Q. My mother recently was diagnosed with early dementia during her annual visit with her doctor. I would like a second opinion from a geriatrician in my area. I am having difficulty in finding one. Can you help? D.J.
The challenge you describe is both a local and national one. Here is the fact: We have a profound shortage of geriatricians.
There currently are 7,300 board-certified geriatricians in the U.S. to care for over 55 million older adults. That’s roughly one geriatrician for every 10,000 geriatric patients. The American Geriatrics Society, however, estimates that one geriatrician can care for about 700 patients. They make up less than two percent of all physicians in the country.
As this shortage continues, more older people are aging. By 2060, one quarter of our population is projected to be over age 65. Their need for medical care grows with age.
But we are witnessing a paradox. As the aging population increases, the number of geriatric medical practitioners continues to decline, writes Dr. Jerry H. Gurwitz in his JAMA article. And current geriatricians are retiring faster than there are new docs training to take their place.
Here are some reasons for the shortage:
Money: Geriatrics typically is not as lucrative as many other disciplines. This is a disincentive to students considering the specialty. They are at the bottom of the income scale for clinical specialties. Annually, geriatricians earn on average roughly $258,000. Radiologists make almost $550,000; dermatologists earn an average of $655,000 and orthopedic surgeons earn on average $788,000. Note, earnings vary by state. Furthermore, geriatricians are paid at a lower reimbursement rate from Medicare compared to rates paid to doctors from private health insurance companies. They typically take more time with their patients to make sure they discuss all their medical concerns which means they may see fewer patients than other specialists. Seeing fewer patients means less billing.
Debt: While earning less, they have expenses such as medical school debt, licensing and certification fees and lower pay throughout fellowship training. The average medical school graduate owes $250,995 in total student loan debt. Consequently, the financial incentive to go into geriatric medicine is low which contributes to the shortages.
Mindset: Ageism plays a role. As it exists in society, it is reflected in medicine. “(Then) they have an overwhelming experience with a complex older patient during their internal medicine rotations…(and they) want to run in the opposite direction,” as quoted in AAMCNEWS by Dr. Amit A. Shah, associate dean for faculty affairs at Mayo Clinic Alix School of Medicine in Scottsdale, Arizona. Also, many often “see older patients as near death and beyond help,” according to a doctor quoted in the Forbes piece. “Part of the reason aging has such a negative connotation (in medicine) is that… you can’t cure older people’s problems. However, “a good geriatrician can bring someone back to functional status,” said geriatrician Kenneth Brummel-Smith in a MyElder piece.
Lack in medical schools: Research published in 2022 found that just over three-quarters of medical schools provide only an optional clinical experience in geriatrics and less than half (45 percent) required a geriatric rotation for all students. In the same year, less than half (43 percent) of geriatric fellowships were filled, the lowest among 71 specialties according to a 2023 Forbes piece. Note in the UK, geriatric medicine is one of their largest specialties. Due to the shortage, demography and commitment to patients, most internists treat older adults.
To find a geriatrician in the South Bay, contact Torrance Memorial Medical Center’s physician referral line at 310 517-4700 and Providence Health Resource Center 844-510-4325. Ask for names of board-certified geriatricians or family medicine specializing in treating older adults. In other geographic areas, contact your regional hospitals.
Three southern California universities with geriatric programs offer individual appointments: Call UCLA Health at 310 206 8272; USC Keck School of Medicine at 800 872 2273 and UC Irvine at 714 456 7007 with clinics in Orange and Laguna Hills.
Thank you, D.J., for your important question. Your difficulty in finding a geriatrician is understandable. It’s a search many of us will undertake, if not for ourselves, then for a loved one. Take care of yourself and know that kindness is a lifestyle.
Helen Dennis is a nationally recognized leader on issues of aging and the new retirement with academic, corporate and nonprofit experience. Contact Helen with your questions and comments at Helendenn@gmail.com. Visit Helen at HelenMdennis.com and follow her on facebook.com/SuccessfulAgingCommunity
