Medicine, and Medicare, must prepare for more elderly patients

Medical schools, practicing physicians and the federal government all have roles to play in seeing that there are enough doctors trained in geriatric care.

Editorial. March 17, 2003.

Alzheimer's disease. Dementia. Diabetes. Arthritis. High blood pressure. Hearing loss. There's a substantial likelihood that most Americans will face one or more of these medical conditions as they age.

Unfortunately, there's also a likelihood that it will be increasingly difficult for aging patients to find a physician who specializes in treating them and their medical needs.

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According to the Centers for Disease Control and Prevention, the number of Americans 65 and older will increase from 35 million to 71 million between 2000 and 2030. Senior citizens will make up 20% of the population -- up 8% from the roughly 12% they account for now.

By that time, the Alliance for Aging Research, based in Washington, D.C., estimates that the country will need 36,000 geriatricians.

Yet, the number of physicians who specialize in the problems and diseases of old age is expected to drop precipitously in the next year alone. There are about 9,000 geriatricians now practicing, but the Alliance estimates that number will drop to 6,100 by 2004 as physicians give up practice in the face of low Medicare reimbursements or retire. Few experts are predicting the hemorrhaging can be slowed, let alone reversed. Generalist physicians will be expected to pick up the slack.

Just recently, the CDC highlighted the seriousness of the problem by calling on public health officials to expand their mission to include promoting health in older adults, preventing diabetes -- a major health concern for the aging -- and maintaining quality of life.

The idea is a good one, but the wheels of government turn slowly. Significant and immediate action to combat the growing shortage of geriatricians is going to have to come from the medical community. One welcome sign comes from medical schools, which are experimenting with a variety of programs to steer more medical students into that specialty. Another valuable resource is the knowledge to be shared by physicians already well-versed in treating these patients.

Practicing physicians have a solid treatment track record for many of the chronic conditions that plague senior citizens. With some fine-tuning, they are poised to offer the most immediate and comprehensive care for seniors in need of it.

This fact has been recognized by the AMA, whose policy "encourages enhanced training in residency programs for patient care of the elderly and that the leadership of specialty societies and continuing medical education centers encourage joint educational activities in geriatrics-related topics."

The American Academy of Family Physicians and the American College of Physicians--American Society of Internal Medicine are to be applauded for stepping up their CME offering in geriatrics.

Next month when the ACP-ASIM holds it annual meeting, 10 physicians will be trained to teach their colleagues about geriatric patient assessments. They will then be sent back to their regional chapters to share the knowledge. They follow 10 physicians who underwent the same training last year.

It is a commendable effort that could go a long way toward providing the specialized care that this country's growing senior population will require in the coming decades.

It would be remiss, however, to lay the responsibility for increasing geriatric care entirely at the feet of the medical profession. One of the main reasons geriatrics doesn't garner overwhelming interest from medical students is low pay. And the responsibility for that falls squarely at the feet of the federal government.

The recent vote by Congress to replace a 4.4% Medicare payment cut scheduled for this year with a 1.6% increase is a step in the right direction. But if Congress is going to do its part to right the ratio of senior citizens to those who treat them, it is going to have to fix the Medicare payment schedule permanently.

Only in that way will it be joining the physicians and medical educators who are stepping up to do their part to address the shortage of care for an aging population.