The need for geriatricians far exceeds the number of physicians who choose to specialize in geriatrics.
“That’s been the case for a long time, but it’s getting worse,” according to AMA member Peter Hollmann, MD, himself a geriatrician and the physician director of population health at Brown University Health in Rhode Island.
For example, from 2000 to 2022, the number of people in the United States 65 or older rose by 60%, but the number of board-certified geriatricians fell by 28%.
In honor of Older Americans Month, May is marked each year as AMA Senior Physicians Recognition Month. Learn about the AMA Senior Physicians Section (AMA-SPS), which gives voice to and advocates on issues that affect senior physicians, who may be working full time or part time or be retired.
As part of that observance, Dr. Hollmann talked with the AMA about the causes of the geriatrician shortage, the particular clinical needs of the fast-growing population of older adults, and how the health system can address this mismatch.
MDs need to know the 4 M’s
Dr. Hollmann said that the decline in geriatricians is part of a larger drop in physicians who choose primary care as a specialty.
“Geriatricians come through primary care,” he noted. “The pipeline is shrinking,” exacerbated by declining Medicare payment. The U.S. will need more than 23,000 new geriatricians by 2030, according to the American Geriatrics Society.
In addition to providing routine primary care, geriatricians focus on priorities established by the John A Hartford Foundation and Institute for Healthcare Improvement known as the four M’s:
- What Matters: That is, understanding an older patient’s desired health outcomes and care preferences and matching treatment with them, including end-of-life care.
- Medication: That is not more and not riskier than necessary, and that interferes with the other M’s as little as possible.
- Mobility: an emphasis on keeping older adults move safely each day so they maintain function.
- Mentation: the prevention, identification, and management of dementia, depression and delirium.
To this list, Dr. Hollmann adds a fifth M, the management of multiple chronic conditions such as dementia, diabetes and heart failure.
“It’s trying to get the big picture rather than treating each condition on its own,” he said.
In lieu of an adequate supply of geriatricians, medical educators in medical schools and in residency training medical education should try to embed its core skills in as many physicians as possible, Dr. Hollmann said.
“We want people to have a good understanding of things, at least enough to not make errors” such as prescribing medications inappropriate for older-adult patients. He also stressed the importance of physicians being able to recognize age-related conditions such as dementia.
There has been progress in integrating such training since Dr. Hollmann’s days as a geriatrics fellow.
“Some elements of it now are part of regular residency,” he said.
Making the most of geriatricians’ skills
Geriatricians, like physicians more broadly, are increasingly turning to employment in hospitals, health systems or in multispecialty group practices, Dr. Hollmann noted. In many of these settings, healthcare leaders are participating in Medicare and commercial value-based care arrangements. Such efforts can improve the healthcare organization’s care for older adults and be cost-effective.
“If you have a geriatrician service, your hospital can take better care of older patients. You are less likely to have readmissions. You improve care and lower costs,” Dr. Hollmann said. He added drily that, compared with other organizational expenses, “It’s pretty cheap to hire a doctor.”
Because older-adult patients often have complex health conditions, caring for them effectively also requires a physician-led, team-based approach to care that effectively incorporates the skills of an array of other health professionals. That can include some combination of nurse practitioners, physician assistants, pharmacists, social workers, navigators and community health workers. It is also the only way more of the need can be addressed.
“By figuring out how to effectively use the care team, you can take better care of the patient,” he said.
Healthcare organizations now have an added financial incentive to integrate geriatricians into care delivery, Dr. Hollmann explained. In 2025, Medicare introduced three billing codes that are available to physicians and other health professionals who offer advanced primary care management services, as most geriatricians do.
The codes provide monthly payments of $15 for care of a Medicare patient with one or fewer chronic condition; $50 a month for patients with two or more such conditions; and $110 for qualified Medicare beneficiaries such as low-income patients with two or more such conditions.
“That can be a lot of money,” Dr. Hollmann said. “Medicare is trying to do something to create a better situation for people to provide primary care and care for complex patients.”
Paradoxically, while relatively few physicians choose to become geriatricians, surveys have found that those who do are among the happiest with their specialty.
“They wouldn’t have gone into it if they weren’t expecting it to be challenging,” Dr. Hollmann noted.
He personally enjoys geriatric care because he likes the relationships he developed with patients, and with family members. “Your services are in high demand, and people are extremely appreciative of it.”
Any AMA physician member 65 or older is an automatic member of the AMA Senior Physicians Section, whether working full time, part time or fully retired. The sections tackles issues related to ageism, senior physician competency, telemedicine services for the underserved, healthy aging and more. Learn how the AMA-SPS gives voice to—and advocates for—issues that affect senior physicians, and explore opportunities to get involved.
