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Too few geriatricians for an aging U.S.
Doctor and patient.
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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.
I have taught gerontology in both a medical school and a school of social work for 27 years. One of my objectives is to enable students to see how challenging and intellectually exciting aging issues can be. I start the course by assessing students' attitudes toward their own aging. Sadly, their general attitude is nearly always very negative. They don't like what aging looks like and they don't believe there is anything positive about life after 60. Unfortunately these students mirror the general population. With this basic attitude, (let alone poor compensation) how will we EVER convince enough young people to choose to specialize in geriatrics? After 27 years of trying, I am very discouraged.
I greatly enjoyed listening to your story covering the lack of gerontologists in our country's health care system. As a nurse practitioner working as a case manager and primary care provider for patients over the age of 65 in the community, in their homes, and in nursing homes I have great appreciation for the work of these physicians. However, your story remains incomplete without mentioning the role of the nurse practitioners and nurses that provide care to these patients. The nursing model, with its emphasis on quality of life and treating the whole patient, is particularly relevant to the geriatric population with its myriad psychosocial, medical, and practical needs. Furthermore, in an environment where fewer and fewer physicians are choosing to specialize in geriatrics, the cultivation of the role of alternate providers will be a necessity if we are to provide adequate care for these patients.
I am a graduate of the Gerontolgy program at UT Southwestern in Dallas. As a Gerontologist, I try to refer seniors to Geriatiricans in the Dallas-Fort Worht area for medical services.However, in the DFW area there are only about 15 board certified Geriatricians and only around 7 of them will accept new patients! There are less than 200 Geriatricians in the state of Texas and we are the 2nd largest state in the nation with a growing aging population.Also,many Internal Medicene doctors will not accept new Medicare patients and some are discharging the ones that are in their practice! Please continue your reporting on this issue that will hit millions of Americans as the U.S. must deal with this crisis in our health care system. The " Greatest Generation" is in for another test of their will power!
Thank you for this very important story. As others have pointed out there are many other providers of vital services to older adults that rarely get recognized. For example, vision loss is of monumental proportions in older adults, but vision rehabilitation services (mostly provided by non profit organizations) help people learn alternative skills to maintain independence despite vision loss. However, most of these services are not covered by any kind of health care insurance, yet most referrals come from the health care sector that recognizes the value but doesn't have funding or expertise to provide these services. I am sure there are many other providers like this who rarely get recognized or acknowledged in reports like this, but are also an important part of the mix that needs to be recognized for what it does to support older adults in their home.
As a gerontological NP I provide primary care to very frail elders in private homes, assisted living facilities & nursing home. Dr Altman's comment about being the couch is a great comparision. My job is to gather information from many sources--patient, family, vising nurses, physical therapists, social workers, home health aides & pharmacies. After I perform an assessmnet, make a diagnosis, prescribe treatment I must again contact all team members & co-ordinate the effort to provide the care, evaluate the results & fine tune the plan. My goal is to keep elders in their own homes as long as possible.
Thank you for this story. Quality geriatric healthcare is a real societal concern. I was disappointed that you neglected to mention other providers of healthcare to elders -- geriatric nurse practitioners and registered nurses. The shortage of specially trained nurses should also be a grave concern because outside of friends and family members nurses provide the bulk of care to America's elderly population.
