Geriatrician Shortage Looms As U.S. Population Is Aging


WASHINGTON – The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine. To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. “That rate is not nearly enough to keep up with the predictions” of the number of geriatric specialists needed, she said.

Geriatrics is challenging because “it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties … that you will be referring to,” she noted. The physician must also understand the difference between disease and aging, and know how to evaluate physiologic age.

In addition, “no geriatrician thinks you can be a solo practitioner in an office by yourself.” Instead, geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said.

Dr. Cassel noted that Japan, Germany, and Sweden–countries where life expectancy for males and females is higher than in the United States–not only provide universal health insurance for the entire population, but also universal, government-funded long-term care insurance. “Somehow they managed to do this and still spend less money than we do,” she said. “This idea that the United States provides the best quality of care is getting less and less defensible.”

The lesson to be learned from these other countries is that “there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population,” she said.

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