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How do we Address the Geriatric Care Crisis?

Atul Gawande, MD, confronts these stark facts in his thoughtful essay "The Way We Age Now" in the April 30 New Yorker:

Only 330 doctors will complete geriatrics training this year, not nearly enough to replace the geriatricians going into retirement, let alone meet the needs of the next decade.

Dr. Gawande asked Dr. Boult, a geriatrics professor at Johns Hopkins, what can be done to ensure that there are enough geriatricians for our country's surging elderly population. "Nothing," he said, "It's too late." Dr. Boult advocates another strategy — training primary care physicians to provide care for the very old.

But that assumes a growing number of general internists and family physicians — enough to replace retiring generalists plus a substantial increment to care for the burgeoning elderly population. Present trends show no letup in the declining interest in primary care — even though it can offer the most challenging, and rewarding, path in medicine.

The ACP and AAFP envision a medical home for every citizen. Making that a reality for elderly patients will require new models of care -— true innovations in organization, teamwork, and financing.

We received the following comment (identifying information removed). (Note: These views may not necesarily reflect those of the AMA.)

I am a physician in practice for more than 30 years and involved in GME for several decades. I think it is important for organizations like the AMA to consider publishing a historical review of the reasons why we are in this crisis. Many clinicians and educators warned of it in the early 1990s and were largely ignored by the policy makers/administrators/economists. There needs to be some honesty and lessons learned for public review.

And then some questions need to be asked why more and more people are leaving the clinical front lines and are burnt out. If you treat the caregivers badly and make the work full of catch-22s and impossible demands, then people will chose to leave. Is that a surprise? Perhaps looking at ways to heal the healers, whether physicians or nurses, might help encourage more students to pursue practice in geriatrics or other needed specialties.

What about the healthy elderly who love medicine and would still work, if offered something that was manageable in terms of malpractice and reimbursements that made part-time work reasonable?

What about a multidisciplinary series of regional conferences for brainstorming solutions and listening to why the front lines are so unhappy?

We need to engage patients, caregivers, and health care workers at all levels to focus on improvements and solutions.

It is sad to see the disconnect between policy makers, administrators, and regulators and those who do the work. A similar disconnect exists in teaching. No one should make rules that they do not have to experience and try to implement. When the emperor has no clothes, when are we going to have the courage to stand up and say it and stop pretending he has clothes?

Our medical system is in crisis — as the science gets better the delivery is getting worse.