The Growing Crisis of Geriatric Care in America
As the US population ages, a critical challenge is emerging: the dwindling number of geriatricians, or doctors who specialize in caring for older adults. By 2050, more than 80 million Americans are expected to be over the age of 65, according to the US Census Bureau. This demographic shift is creating a pressing need for healthcare professionals trained to address the unique medical needs of older adults. However, the supply of geriatricians is not keeping pace with demand, raising concerns about the quality and accessibility of care for aging Americans.
The Shrinking Supply of Geriatricians
The shortage of geriatricians is stark. According to the American Geriatrics Society, the US will need approximately 30,000 geriatricians by the end of the decade. Yet, in 2022, only about 7,400 board-certified geriatricians were practicing, down from around 10,000 at the start of the century. This decline is alarming, especially as the number of older adults continues to rise. Jerry Gurwitz, a 68-year-old geriatrician in Massachusetts, has witnessed this trend firsthand. He chose to specialize in geriatrics decades ago because few others were interested in the field—a situation that remains unchanged today. Gurwitz warns that the healthcare system will be overwhelmed in the coming years, as fewer young doctors are entering the field to replace retiring geriatricians.
The Strain on Geriatric Care
The impact of the geriatrician shortage is already being felt. Wait times for appointments have increased significantly, with the average wait for a physician appointment rising to 26 days in 2022, up 8% from five years earlier. Geriatric units in hospitals and nursing homes are particularly strained. Timothy Farrell, a geriatrician and professor of medicine at the University of Utah, notes that the stress on these units is higher than in other areas of healthcare. Some geriatricians report waiting lists that stretch for six months, while nursing homes are struggling to meet demand. A survey of over 400 nursing homes found that 72% had fewer staff in 2024 than before the pandemic, with many limiting admissions or turning patients away.
Causes of the Geriatrician Shortage
The shortage of geriatricians is rooted in several factors. One major issue is the lack of interest among medical trainees in pursuing careers in geriatrics. Data from the National Resident Matching Program shows that only 174 out of 419 available positions in geriatric specialty programs were filled in 2023, making it one of the most unfilled programs. This lack of interest is driven in part by financial considerations. Geriatricians typically earn lower salaries compared to other specialists, such as cardiologists or surgeons. For example, the median salary for a geriatric physician in New York is around $264,163, less than half the median salary of a cardiologist in the same state.
Another factor is the perception that geriatrics is less prestigious than other fields of medicine. Gurwitz points out that certain specialties are more respected and sought after, while geriatrics is often overlooked. Additionally, the complexity of caring for older adults, who often have multiple chronic conditions and take numerous medications, can be daunting for some healthcare providers. Geriatricians like Farrell emphasize that their work requires specialized skills, such as managing overlapping health conditions and preventing falls, which can be challenging for primary care physicians to handle effectively.
The Impact on Older Adults
The shortage of geriatricians has serious implications for the quality of care older adults receive. Longer wait times and overburdened healthcare systems mean that many older patients are not getting the specialized care they need. This can lead to poorer health outcomes, as older adults are more likely to have complex medical conditions that require expert management. For example, untreated or poorly managed chronic conditions can result in hospitalizations, disabilities, and a reduced quality of life.
The strain on nursing homes is particularly concerning, as these facilities often serve the most vulnerable older adults. With fewer staff and limited capacity, many nursing homes are unable to provide the level of care residents require. This has left many older adults and their families struggling to find adequate care options.
Addressing the Crisis
Solving the geriatrician shortage will require a multifaceted approach. One step is to increase funding for geriatric training programs and incentives for medical students and residents to pursue careers in the field. This could include scholarships, loan forgiveness programs, and higher salaries for geriatricians. Additionally, there needs to be a shift in the perception of geriatrics as a less prestigious specialty. Highlighting the rewards of working with older adults, such as the opportunity to make a meaningful difference in their lives, could help attract more young doctors to the field.
Another critical step is to address the systemic challenges facing geriatric care, such as the complexity of caring for older adults with multiple chronic conditions. This may involve better integration of primary care and geriatric services, as well as more support for healthcare providers who work with older patients. By taking these steps, the US healthcare system can begin to meet the growing needs of its aging population and ensure that older adults receive the high-quality care they deserve.
In conclusion, the shortage of geriatricians is a pressing issue that requires immediate attention. With the US population aging rapidly, the demand for specialized care for older adults will only continue to grow. Unless steps are taken to address the shortage of geriatricians, the healthcare system will be unable to meet this demand, leading to a crisis in access and quality of care for older Americans.
