As population ages, geriatrics eyes some young blood

Old story: With a new twist, as an aging population quickly outpaces available geriatric healthcare professionals.
By TERRY LYNAM //

By the year 2050, there will be as many people in their eighties as teenagers.

People are living longer and living healthier, and it’s amazing. It’s also scary: This phenomenon will fundamentally change the country’s healthcare industry.

No matter how healthy our lifestyles, age inevitably takes over. Enter geriatric care, the process of planning and coordinating care for the elderly, with services and professionals dedicated to helping patients maintain independence and quality of life, and helping their families deal with their loved one’s declining physical and mental capabilities.

If current trends continue, we will not have enough medical professionals who specialize in geriatric care to meet demand. There’s already a shortage, and the need is only going to grow.

There are 44 million people currently receiving Medicare benefits. That number is expected to rise to 79 million by 2030 as Baby Boomers age. There are also about 7,300 certified geriatricians currently practicing in the United States – a far cry from the 30,000 that would be needed to care for those Boomers.

Terry Lynam: New tricks for geriatrics.

Medical school trends are not aligning with population trends. Although more people than ever are attending medical school or pursuing healthcare careers, there’s a significant shortage of doctors and nurses focusing on geriatrics.

In 2018, data from the National Resident Matching Program showed that of the nation’s 139 geriatric fellowship programs, 104 were left unfilled – and fewer than 50 percent of all resident positions were filled.

One major factor is salary: Geriatricians earn far less than other clinical specialists, with a median annual salary less than half of an average cardiothoracic surgeon.

Jerome Kowal of the Association of Directors of Geriatric Academic Programs put it most eloquently in a recent report for the U.S. House of Representatives’ Select Committee on Aging, in which he called for new incentives for physicians to choose careers in geriatric medicine.

Kowal also called on the national medical community “to provide greater opportunities for clinical research training, to increase geriatric content of undergraduate and postgraduate medical programs, to improve attitudes towards geriatrics by medical students, house staff, and academic administrative leaders, and to develop public-policy initiatives that will mandate increased geriatrics training and facilitate the development of clinical programs targeting older persons.”

Several states are putting systems in place to make this a reality. More medical schools are including geriatrics in their basic curricula and many are also giving students opportunities to engage with healthy seniors, so they can learn more about the aging process from those living through it.

Edith Burns: Educating tomorrow’s geriatric educators.

There are also debt-relief programs to incentivize doctors to go into geriatrics. For example, the National Health Service Corps Loan Repayment Program offers up to $50,000 in tax-free student loan repayment for doctors in “health professional shortage areas.”

And in December, the U.S. Senate Committee on Health, Education, Labor and Pensions voted to reauthorize a $41 million program that focused on educating health professionals in geriatrics.

Hospitals throughout the country have also been implementing new programs to enhance geriatric care. Northwell Health, which has been championing this initiative for years, does this by recruiting mid-career medical professionals looking for a change.

For example, North Shore University Hospital created a new fellowship to help transition emergency-medicine specialists to palliative medicine, an Emergency Department specialty in increasing demand.

Developing clinical expertise is obviously a critical goal of these fellowships, but so is creating leaders. The palliative medicine and geriatrics fellowships very intentionally include training in leadership skills, because both specialties are critical to the future of healthcare.

“If you draw a Venn diagram of the roles that constitute ‘geriatrics’ and ‘palliative medicine,’ there’s a huge overlap,” notes Edith Burns, Northwell’s associate fellowship program director for geriatric medicine. “The goal is to train individuals to have skills in both of those areas, and to become clinical educators, scholars and researchers who can then train other physicians.

There might never be enough trained geriatricians to care for a rapidly aging population. But Northwell has been mindful of providing skillsets to professionals in internal and family medicine to help them care for the elderly.

We have to work together and effectively mentor the next generation of doctors and nurse practitioners, or “healthcare” will never be able to care for the geriatric population. Thankfully, we’ve identified the problem – now it’s time to act, before the Silver Tsunami becomes dangerous.

Terry Lynam is a senior vice president at Northwell Health, New York State’s largest healthcare provider and private employer.