By 2030, more 20% of the population in the United States will be over the age of 65. This will be approximately 73 million People. Thirty one million will be above 75. It’s an unprecedented number and, frankly, a bit shocking because the medical systems in this country are not equipped to serve the elderly.
Today in the United States there are approximately 7,300 practitioners Geriatricians. These are doctors who have specialized training in caring for people over the age of 65. They diagnose and treat the most common conditions in the elderly. They help their patients monitor their conditions, and coordinate treatment with cardiologists, neurologists, oncologists, and other specialists. The math is pretty easy: it comes to one geriatrician for every 10,000 seniors in the country. This is, of course, a ridiculous number, made even more ridiculous due to the fact that practicing geriatricians tend to congregate around large medical facilities, leaving rural areas, and in some cases entire states, without a licensed geriatrician.
Why does this happen? We are graduating 25000 Fully qualified doctors in this country every year. With the population leaning heavily towards the elderly, why not more doctors going into this high-demand specialty? It may seem like the simplest answer is that it doesn’t pay well, and yes that is part of the problem. In 2014, the average annual salary of a geriatrician in a private practice was less than Half The salary of a cardiologist. It is even less than a general internist, although geriatrics requires an additional year or two of training outside of general practice. Most of that is due to the fact that the primary source of income from practicing geriatrics comes from Medicare payments, which are often reimbursed at a lower rate than other insurance companies for the same service. And this difference does not even take into account the huge amount of debt that a medical student has to pay off during the first 10 years of practice.
There are other reasons as well for the paucity of medical students’ interest in geriatrics. Resident physicians are often more enthusiastic about a vibrant field such as cardiology or neurology, which combines a good salary with the excitement of new techniques for surgery and drug treatment. There’s also the psychological factor – the inevitability of watching your patients die, sometimes quickly, sometimes slowly.
This paints a terrible picture, but promising developments are looming for elderly care. Some medical schools are experimenting with programs that combine hospice training with other specialties, such as palliative care. There is also a burgeoning movement to train other healthcare professionals to see older patients through the lens of aging. Pharmacists, nurses, physician assistants, physical and occupational therapists see seniors every day in their field. They are the prime candidates for this specialized training, which can complement and supplement the physician’s lack of training in geriatrics.
Fortunately, there are still those who are willing to provide decisive assistance and a human face to those in greatest distress. Sometimes it’s a strong connection with an older family member that motivates a medical student to study geriatrics or a moment to watch a cute doctor save the life of someone they love. The need is there and is not completely lost on the health systems that run medical care in this country. Medical optimists are looking forward to a day when more focus will be placed on keeping people healthy throughout life rather than rushing into heroics at 11The tenth hour.