Providers focused on the Elderly are growing smaller in numbers
Doctors who specialize in aging are in short supply and their shortage will grow worse as the population ages in coming decades, a new report concludes.
The report, published this month in theJournal of the American Geriatric Society, warns that as the proportion of older adults spikes from 12% to a projected 20% by 2030, caring for 70 million people 65 and older and 10 million 85 and older will be a challenge.
Other types of health care providers will need to work in teams with the doctors to help coordinate patient care, according to the report.
"There are not going to be enough geriatricians," says physician Gregg Warshaw, an author of the report and chair of the division of geriatrics at the University of Cincinnati. Currently, he says, "80% of pediatric patients see pediatricians, while 80% of geriatric patients see primary care doctors or internists."
Earlier studies by physicians groups predicted 36,000 additional geriatricians will be needed by 2030 . But the new report calls that "impossible and unrealistic." Fewer than 320 physicians entered geriatric medicine fellowship training from 2004 to 2008, the report said, noting a lack of geriatricians in some rural areas is acute.
The authors call on policymakers and health care systems to change payments to reward team members other than physicians — such as nurses and social workers — and to improve training in care for the elderly.
Physician Steven Counsell, director of geriatric medicine at Indiana University School of Medicine, says one of the problems with current Medicare policy is "so much of the payment is based on the face-to-face visit between the doctor and patient."
Success stories involving teams of health care providers working in concert with geriatricians are good models for others to pursue, Counsell says. He helped create the Geriatric Resources for Assessment and Care of Elders (GRACE), which aligns low-income adults living in their homes with two medical teams.
The support team includes a nurse practitioner and social worker who visit patients at home to assess their needs. Then a larger team, including a geriatrician, pharmacist and physical therapist, develop a care plan. The support team, rather than the doctor, follows the patient.
A report in the Journal of the American Medical Association in November praised the program as one of the models that would be most effective and efficient in caring for the complex needs of older adults. GRACE saved money for the sickest (three to four chronic diseases). It decreased emergency room visits and lowered admission rates.
"In half a day, a geriatrician meeting with one team can impact 500 patients," Counsell says.