When the doctor started downsizing, she started looking for someone new and stumbled upon a geriatric practice that specialized in patients 65 and older. Early didn’t think she was old, so she said, “I never thought of that.” That’s what I find remarkable,” she said. But she’s grateful for the switch.

“They said, ‘We want to have a personal relationship with you and we want to be with you until the day you die,'” Early said. They seemed to have a deep understanding of the issues faced by older adults and their families, from aging to end of life. “I feel very lucky because I know that people my age don’t have that.”

People 65 and older use more health care services than any other age group and account for nearly half of hospital admissions. However, there are only 7,300 board-certified geriatricians in the United States, less than 1 percent of all physicians, according to the American Geriatrics Society. In contrast, there were more than 60,000 practicing pediatricians in 2021, according to the Association of American Medical Colleges (AAMC).

However, research shows that geriatricians manage older patients more effectively and efficiently than physicians without such training, resulting in lower inpatient mortality, shorter length of stay, and patient costs. It is known that this leads to a reduction in Currently, there is approximately one geriatrician for every 10,000 elderly patients in the United States. Only 41.5% of geriatric medicine fellowship positions were filled in late 2023, down from 43% in 2022. Meanwhile, the population aged 65 and over is expected to increase by nearly 40% within 10 years.

He is a professor of geriatric medicine at the University of California, San Francisco, and author of Older Adults: Redefining Aging, Transforming Healthcare, and Reimagining Life. ”

psyche, motor skills, medicine

This shortage stems from negative stereotypes about the aging population, physicians’ lack of experience in the field, and low pay compared to many other specialties, which can lead to doctors misdiagnosing conditions and aging patients. Experts say patients can be overprescribed with drugs that can lead to cognitive impairment and other problems. . “It’s tragic,” Aronson said.

Ryan Pate, a geriatric psychiatrist at Stanford University, said changes in body composition as we age change the way we metabolize drugs. Even at low doses, older adults may begin to react differently to medications they have been taking their entire lives as they get older. Many doctors and patients don’t realize that some common medications can impair executive function, attention, language, and memory in older adults.

“The vast majority of older adults receive care from people who have little or no training in caring for older adults.”

— Louise Aronson, Professor of Geriatrics, University of California, San Francisco

For example, digoxin, a prescription drug used for abnormal heart rhythms, can cause loss of appetite, and over-the-counter sleeping pills, such as Benadryl and its generics, can cause delirium and falls. Even the widely used anti-inflammatory drugs Advil and Aleve can increase the risk of gastrointestinal bleeding, increased blood pressure, impaired kidney function and heart failure in older patients, experts say.

Pate said he often sees patients experiencing confusion, hallucinations and sleep problems due to medications given for other conditions. “Another important part of my job is sometimes discontinuing or reducing medication prescriptions. [it is] I prescribe it,” Pate said.

Roseanne M. Leipzig, professor emeritus and associate director of the Brookdale Department of Geriatrics and Palliative Medicine, said that all physicians should understand the “5” of mental health, mobility, medications, multicomplexity, and what matters most to patients. He stated that it is necessary to have basic abilities regarding the three M’s. Department of Medicine, Icahn School of Medicine, Mount Sinai, New York.

Some doctors “don’t understand that what they think is a new symptom or problem is actually a side effect of a drug, and that those side effects don’t occur in young people,” Dr. Leipzig said. . “when [a patient] With so much going on, we need someone to quarterback us. ”

This was especially true for Arley, who needed someone to connect the dots between the various states. When COVID-19 caused long-term swelling in Early’s leg, limiting her mobility, her new geriatric worker noticed that she seemed depressed and asked her to help. I asked about it. She responded that Ms. Early was unable to go down her front steps and that she felt trapped inside the house. Her doctor recommended she have a ramp installed, which she affectionately named the “Freedom Ramp.” Early said it changed her daily life.

Medicare portion, student loan incentives

The supply-demand mismatch between geriatric physicians and doctors like Dr. Early who need them has been building for decades. Geriatrics only became a board-accredited specialty in 1988, and accredited medical schools are not required to teach geriatrics, and many are not required to teach geriatrics. Pate wasn’t exposed to specific geriatric medicine rotations until his third year of psychiatry training in 2020. However, he was drawn to it and later pursued the fellowship. The Accreditation Board only requires that he complete one month of geriatrics in a four-year general adult psychiatry training program before graduation. “If we haven’t been exposed to it or learned about it, how can we know if it’s a path we want to pursue?” Pate said.

This shortage is further exacerbated by a shortage of primary care physicians. Family physicians and internists typically form the pipeline to geriatric care. Furthermore, the salaries of geriatric doctors are often lower than those of other doctors.

Fellowship-trained geriatricians tend to earn about $20,000 less on average than general internists, despite having more training, according to a study published in the journal Nature Aging. It is said that there is. (According to the 2019-2020 AAMC Faculty Salary Report, the median starting salary for geriatricians is about $186,000, compared to about $205,000 for general internal medicine and about $205,000 for general family medicine.) ($216,000)

One reason for the low pay is that most of geriatricians’ patients are covered by Medicare, the federal health insurance program for people 65 and older. On the other hand, a high proportion of patients of general internists have private insurance, and some patients have Medicare. According to KFF, private insurance companies pay nearly twice as much in Medicare rates. Health insurance tends to pay based on the number of patients a physician treats, but given that older patients may require more time and outpatient management, geriatricians are paid less than internists. patients are often not examined.

Experts emphasize financial incentives and creative ways to increase exposure. Leipzig notes that since Medicare funds some training and fellowships regardless of specialty, “why doesn’t Medicare require these trainees to demonstrate basic competency in the field of geriatrics? ” he pointed out. Funding programs on this basis will ensure that residents across disciplines have some level of knowledge about aging issues. Aronson proposed a student loan forgiveness program for physicians specializing in geriatric medicine, similar to the medical school loan forgiveness program offered to eligible nonprofit and public hospital physicians.

Leipzig noted that a new pilot program is underway to encourage more geriatric expertise by creating a mid-career path for general internists, similar to an executive MBA program. Some experienced internists are able to pursue intensive, short-term geriatric training without sacrificing pay or an established practice.

This is good news for the growing number of elderly people. “When your body doesn’t function the way it used to, it’s easy to lose confidence,” Early says. “You already feel ignored as an older person.”

“If you don’t have a doctor that you feel close to, or someone who really sees you and cares about you, you might be able to say, ‘Well, I don’t think I’m worth it.'”