Where are the Geriatricians?
By Lewis A.Lipsitz, Globe Newspaper
the enormous growth of the elderly population over the next few decades,
medical care in the
Geriatrics is a
medical subspecialty that focuses on the diagnosis and treatment of
conditions that affect people as they age. There are approximately 9,000
certified geriatricians in the
A geriatrician is
a physician trained to handle the multiple, interacting conditions, drugs,
social situations, and psychological problems an older person may face.
Rather than trying to extend life at all cost, the geriatrician is focused
on preserving or improving physical and mental function for whatever time
remains. The quality,
rather than quantity, of
life becomes most important.
patients who are concerned with preventing illness or treating one
disease, older patients may be grappling with falling, urinary
incontinence, confusion and memory loss, depression, osteoporosis, and
heart disease. The average 75-year-old has three chronic conditions and
takes five prescription medications. The treatment of one condition may
worsen another. Rather than looking at individual symptoms -- or
dismissing a problem as "just part of getting old" -- a
geriatrician considers the whole person, examining each individual's
special characteristics, medical conditions, medications, values, and
preferences in order to develop a treatment plan.
geriatrician, treating a patient is more than treating a disease: If a
patient doesn't have transportation, keeping medical appointments is
nearly impossible. If an individual can't pay the rent, then paying for
expensive drugs is out of the question. If fingers are twisted by
arthritis, then opening a pill bottle can be difficult.
Because of their
unique needs, older people can fall between the cracks of conventional
medicine. Most of the drug doses learned in medical school, for example,
are based on studies done in younger people. Few medical schools and
residency programs provide formal training in geriatric medicine. In
addition, a specialist trained to focus on treating one condition may well
miss another. The orthopedist, for example, who evaluates a patient's
fall, looks for injury, just as the neurologist examines the brain and
nervous system. Both doctors could miss an underlying cardiac condition
that caused the fall. A geriatrician takes into consideration all the
We need more
academic leaders in the field to teach medical students, residents,
practicing physicians, and nurses how to provide better care of their
elderly patients. Unfortunately, only 20 of 126
doctors to geriatric medicine presents its own challenges. Few role models
and mentors exist in teaching hospitals. The field lacks glamorous
technology. Reimbursement rates are low, and patient care demands are
high. In addition, hospitals and HMOs are reluctant to spend what it takes
to provide excellent geriatric care. However, the potential cost savings
to society are enormous. If proper geriatric care results in a modest 10
percent reduction in hospital, nursing home, and home care costs, the
nation would save $50 billion in health care costs each year.
promising solutions to the shortage of physicians equipped to care for
elderly patients. With funding for additional geriatric training programs,
more doctors could gain the skills they need. Higher payments for
geriatric care and loan forgiveness programs would do much to attract new
physicians to the field. Greater research funding could help promising new
investigators become leaders in the field of aging.
geriatricians are needed to provide direct care to elderly people, consult
on complex cases, improve the quality of care in nursing homes and other
chronic care settings, and teach primary care and specialist physicians
how to care for elderly patients. Not every older person needs a
geriatrician; however, every physician needs some training in geriatrics.
We urgently need to create incentives for more physicians to enter the
field of geriatrics, before our parents -- or we -- are in need of a
geriatrician, but can't find one.
Dr. Lewis A. Lipsitz is vice
president of academic medicine and co-director of the Research and
Training Institute at