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Elderly patient boom
faces specialist shortage
By Christy Feig CNN Washington Bureau,
28 August
2003 WASHINGTON
(CNN) -- With the elderly population in the United States continuing
to grow rapidly, the number of doctors who specialize in their care is
dwindling.
Americans age 85 and older are the fastest-growing segment of the
population, and the numbers are expected to reach 19 million by 2050 as
baby boomers age, according to the American Geriatrics Society.
That is, if they are
able to find one. Currently, there are about 9,000 geriatricians in the
United States, but the number is declining. The geriatrics society
estimates 36,000 will be needed by 2030. Geriatricians
specialize in medical problems associated with aging. They have several
years of additional training in areas such as neurology, psychiatry and
urology so they can recognize problems other doctors may consider normal
aging. "In American
medical schools, less than 10 percent of medical schools have mandatory
education in geriatric medicine despite the fact that this is the
largest-growing segment of the population," said Dr. Rebecca Elon, a
geriatrician in Glen Burnie, Maryland. Violet Cosgrove, 76,
has found out firsthand how aging can complicate medical problems. She has
severe osteoporosis, arthritis, two artificial knees and an artificial
hip. When her family doctor failed to diagnose a broken pelvis, her
orthopedic surgeon decided it was time she move to a geriatrician. "The difference
is night and day," Cosgrove said. "My other doctors seemed to
always think that my problems were based on my age, and their answer
always was, 'What do you expect? You're getting old.' " She said her
geriatrician spends four to five times longer with her than her regular
doctor. Elon said spending
time is essential when working with older people. As a result, she can see
only about 12 patients a day, half of what a regular doctor will see. "It takes
[older people] longer to walk from the waiting room to the exam room; it
takes longer for them to use the restroom before the visit; and it takes
longer for them to respond to any requests as far as the physical
exam," Elon said. Seeing fewer
patients means less money, and Elon said her practice runs a 30 percent
deficit every year. It is able to stay in business because the local
hospital makes up the difference, she said. Budgets will be even
tighter next year when Medicare payments to doctors are scheduled to be
cut more than 4 percent. "Geriatricians
are the only group of physicians that have Medicare as almost their
exclusive payer," Elon said. "Most other practices have other
sources of payment that can offset the cuts in Medicare." U.S. Health and
Human Services Secretary Tommy Thompson said he agrees changes need to be
made. "There's no
question that the doctors are going to be receiving a reduction next year
unless Congress makes an adjustment," Thompson said, "I'm fairly
confident that's going to take place." For now, the
American Geriatrics Society is trying to work with Congress to pass the
Geriatric Care Act that would help improve payment for doctors who care
for senior citizens. Measures to keep
doctors specializing in geriatrics is reassuring to patients such as
Cosgrove. "[Geriaticians
are] like the old-fashioned doctor who really cared," Cosgrove said.
"And we need a whole lot more of them."
Copyright
© 2002 Global Action on Aging
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