We are living amidst a concerning paradox: while the elderly population in the United States is rapidly growing, the number of healthcare providers who specialize in their care is dwindling. Geriatricians are becoming increasingly vital, yet are in short supply.
A geriatrician is a physician who specializes in managing the unique and complex health needs of older adults. A geriatrician’s training includes medical school, an internal medicine residency, and a geriatrics fellowship. Geriatrics became a board-certified specialty relatively recently in 1988; however, the proportion of geriatricians in the U.S. population has continued to decrease over the past few decades.
By 2034, the U.S. population is expected to grow by 10.6%, with a staggering 42% increase in individuals over 65. Currently, the U.S. has about 7,300 geriatricians, roughly translating to 1.07 geriatricians per 10,000 elderly patients. The American Geriatrics Society estimates that each geriatrician can adequately care for approximately 700 patients, highlighting the striking shortfall in our healthcare system.
Dr. Heather Whitson, a geriatric medicine specialist and professor of medicine at Duke University School of Medicine, succinctly described the issue, stating, “We are not prepared as a nation. We are facing a crisis.”
While many older adults can have their primary healthcare needs addressed by primary care physicians, geriatricians bring a specialized skill set to the table. Aging comes with a higher likelihood of multiple chronic conditions like diabetes, heart disease, and dementia. Geriatricians are trained to navigate these complexities, offering personalized care tailored to the unique health challenges that come with aging, which can improve the quality of care the patient receives.
While we don’t know which of these factors is the largest contributor to the geriatric physician shortage, there are many compounding factors to explain the geriatrician shortage. Attitudes of medical students and residents about aging and older adults influence their career decision-making, and some have theorized that ageism may play a role in new physicians not pursuing this specialty. Medical students may view the elderly population as one that will not get better or that is beyond help, which may dissuade students from pursuing the specialty. As Dr. David Greer, a geriatrician and former dean of Brown University’s medical school, put it: “Doctors don’t like patients who don’t get better.” Additionally, medical schools often do not provide enough geriatric exposure or host prominent role models within the field at their institution, preventing potentially interested medical students from receiving adequate exposure to the field. Moreover, geriatrics is often viewed as less prestigious compared to many other medical specialties, which may also be a factor in dissuading many students from considering the specialty. Finally, geriatricians are not compensated as highly as other medical specialties that require similar levels of training, making the career less appealing to many. In fact, geriatric medicine is one of the few specialties where completing a fellowship and earning board certification actually leads to a lower salary compared to not pursuing either. According to the 2022 Association of American Medical Colleges (AAMC) faculty salary survey, the median salary of geriatricians was 9% lower than that of general internists and 14% lower than that of hospitalists (physicians who primarily work in hospitals). Young physicians, often finishing their residency with significant student debt, typically cannot afford that or may be hesitant to enter specialty fields that offer lower compensation rates compared to others.
While there are many barriers to pursuing a career in geriatrics, it is important to note that geriatricians are often very satisfied with their careers. The American Geriatrics Society notes that in several studies, geriatrics consistently ranks among the most satisfying health professions. Geriatricians frequently cite their meaningful relationships with older patients, the opportunity to make a profound impact on their patients’ quality of life, and generally steady work hours as contributing factors to their job satisfaction.
For premedical or medical students, shadowing a geriatrician in their area can provide insight into the day-to-day work of this specialty and help determine if it aligns with their interests. Many may fall in love with this in-demand field of medicine! As the elderly population continues to grow, the demand for geriatricians will only intensify. By considering a career in geriatrics, students of today can be part of the solution, ensuring that the aging population receives the compassionate, specialized care it deserves.
Sources
Aging America: the Growing Need for Geriatricians | UNC School of Medicine
Is Geriatrics Right For You | AGS
The Paradoxical Decline of Geriatric Medicine as a Profession | JAMA Network
The Physician Shortage in Geriatrics | ChenMed
The Value of Geriatricians and Why We Need More of Them | Alliance for Aging Research
Why Do So Few Doctors Want To Specialize In Caring For Older Adults? | Forbes
Will We Have Enough Geriatricians In The Future? | My Elder
