Geriatric Doctor Shortage Means People Who Need Care The Most Receive It Least

Jul 6, 2016

Credit Mister G.C.

Brenda Crawford lives in Indianapolis. She began having trouble with her primary care doctor when she started getting older.

"There’s so many times that you try to explain what’s going on,” she says, “and if it’s something they haven’t experienced or had in another patient, they just don’t know and they don’t understand.”

She said she believes her doctors cared about her, but couldn’t keep up with her multiple conditions as well as with the complicated medical insurance procedures elderly people bring into the clinic along with their illnesses.

“It’s really difficult to try and tell them when they don’t have a clue where you’re coming from,” Crawford says.

Crawford is a member of one of the fastest-growing demographics in the nation….senior citizens. By 2030, nearly 20 percent of the population will be older than 65.

Steven Counsell is the president of the American Geriatrics society and a professor of geriatrics at Indiana University. He says while the number of patients is increasing, the supply of doctors isn’t…a serious problem for a population with a higher risk for health problems, like, for example, falls.

“If we don’t have trained in the healthcare workforce around normal aging and risks for some of these poor outcomes—like falls—we’re not picking up and avoiding them as much as we can and thus experiencing the fallout of that problem,” says Counsell.

Here is the supply and demand breakdown: In Indiana, there are 91 geriatricians serving an over-65 population of 900 thousand people.

The American Geriatrics Society says the standard should be closer t one doctor for every 2,500 elderly people, assuming the doctor needs to care for the sickest 30 percent of that population. Counsell says to meet that demand, Indiana would need to immediately mint 300 new geriatricians—a specialty unattractive to many because it requires more training for less pay.

Oak Street Health is a company that provides care exclusively for low-income adults on Medicare.

Nurse Alicia Mendoza, who’s new to working with geriatric patients, says navigating the complicated world of Medicare and other insurance programs for the elderly can prove frustrating.

“Previously, I didn’t need to worry about stuff like prior authorizations,” she says. “’Is this covered? Like, can I just get this person some Depends, because they’re incontinent?”

Most of the health problems in older people actually aren’t that different from patients of other ages. But the amount of simultaneous conditions make treatment—and prescribing medicine—really complicated. Geriatricians and nurses like Mendoza have to consider whether one medicine clashes with another or will exacerbate another condition. Or a medication might make a person more susceptible to—again—falls. No big deal for a 28-year-old, but potentially disastrous for an octogenarian.

Geriatricians are also more adept at understanding age-related problems such as osteoporosis and dementia. So a doctor who works solely with the elderly is more likely to spot important patterns and common issues.

That’s what happened to Brenda Crawford. After she left her previous doctor, she started seeing a geriatrician at oak street health about a persistent cough she had been dealing with for decades:

“They started sending me for tests, and they found names for just about everything wrong with me,” she says.

Crawford’s cough turned out to be chronic obstructive pulmonary disease—COPD—a condition that often makes its first appearance in older adults.

Crawford found a doctor. But until the state figures out how to produce more doctors—or other medical caregivers who specialize in adults on the far side of 65, many other senior citizens might not have the same kind of luck.