An edited version of this story was published on health journalism.org.
Athens, Ga.—When Luciano Horescu turned 65 and qualified for Medicare benefits, he didn’t go online and hunt for a geriatrician in the Athens area. He keeps his mind and body active, is self-sufficient and pretty healthy for a guy his age.
But if Horescu, now 66, had sought a doctor specially trained to care for older people – and who accepted his insurance – he probably would have been disappointed. Athens’ population is 120,00, it is the medical hub for thousands more in nearby counties, but only three office-based geriatricians practice here.
Dr. Wayne Morris is one of them.
Like others in his specialty, Morris completed a residency in internal medicine and then spent an additional year focusing on the care of older people. He’s been in practice for 38 years and is in his late sixties himself. He says he doesn’t have any immediate plans to retire, but recently sold his practice to Athens Family Medicine.
He’s always been an advocate for seniors, and now he’s worried that as their numbers skyrocket, there simply won’t be enough geriatricians to care for them. Young doctors can make lots more money in cardiology, orthopedics, gastroenterology and many others. Even general internists do better, he says, because geriatricians often provide more care for less pay.
Like all businesses, Morris’s solo practice has bills to pay.
About half his patients are adults with run-of-the-mill primary care needs, and the rest are older people with multiple ailments. Unlike many family doctors, he does accept new patients covered by Medicare.
When an older patient comes to Morris for an initial visit, they’re carrying the bag of prescription drugs he asked them to bring. “It often takes the first twenty minutes of an appointment just to get through all their medicine,” said Morris. He is soft-spoken and patient, and takes the time required.
The geriatrician shortage is not unique to Athens, to Georgia, or to the U.S. Right now, there are about 2,000 seniors in need of specialized care for every board certified geriatrician, according to the American Geriatrics Society. This is more than double the number of patients that one doctor can handle, they say, and this estimate doesn’t even take into account the two-thirds of people over 65 who don’t need specialized care. Not yet, anyway.
As the Boomer generation ages, the geriatrician workforce will need to grow by 1,500 annually for the next 15 years to satisfy the nation’s need for senior care in 2030.
In Georgia, about 19 percent of the state’s population will be over 65 by then, hovering around 2 million—calling for more than triple the current number of geriatricians.
Athens residents may be better off than some Georgians, because they are close to St. Mary’s Hospital and Piedmont Athens Regional. As rural hospitals continue to close across the state, Morris points out that Athens plays an important role in preparing young doctors to care for their elders
Both hospitals have fledgling residency programs in internal medicine, and every year the Augusta University/University of Georgia Medical Partnership graduates 40 new M.D.s.
But few of them want to pursue geriatrics as a career, according to internist and geriatrician Donald W. Scott, an associate professor at the medical school, who also trains residents at St. Mary’s. When Scott was born, his father was older than most. As he aged, he saw many different doctors and was prescribed medications that didn’t always work well together. Seeing the impact of fragmented care on his dad motivated Scott to become a geriatrician, but he doesn’t see that same drive among his students.
“I usually get one or two fourth-year students interested in geriatrics,” says Scott, “but it tends to be at the very bottom of the list for most.”
So he’s come up with a different strategy.
Scott is setting up a new, month-long rotation designed to “geriatricize” medical students. The goal is preparing general internists for aging Boomers like Horescu, who will be a large part of their future practice.
Sean Olinger, a second-year AU/UGA med student, isn’t going to be a geriatrician but he’s eager for the extra training. He knows he will see a lot of older patients no matter what field he goes into, and right now he’s planning on cardiology.
“We have a great physiologic understanding of aging, but we haven’t learned to ask the questions that we may be uncomfortable with” he said. “And that’s not fair to the patients.”
The new rotation will emphasize not only how to care for seniors, but how to talk with them about sexuality and other sensitive topics. Scott will help prepare young physicians to work with patients struggling with Alzheimer’s disease and other memory disorders, too.
The students will get hands-on practice during a weekly geriatrics clinic that Scott is organizing at Community Internal Medicine of Athens, the new primary care clinic set up by St. Mary’s. Here, medical students and internal medicine residents will learn about how home visits and end-of-life planning fit into patient care, Scott said.
“Taking care of frail older people requires patience and can be frustrating to primary care doctors,” says Scott. Doctors love to think that they are curing disease and relieving suffering, but that’s simply not possible for frail patients with multiple maladies.
Scott agrees with Morris, the long-time Athens geriatrician, that managing complex drug regimens is one time-consuming element in patient care. Others include making sure that orders from specialists aren’t in conflict, and that fragmented care doesn’t lead to overwhelming insurance complications.
Ultimately, making life’s final chapter as satisfying and comfortable as possible is the goal for doctor and patient alike.
Aging isn’t easy for doctors or patients. And because people like consistency, and a sense of familiarity, many stick with their long-time primary care physician – typically an internist, family practitioner or OB/GYN for women – as long as possible.
People who are in generally good health age more slowly than those with chronic diseases, and many don’t undergo physiological changes that require specialized geriatric care until their late seventies or early eighties, said Scott.
Horescu is one of them and he doesn’t anticipate needing specialized senior care for a while. Instead of sitting in a clinic waiting room, he’s more likely to be selling low-cost veggies and tea at his neighborhood produce stand, or reading poetry at a local open mic.
But when he does, workforce forecasts indicate he’ll rely on Olinger and his med school classmates – doctors who didn’t specialize in geriatrics, but who will nonetheless bear the brunt of senior care.