Successful Aging: What is a geriatrician, and how do I know if I need one?
Q. I am concerned about my father who is 83 years old. He is sometimes forgetful and confused, unsteady on his feet, sleeps a lot and periodically is withdrawn. Add to that he doesn’t like doctors. Assuming I can convince him to see one, do you recommend a geriatrician? What exactly do they do and where can I find one? Many thanks. M.S.
Finding a geriatrician, particularly one that is board-certified can be difficult.
Let’s first describe geriatricians: They are medical doctors trained to meet the unique healthcare needs of older adults, specializing in the diagnosis, treatment, care and prevention of disease and disability. They generally are primary care physicians and typically are board-certified in family or internal medicine and complete additional training for geriatric certification. Their approach is usually holistic. Geriatricians must be able to effectively manage five to eight chronic conditions of their patients and understand their goals or preferences. They typically see patients in their mid-70s and older. However, this is not a steadfast rule.
Here’s the problem: The number of geriatricians is decreasing while the number of aging Americans is increasing. Today, there are roughly 7,300 board-certified geriatricians in the U.S. By the year 2030, The American Geriatrics Society expects we will need 30,000 geriatricians, the year when one out of five Americans will be eligible for Medicare.
Older adults account for about one-quarter of all physician office visits, one-third of all hospital stays and over one-third of all emergency medical responses. We also know that about 80 percent of older adults have chronic conditions such as hypertension, arthritis and heart disease that require care.
Given the need, why do so few residents choose to specialize in geriatrics? One problem is compensation. According to a RAND study, geriatricians are the lowest paid of any of the medical specialties. In 2018, The Medical Group Management Association reports that total annual compensation including benefits for geriatricians averaged $233,564. Salary.com reports that number (possibly without benefits) as $189,879 with a range between $182,310 and $216,549. Anesthesiologists earned twice as much while radiologists and cardiologists earned over $500,000 a year on average.
A second reason few residents choose the field deals with debt. Physicians, in general, have high student loans to pay back. In 2016, the average medical school debt was up to $190,000 with about 25 percent of graduates carrying debts higher than $200,000.
Then there is a limit on earned-income potential. Medicare and Medicaid pay lower reimbursement rates than private health insurance companies, an economic disincentive. Add to that, older adult visits usually take longer than the allocated 15 minutes which means a geriatrician is likely to see fewer patients per day compared to other medical specialists. All of these factors place full-time geriatricians who only see older adults at an economic disadvantage. Furthermore, some may avoid the field because the medical goal might be comfort rather than cure.
Even with economic disadvantages, geriatrics ranks high among the most satisfying professions. One study reported that geriatricians had the highest job satisfaction of physicians practicing in any subspecialty.
Here is some good news. The Senate Committee on Health, Education, Labor and Pensions recently voted to reauthorize a $41 million-dollar program that educates health professionals in geriatrics which is awaiting the Senate vote. That means we should have more health professionals ready to meet the growing healthcare needs of our older population.
There’s more good news. According to a New York Times article of Jan 3, 2020, medical associations that represent cardiologists and oncologists are beginning to focus on older patients. We also now have geriatric nurse practitioners, geriatric social workers, geriatric physical therapists and more. Emergency departments are becoming “age-friendly” with trained staff, comfortable environments, pharmacy reviews with a focus on personal goals.
So where can one find a geriatrician? Contact your local hospital and UCLA’s or USC’s Department of Geriatric Medicine. Given the short supply of board-certified geriatricians, inquire about physicians who are board-certified in internal or family medicine and specialize in treating older adults. In the South Bay, contact Torrance Memorial Medical Center’s physician referral line at (310) 517-4700 and Providence Health Resource Center at (800) 618-6659.
The challenge will be convincing your father to meet with a geriatrician. Perhaps build it into an outing such as dinner or visit with friends.
Thank you, M.S. for your important question. If we are lucky to live long enough, most of us will need a geriatrician.