The American Geriatrics Society - Policy - Shortage of Geriatrics Healthcare Providers

Shortage of Geriatrics Healthcare Providers

Who Benefits from the Care of a Geriatrician?
What are the Current and Projected Future Doctor to Patient Ratios in Geriatrics?
Why is this issue important?
What Factors are Contributing - or are Expected to Contribute to - the Shortage of Geriatricians?

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Patients 85 and older with complex medical problems are most likely to benefit from the care of a geriatrician. Some young-old patients with complex conditions, frailty, disability, dementia or other geriatric syndromes would also benefit from the care of a geriatrician.
These patients benefit from the expertise of geriatricians in managing complex problems with a holistic, patient-centered approach, incorporating knowledge of the physiology of aging and of managing geriatric syndromes and multiple chronic conditions.

According to a recent JAGS editorial, 30 percent of the most frail Medicare beneficiaries will need to be cared for by a geriatrician and because of the frailty, one geriatrician can care for a patient panel of 700.
Primary care internists and family physicians would manage the healthier and better functioning 70% of older adults.
There are only 7,345 certified geriatricians practicing in the US -- a 5.4 percent decrease from the year 2000 and roughly half the number currently needed.
That said, currently about 1.1 million 65 and older Americans would benefit from the care of a geriatrician - a shortfall of 8,421 geriatricians.
There are far fewer geriatric psychiatrists. Currently there are 1,596 - one for every 11,372 older Americans. That ratio is projected to decrease by 2030 to one geriatric psychiatrist for every 20,195 Americans 75 and older.
In 2007, 91 residents who graduated from US medical schools (USMDs) entered geriatric medicine fellowship programs (slightly more than 0.5% of all medical students in that graduating class), down from 167 in 2003. In 2007, 24 USMDs entered geriatric psychiatry fellowship programs (less than 0.2% of all medical students in that graduating class), down from 30 in 2003.

By 2030, when the last of the baby boomers reaches the age of 65, the U.S. population aged 65 and older will exceed 70 million - approximately twice the number in 2000.
As America's 77 million baby boomers age, the need for healthcare professionals trained in geriatrics will be high in demand.
Unfortunately, doctors, psychiatrists, nurses, psychologists, pharmacists, and other healthcare professionals specially trained in the care of older adults are in dangerously short supply.
The complex problems associated with aging will require a supply of healthcare providers with special training in geriatrics.

Over the last 5 years, a declining number of US medical school graduates have been choosing careers in internal medicine and family medicine - the two fields that are the source of applicants for geriatric fellowship programs.
Physicians in internal medicine, family medicine - and geriatrics - earn significantly less and have less predictable work schedules than those in other medical and surgical specialties, especially disciplines such as dermatology, plastic surgery, otolaryngology, radiation oncology, and emergency medicine.
A career focused on caring for older adults can be particularly financially unattractive for physicians who carry increasingly large medical school loan debts.
Over 86% of medical school graduates carry educational debt and the median debt burden for graduates of medical institutions is over $100,000.
The median salary for a geriatrician in private practice in 2005 was $162,977 - significantly lower than that of most other medical and surgical specialties.
In many parts of the U.S., Medicare payment rates for physicians are lower than commercial insurance rates.
Medicare reimbursement rates for mental health services are discounted even further than rates for geriatric medical services.
Medicare reimbursement is the major source of income for most geriatricians and, as a result, community-based geriatricians have lower incomes than most other physician specialists.