Athens, Ga., is a small city about 75 miles east of Atlanta. Older adults love its low cost of living, community-mindedness and proximity to a major urban area. What they don’t love, however, is the poor access to specialized senior health care.
Nearly 10 percent (11,830) of the city’s 120,000 residents are over age 65, but only three office-based geriatricians practice here.
The geriatrician shortage is not unique to Athens, to Georgia, or to the United States. There are fewer than 7,500 board-certified geriatricians nationwide — about 2,000 seniors for every geriatrician — according to the American Geriatrics Society. This ratio is more than double of what one doctor reasonably can handle, the society says, and doesn’t include the two-thirds of other people over 65 who do not need specialized care — not yet, anyway.
About 13,000 additional geriatricians are needed to meet the current demand for care, according to estimates. Moreover, as the boomer generation ages, the geriatrician workforce will need to grow by 1,500 annually for the next 15 years to satisfy the nation’s need for senior care by 2030.
In Georgia, about 19 percent of the state’s population will be over 65 by then — hovering around 2 million — calling for triple the current number of geriatricians.
Athens-area residents may be better off than some Georgians because they have access to St. Mary’s Hospital and Athens Regional Medical Center. As rural hospitals continue to shutter, Athens is set to play an important role in preparing young doctors to care for elders.
Both hospitals have fledgling residency programs in internal medicine, and every year the Augusta University/University of Georgia Medical Partnership, a UGA-housed branch of the Medical College of Georgia, graduates 40 new medical doctors.
Unfortunately, few of them want to specialize in geriatrics, according to geriatrician Donald W. Scott, M.D., a medical school associate professor who trains residents at St. Mary’s.
Scott recounts that when he was born, his father was older than most of his peers. As his father grew older, his many different doctors often prescribed medications that didn’t always work together well. Witnessing the impact of that fragmented care motivated Scott to become a geriatrician. However, he does not see that same drive among his students.
“I usually get one or two fourth-year students interested in geriatrics, but it tends to be at the very bottom of the list for most,” he said.
So Scott has come up with a different strategy. He is establishing a month-long rotation designed to “geriatricize” medical students, expose them to the aging boomers who will be a large part of their future practice.
The rotation will emphasize not only how to care for seniors, but how to talk with them about sexuality and other sensitive topics. Scott also plans to better prepare young physicians to work with patients who struggle with Alzheimer’s disease and other memory disorders.
Programs like Scott’s are popping up across the country as medical schools attempt to catch up with changing age demographics. Only eight of the nation’s 145 medical schools have full-time geriatric departments, according to the Association of American Medical Colleges (AAMC). While schools are unlikely to add new aging departments due to lack of student interest and qualified faculty, many are adapting their programs to teach skills necessary to care for aging populations.
At AU/UGA, students will receive hands-on practice during a weekly geriatrics clinic that Scott is organizing at Community Internal Medicine of Athens, a new primary care clinic set up by St. Mary’s. Here, medical students and internal medicine residents will learn about how home visits and end-of-life planning fit into patient care, Scott said.
“Taking care of frail older people requires patience and can be frustrating to primary care doctors,” says Scott, noting that doctors love to think that they are curing disease and relieving suffering, which often isn’t possible for frail patients with multiple maladies.
Managing complex drug regimens, in particular, is a time-consuming element in patient care, Scott said, and it is training that most young doctors do not receive. Others issues include learning how to ensure orders from different specialists aren’t in conflict and keeping fragmented care from resulting in insurance complications.
Aging isn’t easy for doctors or patients. Because people like consistency, and a sense of familiarity many keep with their long-time primary care physician – typically a family practitioner or an OB/GYN for women – as long as possible.
As the senior population grows, workforce forecasts indicate aging patients will rely on physicians such as Scott’s “geriatricized” students — doctors who may not have specialized in geriatrics, but nonetheless will bear the brunt of senior care. Here are some questions to ask as you report on this trend:
- With geriatrician shortages looming throughout the United States, how is your community addressing it?
- What innovative partnerships exist or are being considered to bring better senior-specific care to older residents?
- What does your local medical school director doing to encourage more students to focus on geriatric care?
