Despite more than 20 years of clear warnings from some of the most prestigious health policy and medical groups in the country, America is facing a severe shortage of health care professionals trained to manage the special health care needs of older people.
Currently there are about 8,800 doctors certified in geriatric medicine. That's up from 6,740 three years ago, but falls far short of the 20,000 that the Alliance for Aging Research estimates are needed now for today's population of 34 million seniors. And, it represents only a fraction of the 37,000 that will be needed by 2030 to care for the 76 million people who will be over age 65.
In many cases, older people can be cared for by a primary care generalist who has some training in geriatric medicine. But according to a report published in April 1998 in the Journal of the American Medical Association (JAMA), generalist physicians are not being prepared properly to manage the problems associated with aging. "Most graduate training in geriatrics is elective, and only a small portion of residents pursue it", writes author Lillian Chiang of the University of California Los Angeles School of Medicine.
In 1993, the Institute of Medicine recommended that all residencies in internal medicine and family medicine offer a mandatory six months of geriatrics training by 1996, and nine months by 1999. But this is yet to happen. Today there are still only a handful of U.S. medical schools with geriatric divisions, and most schools present only a two-week rotation in geriatric medicine or, worst case, an elective study.
What We Need
1. More commitment from medical education.
We need better formal training in geriatrics for all physicians -- generalists and specialists alike. Whether they visit a primary care physician or a specialist, geriatric patients need competent caring physicians with skills in managing multi-symptom chronic conditions over an extended period of time. They need physicians who are informed about the physical and psychological aspects of aging, and how these changes apply to their area of practice.
2. More commitment from students.
Students entering medical school today can expect to spend about half their future careers practicing medicine seeing patients over the age of 65, yet studies show that only 3 percent of medical students are interested in the field of geriatrics. According to the article in JAMA, only half of the available residency positions in geriatrics were filled in 1997. Reasons given for the reluctance to pursue careers in geriatrics were lower pay and persistent "ageist attitudes" - the perception that older patients are difficult, their medical care often futile, and their prognoses depressing.
3. Better role models.
There is a shortage of first-rate faculty members trained in geriatrics who can serve as role models for younger medical students. To help create a cadre of leaders in the field, the Alliance for Aging Research co-sponsors a private-sector initiative called the Paul Beeson Physician Faculty Scholars in Aging Research Program. Each year this program identifies 10 junior level Ph.D. and M.D. physicians and awards them a grant to pursue a focus on aging research. We hope that the government and others will create more of these types of incentive programs.
What You Can Do
Write or call your Representative and Senators in the Congress to express your strong support for greater federal action to promote the development of geriatric medicine and to increase the number of health professionals trained in the field. Urge action to provide:
- appropriate reimbursement under Medicare for a visit to a geriatrician
- increased funding for existing programs which support the training of faculty leaders in geriatrics and of practicing geriatricians
- an appropriate level of funding support from Medicare for graduate medical eduation in geriatrics
Resources on the Alliance Web site have guidelines for letter writing, and a list, by state, of all Senate and House representatives.
We said it in 1996 (Will You Still Treat Me When I'm 65?), and we'll say it again, we cannot afford to ignore this issue any longer. We need an accelerated effort to address the problem. Otherwise, as older Americans place unimaginable demands on the nation's health care system over the next two decades, we'll see misdiagnoses, ineffective health care, and unnecessarily crowded nursing homes.
