Ninety-seven percent of medical students in the United States do not take a single course in geriatric medicine.
A tsunami is coming, but not the kind you envision. It has nothing to do with water, but has everything to do with people … especially those who will be approaching retirement age. It will have serious ramifications that few are ready for.
The bigger problem? In all likelihood, you have never heard about it.
Every day, 10,000 people in the United States turn 65. By 2030, there will be 70 million people over age 65, or one out of five Americans. The good news is 65-year-olds can expect to live at least 19 more years. The bad news is their health care is at risk, because physicians trained specifically to treat older persons — specialists called geriatricians — are becoming an endangered species, according to Dr. Rosanne Leipzig, a geriatrician at Mt. Sinai Medical Center in New York.
Currently, there are fewer than 7,500 geriatricians in practice nationwide and that number is shrinking. This is a serious problem. Research has proved that health care, when managed by geriatricians as compared to traditional medical models, yields important benefits:
- More years of independent living.
- Greater social and physical functioning.
- Increased satisfaction with life.
- Markedly reduced rates of depression.
- Lower death rates.
- Less time spent in hospitals.
- Significantly less time spent in a nursing home.
- Lower morbidity or presence of disease.
Who wouldn’t want to age that way? Few of us, though, will be lucky enough to have our care managed by these specialists. In 2012, only 75 doctors nationwide entered into geriatric fellowships. Current projections indicate there will be only one geriatrician to treat every 4,000 patients in the next 15 years.
Why such a growing gap — the shortage of geriatricians at the same time those over 65 are the nation’s fastest growing age group? The problems are multiple. Geriatrics is one of the lowest paying fields of medicine, even though it requires years of intensive specialization. At the same time, the cost to become a geriatrician is high; student loans for medical school alone can be $200,000. Young doctors discover that even if they wanted to, going into geriatrics makes paying off their huge student loans difficult. Subsequently, many find a different specialty.
Most geriatricians are reimbursed solely by Medicare and Medicaid, whose rates make it unsustainable to keep an office running. Many hospitals and clinics argue they cannot keep geriatricians on staff, saying it is more profitable in terms of reimbursement to order a wart removal than for a patient to engage in an hour-long consultation with a geriatrician who needs to keep track of multiple issues to properly manage an older person’s complicated health needs.
Today, all across the United States, geriatric clinics and hospital units are closing.
A crisis is brewing for those of us entering our senior years, according to Dr. David Reuben, a leading geriatrician at the UCLA Medical Center.
Aside from geriatricians, most doctors today are not trained in how to appropriately manage older patients. Ninety-seven percent of medical students in the United States do not take a single course in geriatric medicine.
While the vast majority of Americans have no conception of what lies ahead, the fact that no trained geriatrician may be available to provide health care will dramatically affect lives. And that is a worry, because, if you are like me, you don’t want to be part of the 50 percent of patients who move permanently into nursing homes, using up their entire life savings and ending up on Medicaid.
So what can we do? Talk to our representatives. Raise awareness about this critical issue that will impact all of us who hope to grow older. Bring this subject into the national discussion.
Your children will thank you.
Marcy Houle, MS, is the co-author, with Elizabeth Eckstrom, MD, MPH, of “The Gift of Caring: Saving Our Parents From the Perils of Modern Healthcare.” The book received a national Christopher Award at the 67th annual Christopher Awards in May, and Houle will be conducting a Colorado book tour in late September; visit www.TheGiftofCaring.net for details. Houle also wrote an op-ed for The New York Times titled “An Aging Population, Without the Doctors to Match,” published on Sept. 22, 2015, and an op-ed for the Los Angeles Times titled “How Our Healthcare System Can Be Deadly to the Elderly,” published on Sept. 1, 2015.
