The good news is that the baby boomers are hitting 65 with a tsunami-like force that will create a tremendous demand for your geriatric services. The bad news is that Medicare, the primary payer for geriatric services, does not yet understand the value of geriatric care -- as illustrated by its lack of funding for education and services. As it stands today Medicare is calling for a 5% cut in physician reimbursement despite significant increases in practice expenses such as malpractice insurance. Political pressures are once again likely to scale back these cuts but a real investment in our services is unlikely. So what does the future hold for a young geriatrician?
It is said that the baby boomers make traumatic changes to every market that they touch; clearly, geriatric care is going to be one where the boomers will bring about lasting effects. We have already seen their demand for individualized care add options to the long-term care market with such innovations as assisted living facilities, concierge care and special needs plans.
What options are there for a young geriatrician? Years ago, the majority of geriatricians went into private, office-based practices. This is actually the place where you're least likely to find a geriatrician today, particularly because of the economic imbalance of rising overhead and dropping reimbursement. Some geriatricians are actually transitioning from their private office-based practices to concierge practices. Concierge practices are finding more success in these transitions since the practice is already starting with a base of patients rather than from scratch. Getting patients to pay privately for these specialized services will get easier as more and more physicians opt away from Medicare, thereby decreasing the supply of geriatricians in the face of increasing demand for these services.
A more popular private practice model for geriatricians focuses on long-term care. Providing services directly at the bedside in a skilled nursing facility, assisted living facility or home not only carries clinical benefits but business benefits as well. These practice types typically don't involve traditional office overhead this makes them much more profitable.
While it is still possible to have a profitable private geriatric practice either in LTC or concierge medicine, most geriatricians are instead turning to structures where they do not have the burden of practice operations and can enjoy regular hours and regular pay checks. These include clinical practice and administrative responsibilities in settings that can utilize the unique talents of a geriatrician such as those required by Medicare Advantage plans and, especially, Special Needs Plans or academic settings.
As you march through these options, from traditional office-based practice to administrative responsibility for regional systems of care, you reach the apex -- responsibility for the entire senior health program, i.e., public policy. Geriatricians are well trained to take leadership responsibilities in state, federal, and private organizations with regard to their public health initiatives. Of course, a geriatrician's training is best when supplemented by continuing education and experiences through fellowships and scholarly programs. These programs can go a very long way in extending one's expertise in unique aspects of geriatric care.
The future holds opportunities for geriatricians who are ready and able to accept challenges. Without geriatricians in leadership roles, the major issues created by the aging baby boomers will not be managed in an efficient and effective manner. Challenges include: (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible, (3) changing the way society organizes community services so that care is more accessible, and (4) altering the cultural view of aging to make sure people of all ages are integrated into the fabric of community life. i
Geriatrics is a fascinating field of medicine that is in the midst of a great revolution and in need of some great leaders, leaders who are not afraid to embrace emerging technologies, expand the roles of non-physician care team members -- or take charge despite the pains these are likely to create. Leaders willing to take up this challenge will find a better place not only for themselves but, more important, for the older adults whose lives they touch - whether that's one life, or several million.
1 Knickman JR, Snell EK. (2002) The 2030 Problem: Caring for Aging Baby Boomers.
Health Services Research 37 (4), 849-884.
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