By now we are all aware of the tremendous increase in the older adult population in the United States. This increase is due to population demographics as well as the fact that advances in medical knowledge and technology are allowing older adults to live longer. For some people, living longer means managing multiple chronic conditions during years when the body is naturally slowing down and responding differently to illness and treatment. Although improvements in medical care have occurred at an astounding rate, the number of medical professionals who are qualified to help older adults navigate complex health conditions has lagged far behind.
The medical care of older adults is known as geriatrics. Compared to other practice areas in medicine, it is a “young” discipline in the U.S., having begun serious development in the 1970’s (compared to the United Kingdom, where geriatrics became a medical specialty after World War II). Certified Geriatricians are physicians who have received advanced training in the care and treatment of older adults. The difference between the number of older adults in our country and the number of specialized physicians available to treat them is staggering. An article from the organization ChangingAging estimates that we need over 20,000 certified geriatricians to meet the needs of only those adults who are age 85 and older. The American Board of Medical Specialties reports that in 2013-2014, the U.S. had a total of only 7, 428 certified geriatricians.
The issue is not only the lack of certified geriatricians, but also the low numbers of qualified educators for older adult medicine and the lack of training that all medical students receive regarding the care of older adults. The same ChangingAging article reported that there are 145 medical schools in the U.S. but only 11 of them have geriatric departments. At schools which offer some geriatric training, these rotations are not required in most internal medicine, family medicine, and psychiatry programs. 112 of the 145 medical schools offer a geriatric elective but only 3% of medical students at these schools chose to take this training. So while physicians are trained in the physical aspects of disease in adults, they lack an awareness of how aging can change the dynamics (physical, social, emotional, and financial) of the diagnosis and treatment of certain conditions.
Why does there seem to be a lack of interest in the field of geriatrics? Perhaps one factor is a lack of understanding about this area of expertise. In an April 2015 article in the Association of American Medical Colleges journal, Laura Diachun, M.D., stated, “Because they all have older people as patients, the common perception is that they are all geriatricians.” But there is a difference in educational preparation. Physicians practicing general internal medicine or family practice are required to have three years of residency following medical school, while geriatricians require an additional 1-2 years of a fellowship after their three year residency. This need for additional training does not translate into higher pay, however. The American Geriatrics Society reports that in 2010, the median annual salary of geriatricians was almost $6,000 less than that of the average family physician, and almost $22,000 less than that of the average general internist. For medical school students facing large student loans, additional training for less money just doesn’t make sense. The structure for reimbursement for physician appointments doesn’t help either, as older adults may require more time and attention. The sustainability of a practice may be at risk if a majority of patients are older adults, since more time means fewer patient visits per day and less reimbursement. On the other hand, shorter appointments may mean that all of the older adult’s needs are not being met. Finally, geriatrics as a specialty lacks the prestige of other specialties such as surgery and cardiology. This aspect may relate to American culture and our negative attitudes about aging. It is interesting to note that in 2013, 63% of the medical school graduates who entered geriatric medicine fellowship programs were from international medical schools, not U.S. schools.
Are there advantages to being a geriatrician? Geriatricians themselves have said it best:
“Witnessing the grace and resilience that many people bring to the challenges of aging is definitely one of the best advantages of being a geriatrician.” Leslie Kernisan, M.D.
“It has been an incredibly wonderful career. Not only did the opportunities for doing good for very needy persons gratify, but so too did the inherent benefits in geriatrics provide daily lessons about the very essence of life.” Walter Bortz II, M.D. (Geriatrician for 50 years)
“The heart of geriatrics revolves around listening to the stories that our patients tell, and building meaningful and deep relationships. …these stories and relationships… keep me going as a physician by constantly inspiring me.” Eric Widera, M.D.
In addition to the above benefits, geriatricians can practice in a wide variety of settings. Studies have found that geriatricians consistently rank among the top physician specialties for job satisfaction.
Next week we’ll take a look at some of the other types of professionals who work with older adults.
Karen Kaslow, RN