Too few geriatricians for an aging U.S.

Doctor and patient.

TEXT OF STORY

Kai Ryssdal: Older Americans spend more time and money in the health care system that almost any other age group, but other than family, they don't often have much help juggling their particular mixtures of ailments and medications.

There are doctors who specialize in caring for the elderly, but geriatricians are in short supply, as Marketplace's Caitlan Carroll reports.


David Reuben: How's life?

Fritiof Sjostrand: Fine.

Reuben: Life is good?

Sjostrand: Yeah.

Reuben: How's your hearing?

Sjostrand: Fine.

Caitlan Carroll: Fritiof Sjostrand is meeting with his geriatrician David Reuben. He just got over a respiratory infection.

Dr. Reuben checks Fritof's heartbeat and listens to his cough. He asks about a blood thinner medication that he thinks might be affecting his patient's memory. Fritiof is 95.

Reuben: There was a little confusion last time. Is everything clearer upstairs here?

Sjostrand: Yeah, yes. I think.

Dr. Reuben heads up UCLA's geriatrics program. It's one of only 39 in the country that trains geriatric fellows.

Reuben's been Fritiof's primary doctor for decades. Fritiof's wife Birgitta says he would be deaf without Reuben's intervention.

Birgitta Sjostrand: My husband just got a cochlear implant and if it were not for Dr. Reuben pushing it, we would not be able to talk together.

First, Reuben had to convince a specialist to do the procedure and then he pushed to have it covered by insurance. Expensive hearing devices like that aren't usually recommended for someone Fritiof's age. Reuben says overseeing an elderly patient's complicated medical care is just part of his job.

Reuben: Sometimes I refer to it as a quarterback, but it's kind of more than a quarterback. It's kind of almost like a head coach. It's really coordinating things, it's communicating; it's getting everybody on board.

But only 7,000 of those quarterbacks are on the field these days. The number of geriatricians has dropped 22 percent from eight years ago.

With 71 million Americans heading toward old age, healthcare experts say elder care could be in crisis.

Stuart Altman: No one finds this a surprise, but the magnitude of the gap is what sets people back.

Dr. Stuart Altman is a professor of National Health Policy at Brandeis University. He says the insurance system is biased against doctors like geriatricians, who concentrate on preventive medicine to keep patients healthier longer. He says doctors get paid more to treat patients than to talk to them.

Altman: The way the health system pays the workers in it, it has a very strong bias in favor of high-tech services, highly specialized services and primarily services for acute care.

As a result, geriatricians make a quarter to a third less than other specialists. Visit one of those websites that ranks medical careers. Geriatrics always comes in dead last.

Still, geriatrics has some takers, like Elizabeth Goodman.

Reuben: Here she is, the one left. Yes, the last Mohican.

Goodman's doing a rotation in UCLA's geriatrics program. She chose the specialty for its holistic approach.

Elizabeth Goodman: I think very often in most aspects of adult medicine we really only spend the time to focus on people's disease processes and sometimes we don't get to ask as much as we'd like about what their social situation is and what their quality of life is.

The federal government offers loan forgiveness for geriatric training and lawmakers are pushing for more incentives. There's also talk of creating a geriatric service corps to bring more people to the field.

For patients like the Sjostrands, seeing a doctor who understands their needs as seniors has made all the difference.

Birgitta Sjostran: Remember before you always said that people used to look at you like
you were stupid because you couldn't hear?

Fritiof Sjostrand: Well, yeah. That's true.

Carroll: But not anymore, because you can hear everything.

The question for the millions of baby boomers is will there be a geriatrician there to listen?

In Los Angeles, I'm Caitlan Carroll for Marketplace.

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