The Looming Geriatrician Shortage: Ramifications and Solutions

Abstract

Objective: Geriatricians are skilled in the recognition of asymptomatic and atypical presentations that occur in the elderly and provide comprehensive medication management including recognizing adverse drug events, reducing polypharmacy, and de-prescribing. However, despite the increasing average age of the U.S. population, with the number of individuals above 65 years old predicted to increase 55% by 2030, the geriatric workforce capacity in the United States has actually decreased from 10,270 in 2000 to 8,502 in 2010. Method: We describe physiologic changes in older adults, historical trends in geriatric training, and propose solutions for this looming crisis. Results: Many factors are responsible for the shortage of skilled geriatric providers. Discussion: We discuss the historical context of the lack of geriatricians including changes to the training system, describe the impact of expert geriatric care on patient care and health system outcomes, and propose methods to improve recruitment and retention for geriatric medicine.

The US eldercare workforce is falling further behind

“…A major driver of persistently low physician recruitment into geriatrics is compensation. In addition to incremental debt associated with geriatric fellowship training, a board-certified geriatrician can expect to make US$20,000 yr -1 less than an internist largely because all geriatric patients are on Medicare, which pays less than the commercial insurance common in a general internist's practice 7 . Medicare does not reward physicians for extra training or Board certification in geriatrics.…”

“…Numerous approaches, including curricular revisions and shortening the required fellowship period from two years to one year, have had little effect in increasing recruitment 7 . Increasing compensation would seem an obvious strategy and it would cost Medicare little, as there are so few geriatricians.…”

Comprehensive Geriatric Assessment

“…Once the process of CGA identifies those at risk, the steps that follow should involve the team members to assess the different elements of CGA, develop a coordinated plan, and finally help implement the plan tailored to the individual. While any physician can coordinate the process of CGA, geriatricians are particularly skilled in the recognition of asymptomatic and atypical presentations in older people, in the recognition of adverse drug events, in addressing polypharmacy, and in offering a comprehensive plan for care; however, in view of the looming geriatrician shortage, it is usual for primary care physicians to engage in the process with an understanding of basic geriatrics (Lester et al 2020). A geriatrician has received training to provide CGA, health promotion, and disease prevention; work with patients and caregiver; deal with multiple chronic and acute conditions; facilitate complex decisionmaking with skills in communication with patients and families; design or implement plans to diagnose and treat geriatric syndromes; and review prescribed and over-the-counter medications for indications and appropriateness of use (Leipzig et al 2014).…”

Personalised treatment for older adults with cancer: The role of frailty assessment

“…Geriatric oncology does not exist in many radiotherapy departments at the current time, but there are many international models to use as exemplars as to how it may be implemented in clinical practice [118][119][120]. One major challenge is that there is a notable shortage of geriatricians worldwide [121]. However, international models of geriatric oncology are based upon upskilling oncologists, nurses and allied health professionals to be able to implement, understand and interpret the findings of a CGA and how they may impact patient care [122].…”