Despite the growing older population, the number of specialized doctors for the elderly, known as geriatricians, has dropped from 10,270 in 2000 to just over 7,400 now. The current ratio of geriatricians to older patients is 1 to 10,000, while research suggests each geriatrician should care for no more than 700 patients. Geriatricians attribute the decline to factors such as low Medicare reimbursement for services, lower earnings compared to other medical specialties, a lack of prestige, and the belief that older patients are unappealing or too difficult to treat.
Concerns over Declining Number of Geriatricians in the US
Three and a half decades ago, Jerry Gurwitz became one of the first geriatricians in the US. Today, he expresses concerns about the dwindling number of geriatricians, which has fallen from 10,270 in 2000 to just over 7,400 today, despite a more than 60% increase in the population aged 65 and older. According to his recent JAMA piece, the current ratio of geriatricians to older patients is 1 to 10,000.
Geriatrics is not a mandatory course in medical schools, and less than half require any geriatrics-specific training. Furthermore, the pipeline for doctors specializing in geriatrics is narrow, with 30% of 411 geriatric fellowship positions unfilled for the 2022-23 cohort.
The Aging US Population Faces a Healthcare Crisis
As the aged population in the US continues to grow, there is a looming healthcare crisis due to the shortage of geriatricians. A 15-year-old report suggested that 30,000 geriatricians will be needed by 2030 to care for frail, medically complex seniors. However, this goal seems unattainable at the current pace.
Low Medicare reimbursement, poor earnings compared to other specialties, lack of prestige, and ageism are among the challenges hobbling progress in the geriatric field, according to Gurwitz and other physicians.
The Success of Geriatrics and The Way Forward
Despite the challenges, geriatrics has been successful in sharing principles and practices to improve the care of older adults. Numerous innovations have been spearheaded by geriatricians, such as hospital-at-home programs, age-friendly health systems, geriatrics-focused surgery standards, geriatric emergency departments, and new dementia care models.
Artificial intelligence has opened up new possibilities, with geriatricians consulting with developers to create products that aid older adults in living independently at home, notes Lisa Walke, chief of geriatric medicine at Penn Medicine.
Michael Harper, board chair of the American Geriatrics Society, asserts that significant resources must be invested to expand programs and improve care for older adults. While the path is clear, there is uncertainty about whether this necessary action will be taken given competing priorities in medical education and practice.