-training
Another recommendation is to give more medical students more hands-on experience caring for older adults in the hospital and in an outpatient setting.
Change the playing field
The health system is already moving toward an outcome-based model, where health professionals are paid for better health outcomes versus piecemeal services like tests and office visits. These new models give health care professionals an incentive to focus on the whole patient. This holistic approach is particularly useful in geriatrics where patients often have multiple conditions to be considered and may have difficulty getting to appointments. For example, an innovative payment method could allow doctors in group practices to see their frailest patients at home, thus giving them care that may help improve quality and avoid unnecessary hospitalizations.
It’s been more than eight years since the Committee on the Future Health Care Workforce for Older Americans first highlighted the geriatrician gap. Their report, Retooling for an Aging America: Building the Health Care Workforce, predicted that “as the population of seniors grows to comprise approximately 20 percent of the U.S. population, they will face a health care workforce that is too small and critically unprepared to meet their health needs.”
Filling the pipeline with professional geriatricians and other clinicians with good expertise in the needs of an aging population will take time. Payment reform is starting to take root. Meanwhile, 10,000 people will turn 65 every day for the next 20 years.
Editor’s note: Former Aetna Chairman John M. Rowe, M.D. chairs the Committee on the Future Health Care Workforce for Older Americans, Institute of Medicine.