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Geriatricians Are In Short Supply

Author: Helen Dennis, Specialist on Aging

Question: My long-time internist has changed his general practice to a specialty.  Consequently, I have been displaced.  I am in my 80s and looking for a local doctor who treats people of my age.  Is that a geriatrician?  How do I go about finding one?

Answer: Yes, you are correct.  You are looking for a geriatrician, a medical doctor trained in geriatric medicine.  Geriatricians focus on diseases of older age with an emphasis on diagnosis, treatment and the care of older adults, as well as encouraging health promotion and disease prevention.

Geriatricians generally are primary-care physicians.  They are board-certified in family medicine or internal medicine and complete additional training to become board certified in geriatric medicine.

The challenge your face in finding one is a local and national issue.  We have a profound shortage of board-certified geriatricians as we face an impending demographic shift.  Currently, one out of eight Americans (13 per cent) is 65 or older.  In 2030, that figure is likely to be one out of five people (20 percent).  And the fastest growing population is the 85-plus age group.

Robyn Stone, former U.S. assistant secretary on aging and currently executive director for LeadingAge Center for Applied Research, sums up the problem in her recent article in “Generations,” the Journal of the American Society on Aging.  “While the demographic phenomenon it is to celebrated, it also is expected to place increasing demands on those who care for our elderly population – a group that uses considerably more services than younger people and whose health and long-term-care needs are often more complex.”

In 2010, there were approximately 7,000 geriatricians to treat almost 21 million adults 70 and older.  That’s one geriatrician for every 3,000 people.  If we include the 65 and older group, the ratio is one geriatrician for every 5,333 adults.

The question is, “Why are geriatricians in such short supply?” In their publication “Status of Geriatric Workforce Study,” the American Geriatric Society describes factors that are contributing to – or expected to contribute to – the shortage of geriatricians.

  • Over the past five years, fewer U.S. medical school graduates have chosen careers in internal or family medicine.  Applicants for geriatric fellowship programs come from these two fields.  A reason for this decline is that physicians in internal medicine and family medicine earn less than those in other fields and have less predictable work schedules than other specialties.
  • In 2009, with an average medical school loan of $157,990 to pay off, 40 percent of graduates said that their expected salary was a moderate or strong factor in selecting their specialty.
  • The median salary for a geriatrician in private practice in 2008 was $179,150.  That was  $12,048 less than the average income of a general internist.
  • Geriatricians train at least one year longer than primary-care physicians and are compensated at a lower level.
  • In many parts of the U.S., Medicare rates for physicians are lower than commercial insurance rates.  Since Medicare reimbursement is the major source of income for most geriatricians, their income is lower than for most other physician specialists.
  • Geriatricians spend more time with their patients.  Therefore, they are likely to see fewer patients per day, which affects their income.

Some encouraging news: Geriatricians who provide hospital care and hospital-based palliative care are in greater demand and are earning more competitive salaries.

Finally, to answer your question, “Where to find a geriatrician?”  Contact your local hospital(s) and ask for their board-certified geriatricians.

Given the short supply, also inquire about physicians who are board certified in internal or family medicine and specialize in treating older adults.

Thank you for your good question.  If we are lucky – in time we all may be looking for a geriatrician.

Copyright 2011 Helen Dennis. All rights reserved.

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