You could call it ironic, I suppose, but the fact that our population is rapidly aging at a time when the number of geriatricians is rapidly dwindling has Jerry Gurwitz, MD, looking beyond the unfortunate coincidence. He’s worried.
“Our nation is beginning to experience the full impact of the aging of our population,” the chief of geriatric medicine at UMass Chan Medical School writes in a recent JAMA editorial. “Sadly, our health system and its workforce are wholly unprepared to deal with an imminent surge of multimorbidity, functional impairment, dementia, and frailty.”
The numbers don’t lie: Between 2000 and 2022 the number of board-certified geriatricians in the United States fell from 10,270 to 7,413. During that same period, the number of my Boomer compatriots who turned 65 rose from 35 million to 54 million. That leaves us with about one provider for every 7,300 seniors.
The alarming decline in the number of these eldercare specialists, Gurwitz notes, is partly due to the initial wave of retirement among those physicians who entered the field when it was declared an official medical specialty in 1988. But some experts point to lower salaries (geriatricians, on average, earn 9 percent less than general internists) as a reason for the deficit, while others highlight the fact that few medical schools teach geriatric principles as part of their curriculum.
Gurwitz argues, however, that the dearth of geriatricians is more complicated than simply lower pay or a lack of familiarity with geriatrics. Pediatricians also earn less than other specialists, he notes, yet it remains a popular career option for newly minted doctors. And funding for geriatric research and training remains generous: The National Institute on Aging’s $4 billion annual budget is the third largest among the sprawling National Institutes of Health.
So, how to explain the general lack of interest in gerontology? Gurwitz suggests it’s simply ageism.
“Attitudes of medical students and residents about aging and older adults strongly influence their career decision-making,” he argues, and those perceptions are generally negative. He cites a recent survey at two teaching hospitals in California. Students and residents training there described older adults as “inherently end-of-life patients” who were “cognitively impaired” and complained “that their medical problems were complex and unlikely to be resolved, and that they were socially needy and slow to interact with.”
What seems to trouble Gurwitz even more than these ageist attitudes is the apparent inability or unwillingness of healthcare organizations and medical schools to mitigate such perceptions in the face of a continuing tsunami of new seniors. Under the circumstances, he writes, “it will be extraordinarily difficult to alter the trajectory of the specialty of geriatric medicine.”
And that’s particularly vexing when you consider the degree to which geriatric principles and practices have infiltrated the healthcare system in recent years. As Judith Graham reports in Kaiser Health News, it’s now generally accepted that the priorities of older patients should guide their care plans; that doctors should make treatment decisions based on their effects on a senior’s functioning and independence; and that interdisciplinary teams are best equipped to address the various medical, social, and emotional needs of older adults.
As a result, doctors are now more likely to re-evaluate — and often de-prescribe — medications their older patients are taking, encourage them to resume physical activity after an illness, and weigh more carefully the benefits and liabilities of medical interventions.
This “holistic understanding of older adults’ physical and social circumstances,” Graham writes, has led to myriad innovations to serve seniors more effectively. Among the more notable of these include hospital-at-home services, geriatric emergency departments, and new dementia care models.
“We now have a very good idea of what works to improve care for older adults,” Michael Harper, MD, chair of the American Geriatrics Society board of directors, tells Graham. Now all we need is to convince more medical students that it might be worth their while to provide that care.
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