Elderly patient boom faces specialist shortage
By Christy Feig
WASHINGTON (CNN) -- With the elderly population in the United States continuing to grow rapidly, the number of doctors who specialize in their care is dwindling.
Americans age 85 and older are the fastest-growing segment of the population, and the numbers are expected to reach 19 million by 2050 as baby boomers age, according to the American Geriatrics Society.
Most senior citizens can see a family physician for the majority of their medical problems, but as they get older and sicker, their complex medical conditions often require the specialty of a geriatrician.
That is, if they are able to find one. Currently, there are about 9,000 geriatricians in the United States, but the number is declining. The geriatrics society estimates 36,000 will be needed by 2030.
Geriatricians specialize in medical problems associated with aging. They have several years of additional training in areas such as neurology, psychiatry and urology so they can recognize problems other doctors may consider normal aging.
"In American medical schools, less than 10 percent of medical schools have mandatory education in geriatric medicine despite the fact that this is the largest-growing segment of the population," said Dr. Rebecca Elon, a geriatrician in Glen Burnie, Maryland.
Violet Cosgrove, 76, has found out firsthand how aging can complicate medical problems. She has severe osteoporosis, arthritis, two artificial knees and an artificial hip. When her family doctor failed to diagnose a broken pelvis, her orthopedic surgeon decided it was time she move to a geriatrician.
"The difference is night and day," Cosgrove said. "My other doctors seemed to always think that my problems were based on my age, and their answer always was, 'What do you expect? You're getting old.' "
She said her geriatrician spends four to five times longer with her than her regular doctor.
Elon said spending time is essential when working with older people. As a result, she can see only about 12 patients a day, half of what a regular doctor will see.
"It takes [older people] longer to walk from the waiting room to the exam room; it takes longer for them to use the restroom before the visit; and it takes longer for them to respond to any requests as far as the physical exam," Elon said.
Seeing fewer patients means less money, and Elon said her practice runs a 30 percent deficit every year. It is able to stay in business because the local hospital makes up the difference, she said.
Budgets will be even tighter next year when Medicare payments to doctors are scheduled to be cut more than 4 percent.
"Geriatricians are the only group of physicians that have Medicare as almost their exclusive payer," Elon said. "Most other practices have other sources of payment that can offset the cuts in Medicare."
U.S. Health and Human Services Secretary Tommy Thompson said he agrees changes need to be made.
"There's no question that the doctors are going to be receiving a reduction next year unless Congress makes an adjustment," Thompson said, "I'm fairly confident that's going to take place."
For now, the American Geriatrics Society is trying to work with Congress to pass the Geriatric Care Act that would help improve payment for doctors who care for senior citizens.
Measures to keep doctors specializing in geriatrics is reassuring to patients such as Cosgrove.
"[Geriaticians are] like the old-fashioned doctor who really cared," Cosgrove said. "And we need a whole lot more of them."