The scarcity of geriatricians in the United States is a severe problem in the public health sphere due to the increased number of older adults and the lack of health care professionals who specialize in this demographic. Approximately 7,000 geriatricians are practicing in the United States, and around half of them are full-time. Research shows that 30 percent of people 65 years old and older need care from a geriatrician, and each geriatrician can care for up to 700 patients. This translates to a greater demand for geriatricians — both nationally and region by region across the U.S. But the problem is solvable. This looming crisis started 32 years ago and is on the verge of epidemic proportions. In 2019, the population in this country aged 65 and older was 54.1 million — 30 million women and 24.1 million men. In 2019, people age 65 and older represented 16 percent of the population in 2019. That is expected to be 21.6 percent by 2040. The issue of aging is especially important in rural areas because residents tend to be older, on average, than those in urban areas. In 2010, one-quarter of all adults 65 years and older lived-in rural areas. With only 7,300 geriatricians in the U.S., that is roughly 1.07 geriatricians for every 10,000 geriatric patients. To put this into perspective, the American Geriatrics Society estimates that one geriatrician can care for about 700 patients. This deficit is striking and will have a multitude of implications for the senior population in the future. Geriatricians are trained medical doctors who specialize in older adult health care for those over 65 and are vital to people managing three or more health problems such as diabetes, high blood pressure, and cardiovascular concerns in later life. These doctors understand the dynamics of an older person’s body and can prescribe treatment methods that will have the best outcomes for this population segment. Medical treatments are different for this age group. The older adult population in the U.S. is increasingly becoming more obese and sedentary as a result of lifestyle choices. The cardiorespiratory fitness of men and women continues to decline with age. As a gerontologist and Community Engagement Coordinator for the Alzheimer’s Disease Center at a major urban U.S. hospital, I am witness to the reality that geriatrics is not successful in attracting new medical professionals. This is perhaps due to the comparatively low prestige of the specialization among most Americans, as well as decreased income due to health insurance issues of many patients. Trending forward, supply projections reflect the estimated number of new entrants to this profession and the number of practitioners lost due to changing work patterns, retirement, and mortality. The population will require an estimated 33,200 geriatricians in 2025 to provide care for elderly patients, nearly five times more than the number of geriatricians practicing today. As the baby boomer generation in the United States ages, the number of graduate fellowship programs that train geriatricians and are financed by Medicare has not increased with the demand for such programs. For example, according to a 2018 study, geriatrics is still failing to attract new doctors even as the last decade was marked by the significant increase in the number of fellowship programs for specialists in geriatrics. The number of programs increased from 182 to 210 during this period, and the results in the sphere improved significantly at the end of the 2017-2018 academic year. Still, a 2021 study from Massachusetts General and Harvard University defines the situation in geriatrics as “stagnation,” meaning the demand for geriatricians is significantly higher than their current number. One of the reasons why the field has not expanded significantly is because many newly minted residents opt for higher-paying options other than geriatrics. According to data provided by the American Geriatrics Society, 384 open positions for graduate fellowships in the field of geriatrics went unfilled in 2019. The average physician in geriatrics salary in the U.S. is $209,185. Anesthesiologists have been paid twice as much, and the incomes of cardiologists and radiologists have topped $500,000. Latest statistics show that self-employed physicians earn more than employed physicians, with self-employed physicians earning an average of $395,000 annually and employed physicians earning $289,000 annually. According to a report by the American Medical Association, the main difference in how doctors get paid lies in this ownership status. Salary ranges can vary widely depending on many important factors, including education, certifications, additional skills, and the number of years spent in the profession. The main reason geriatricians are paid less is that the reimbursement rate from Medicare is not up to date and far below what regular private health care insurance pays to doctors. Under the Medicare Access and CHIP Reauthorization Act of 2015, revised methodology for annually updating the Medicare physician fee schedule, physician payments have not kept up with inflation or the cost of running a medical practice. This is a significant problem because the June 2021 Medicaid/Children’s Health Insurance Program enrollment snapshot shows more than an estimated 83 million individuals now have access to comprehensive, life-saving coverage through Medicaid and CHIP. Since February 2020, enrollment in Medicaid and CHIP has increased by nearly 13 million individuals or 17.7 percent. The financial component is essential in the promotion of the profession. It is easier and more justified for graduates to work with patients whose expenses are covered by health insurance like Medicare. It allows them to pay their student loans quicker, which is the critical thing for the graduates of medical colleges where payment for education is high. The average medical school debt is $215,900, excluding premedical undergraduate and other educational debt. The average medical school graduate owes six times as much as the average college graduate. The Public Service Loan Forgiveness Program is an important — but unmet — promise to provide debt relief to support the teachers, nurses, firefighters, and others serving their communities through hard work that is essential to our country’s success. By canceling loans after 10 years of public service, PSLF removes the burden of student debt on public servants, makes it possible for many borrowers to stay in their jobs and entices others to work in high-need fields. Policymakers and educators can introduce incentives and new educational programs to recruit more physicians to fill the care gaps for elderly patients. Perhaps one solution is raising Medicare reimbursements to doctors at the same rate that private insurance pays. Another avenue might be recruiting doctors that are licensed in other countries offering citizenship opportunities. Health care professionals and pharmacists may help address the gaps in care for elderly individuals by using innovative approaches involving collaboration between physicians, pharmacists, and sometimes nurses have demonstrated reductions in inappropriate medications. These approaches build on growing evidence that highlights the importance of team-based care delivery in ensuring that care practices are patient-centered, safer, timelier, and more effective. Providing the aging adult population with high-level care is crucial in building a just and equal society where all vulnerable categories of people are protected, and their needs are recognized. Source
