There is a shortage of doctors specializing in older patients — here’s why that needs to change

In a class of about 160 medical school graduates, Christian Gausvik, 27, was the only one interested in pursuing a career in geriatrics.

His interest in the field was first sparked when he worked at a nursing home during high school, where he bonded with residents he cared for and attended to their medical and social needs. “It was interesting as a younger kid at the time to see how big of an impact you can make with a small interaction,” he said. “Just spending a few minutes seemed like it made such a big difference.” He learned then and there, he said, that older people tend not to get as much attention as other parts of society.

Fast forward nearly a decade and Gausvik is now a resident at Christ Hospital in Cincinnati. After four years of training he will be a full-fledged geriatrician, a type of doctor that specifically cares for senior citizens — not just by having older patients, but staying attuned to research for these patients and the process of aging. The country needs more of those, experts say.

As of last year, there were only about 7,300 certified geriatricians in the U.S. About 30% of people 65 years and older will need to be cared for by a geriatrician, according to the American Geriatrics Society’s Geriatrics Workforce Policy Studies Center, but only one geriatrician can care for a patient panel of about 700 people. That means there should be at least 20,000 geriatricians for the more than 14 million older Americans living today.

Source: American Geriatrics Society
Source: American Geriatrics Society

Why the shortage? A few reasons, said Laurie Jacobs, chair of the Department of Medicine at Hackensack University Medical Center in Hackensack, N.J. and president-elect of the American Geriatrics Society. Students incur higher levels of student debt (they are med school students, after all) for extra years of education and training, but are not compensated as highly as other doctors.

“It’s one of the only specialties in which advanced training yields a lower salary,” said Neil Resnick, chief division of geriatric medicine at the University of Pittsburgh — the average annual salary of a private practice geriatrician is $184,000, whereas the average student loan debt for a medical school graduate in 2015 was $183,000.

Patients require more time to discuss (and sometimes repeat) instructions for medication, review previous medical history and assure no two or more medications negatively interact with one another. The time geriatricians take to speak with and treat their patients isn’t always approved by health insurance companies, and there could be poor Medicare reimbursements as a result, according to a 2009 study published by the U.S. National Library of Medicine. In addition, there aren’t enough role models for students and residents to shadow. And aging isn’t always appealing — not for doctors or society, she said.

The need for doctors specifically caring for older Americans is exacerbated by the fact that people are living longer and may juggle numerous medical problems as they age. The fastest-growing segment of the U.S. population is the 85 and older group of Americans, Resnick said. With those extended years comes the potential for more medical stressors, too. Eight in 10 people have at least one chronic disease by the time they turn 50 years old, but people 65 and older are likely to face two or more chronic illnesses, such as arthritis or dementia. It can be discouraging for future geriatricians to see that though, especially during training, Resnick said. “Why would I want to go into a field where I work so hard and have so little to show for it?” he said. “Old people take a long time to recover, only you don’t see that as a trainee, because now you’re on to the next patient. The field doesn’t look that appealing because of the way we train people.”

Geriatricians’ impact on society can be substantial, especially with the additional role they plan in research. “There won’t be enough for us, not like pediatricians where most kids are cared for pediatricians,” Jacobs said. “But geriatricians will remain leaders in research, education, health care delivery and innovation.” Even if geriatricians aren’t directly caring for older patients, their research in the fields of medicine can trickle down to help them. “We hope to have an impact on other physicians, and not just geriatricians,” Jacobs said. Because older people have ailments in all aspects of medicine — be it heart, respiratory, dental and pharmaceuticals — geriatricians’ expertise in these various specialties will assist in how they help other doctors treat their older patients.

But there’s hope for the field, Resnick said. With a change in training and a stronger presence of a mentor, young doctors-in-training may have a newfound interest in geriatrics, especially if they had a close relationship to their own grandparents. Geriatricians also have one of the highest levels of job satisfaction of any medical specialty, only below pediatric emergency medicine, according to that 2009 study, because of their steady hours and relationships with “inspirational seniors.” The best people suited for a career in geriatricians are those who value a long-lasting relationship, prefer working in a multidisciplinary team and want challenges at work, according to a 2000 study published in Family Medicine. They also should “derive satisfaction from making seemingly small but nonetheless important changes in peoples’ lives,” the study found.

Those small changes are one of the ways in which Gausvik hopes to help in the future, along with creating potential policy changes in health care and the quality of care older patients receive.

“We don’t always think of the little things making a big impact. Health care gets pretty overwhelming with fancy tests and machines,” he said. “A lot of the time with older adults you’re at a point where it is more about what will make them more comfortable or make their days a little easier. It is the simple things.”

Source: Marketwatch

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