Since doctors receive just as much per person whether they see two or six patients in an hour, what is their incentive to only see two like Taylor does? There is even less incentive when you remember that doctors treating geriatric patients are mostly paid by Medicare—which simply doesn’t reimburse enough.
The Hanover Research Council recently reported that doctors are now getting paid the same as in 2002, although their costs have increased almost 20%. It adds, “Medicare payments are predicted to drop almost 40% over the next nine years, while the cost of providing care… continue to rise.”
Geriatrics not respected
“We wouldn’t have oncology and other specialties without government support—and we haven’t had it for gerontology. It isn’t just doctors; we desperately need social workers, nurses, physical therapists, and others in geriatrics,” says Robert Butler, M.D., a leading expert in geriatric medicine and president of the International Longevity Center.
Lack of respect leads to lack of funding. “Geriatricians’ status isn’t high. They generally work out of the family or internal medicine departments,” Potter says.
“Getting funding and space doesn’t come easily. You compete with better-compensated specialties like cardiology,” says James Powers, M.D., director of the Vanderbilt-Reynolds Geriatrics Education Center.
Yet other departments are coming to rely heavily on the few geriatricians they have. “We have only five geriatricians here and they are constantly being called into other departments,” Powers says, pointing to ob/gyn.
“Three-quarters of geriatric patients are women. They turn to their gynecologists, who end up treating high blood pressure, diabetes, and other conditions they never thought they’d have to handle.”
Recognition is growing
Experts agree they can’t train enough geriatricians to meet the need. Butler’s alternative: “Everyone graduates with the basics of aging—whether they are a gynecologist, cardiologist, or neurologist. They have to understand 60% of their patients will be older and tend to be in the doctor’s office more often,” he says.
Health care is finding ways to implement Butler’s idea. “Our focus is to expose every physician to the unique needs of the older patient,” says M. Brownell Anderson, senior associate vice president of the Association of American Medical Colleges. Grants have helped institute programs in 40 medical schools around the country, exposing medical students to geriatric care. Among the programs:
Senior mentoring—Students pair with older people who become long-term patients and advisors. Students get to see these people in real life, not just in an office.
Simulation programs—“Students spend a day wearing Vaseline-coated eyeglasses to get the sense of living with cataracts, or navigate grocery stores in wheelchairs,” Anderson says.
The rewards of geriatrics
Another thing keeping students out of geriatrics: “A 25- year-old medical student doesn’t see it as an exciting, innovative field,” Kung says. Experts say students are dead wrong.
“I enjoy working with this age group. It is a challenge,” says Taylor. “Very often a disease doesn’t present itself in a textbook way. Pneumonia in someone younger usually includes cough, fever, and/or shortness of breath. The first indication of pneumonia in someone older might be they fall, because the disease has weakened them.”
“People love the field of geriatrics when they get into it,” Potter says. “Older people are wonderful patients. They have more patience, not expecting the quick fix of the younger generation. And if you improve their quality of life by 10% to 15%, they think you’re great. One survey shows that geriatricians are among the physicians most satisfied.”
What you can do
Besides encouraging your grandkids to look into geriatrics as a profession, what can you do? Demand more money from Congress, which slashed all $31.5 million for geriatric training from the 2006 budget. “Also, speak up to your local legislature,” advises Butler.
Test your primary care doctor’s geriatric expertise. “Not everyone needs to see a geriatric specialist, but every doctor has to be a good geriatrician,” says Powers. “Has your physician asked you lately to bring in all of your medications—even non-prescription drugs and herbal supplements—to be sure of what you are taking?” Butler asks. If not, that doctor may not be paying attention to how much more complex your health care has become.
“You can’t take care of a geriatric patient in 9 minutes (the average time for patient visits in the U.S). Look for physicians who somehow find a way to allow at least 20 to 30 minutes,” Taylor says.
Powers urges women to get more actively involved in fighting to change the health system. “Most of this country’s caregivers are women. Threequarters of the occupants of nursing homes are women,” Taylor points out. That means women will be suffering most if America’s physicians aren’t better trained—soon—in geriatric care.
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