Baby boomer time bomb: Too many aging patients, too few geriatricians

Elizabeth Eckstrom, MD, had been a general internist for 10 years when she did a geriatrics fellowship, after research into fall prevention piqued her interest in older adults. Now that she is a geriatrician, she earns less than she did before. But she thinks the change is still worth it.

"For me, it's about the rewards I see in caring for these patients, even though we aren't paid very well," said Dr. Eckstrom, associate professor at the Oregon Health & Science University School of Medicine.

She is one of a shrinking number of doctors who specialize in treating older patients. Today, there are about 7,100 geriatricians in the U.S. -- a 22% decline from 2000.

There will not be enough geriatricians when the 78 million baby boomers begin to turn 65 in 2011, according to a new Institute of Medicine report. By 2030, there will be an estimated 8,000 geriatricians, but the nation will need 36,000, according to the Assn. of Directors of Geriatric Academic Programs.

"The supply side is really scary," said John W. Rowe, MD, the IOM report's committee chair and former CEO of Aetna.

The IOM report, released last month, recommended an increase in geriatric competency throughout the health care work force to offset a shortage in geriatric specialists. It also called for the adoption of interdisciplinary care models and a fundamental change in how health care is reimbursed.

Low reimbursement was cited as the biggest barrier to building the geriatrician supply. In 2005, average geriatrician income was $163,000, compared with $175,000 for a general internist.

In addition to raising reimbursement for senior citizens' care, the IOM study recommended establishing a National Geriatric Service Corps to create financial incentives for geriatric specialists.

The impending surge of seniors and their health care needs has focused attention on Medicare's solvency, but Dr. Rowe said the health care work force needs addressing, too.
"Even if there is enough money, there isn't going to be anybody there to provide the care," said Dr. Rowe, a professor of health policy at Columbia University Mailman School of Public Health in New York.

Pushing for more training
The AMA is one of several medical organizations supporting greater training in geriatrics.
"With approximately 7,000 geriatricians currently in the United States, all physicians caring for aging patients need to become proficient in geriatric care to help meet the increasing health care needs of seniors," AMA Board of Trustees member Cecil B. Wilson, MD, said in a statement.

Read in Deatil: http://www.ama-assn.org/amednews/2008/05/05/prl10505.htm