Lenice Arias, 76, constantly worried about her health. As an older adult, she knew she was prone to experience a decline in her well-being as she continued to age. In an effort to stay healthy, Arias began to search for a specific type of doctor who could care for her needs: a geriatrician.
A geriatrician — also known as a geriatric medicine doctor — is a physician with a specialized education in managing the complex illnesses and medical care needs of older adults.
After briefly searching for a geriatrician near her home in Keller, Arias gave up. She was not able to find any providers open to taking her as a patient.
“When I finally got a hold of somebody, there were no openings,” Arias said. “I kept asking people around.”
Arias’ frustration during her search isn’t uncommon.
As Texas’ population continues to age, there is a growing concern about a shortage of board-certified geriatricians available to provide specialized care.
The aging baby boomer generation will double the number of people ages 65 and older between 2000 and 2030. This will result in older Americans making up 21% of the population, according to U.S. census data.
About 12.7% of Tarrant County’s population is 65 years old or older, according to 2020 U.S. census data. With that number set to increase, health experts across the region are raising concerns and implementing solutions to meet the needs of older adults.
“You’ve got that large cohort of baby boomers that are marching toward the golden pond and there have been efforts made over the years to keep up,” said Dr. Janice Knebl, professor of internal medicine and geriatrics with the Texas College of Osteopathic Medicine at UNT Health Science Center in Fort Worth.
‘Not going to have enough geriatricians’
Although there has been care devoted to older adults in the U.S. for centuries, the field of geriatric medicine is fairly young — it wasn’t recognized as a formalized academic specialty until the 1970s.
There have been concerns since the field’s beginnings about whether there will be enough supply to meet the demand, Knebl said.
“I graduated my (geriatrics) fellowship back in 1988 and we knew back then that we were not going to have enough geriatricians,” she said.
As of 2021, there were roughly 431 board-certified geriatricians in Texas and more than 7,400 across the United States. There will be a need for more than 12,320 geriatricians nationally by 2030, according to the American Geriatrics Society.
What has fueled the shortage?
Geriatricians are among the lowest-paid physician specialists, earning nearly $20,000 less than internal medicine physicians, according to a study in the National Library of Medicine. Geriatricians also have to rely primarily on Medicare reimbursement for insurance payments, which is known for its lower reimbursement rates than private insurance.
It is a challenge to get medical students interested in geriatric medicine when they have to worry about medical school debt, certificates and licensing, Knebl said.
“Medical students are coming out with close to a quarter of a million dollars in debt,” she said. “Are you going to pick a specialty where you make the least amount or are you going to try to go into a specialty where you are going to make more money?”
Since geriatricians manage complex illnesses, they also have to complete an additional year of subspecialty fellowship training. The number of residents entering geriatric medicine fellowships has been poor despite efforts to improve recruitment, said Dr. Reena Mathews, program director of the geriatric medicine fellowship at John Peter Smith Hospital in Fort Worth.
In the match year for fellowships starting in July 2023, 152 geriatric fellowship programs with 411 available positions participated in the National Resident Matching Program. Only 46 programs filled all of their spots, leaving 234 unmatched positions, according to a research poster from Dr. Paula Lester, a geriatrics researcher in the department of medicine at the NYU Grossman Long Island School of Medicine.
JPS Health Network, which is funded by the Tarrant County Hospital District, has a one-year geriatric medicine fellowship with enough funding to make three slots available. The fellowship program has been “lucky” to have at least one fellow in the past six years, Mathews said.
Knebl also believes children growing up away from grandparents joins ageism in American society as factors in medical students’ disinterest in geriatric medicine.
“Many of them have not grown up around older adults, because we are so mobile today, we don’t live in our family units anymore. I was around a lot of old people,” she said. “We are an ageist society. We really focus on youth culture.”
The bottom line is that while geriatric medicine is a fulfilling field, it is not a glamorous one, said Dr. Nnyekaa Collins, a geriatrician at JPS’ Magnolia Health Center.
The effects of that trickle down can negatively impact patient care, she said.
“As the demand increases, it can be harder for them to find care, especially from a trained geriatrician that is more comfortable working with patients experiencing frailty,” she said. “It impacts our patients day to day.”
Tarrant County works to find solutions
Knebl knows not every Tarrant County medical student will have an interest in pursuing geriatric medicine. It’s important to incorporate more education about older adults into medical curricula and training, she said.
HSC Health Center for Older Adults offers geriatric training education for students, residents and other health care professionals to improve their skills and care for the aging population.
Medical residents and students are eligible to participate in a four-week clinical geriatrics rotation, which exposes them to ambulatory practice, nursing facilities, assisted living centers, home visits and hospice. HSC also has its Seniors Assisting in Geriatric Education program that recruits older adults to volunteer and become mentors for students to learn about their needs.
“By giving them that exposure, I think that’s been really positive,” Knebl said. “Our focus is training all of them about how to do the best care, so whatever field they wind up in, they’re going to have that skill set.”
The JPS geriatric medicine fellowship team is working alongside the family medicine residency program to provide additional training to other medical residents, Mathews said.
“(Family medicine residents) have a required month with us, in total, during their three years of training,” she said. “A primary care provider should be able to have some understanding of the fundamentals.”
Aside from local efforts to train other specialties in geriatric medicine, there could be more funding on the federal level that focuses on growing the prestige of geriatric medicine, Mathews said.
Lester has conducted surveys and collected data on how to more effectively target recruitment for geriatric fellowships. She’s found that low salaries are the easiest barrier to rectify, starting with better pay and health insurance reimbursement. Loan forgiveness and low interest loans for medical students that specialize in geriatric medicine could also alleviate the shortage, Lester added.
“I do think we need to find out if being backed up on loans is prohibiting people from going into geriatrics. I don’t know if the data pans that out, so that’s something that we need to look into,” she said.
As for Arias, she started receiving care from a family medicine physician in her area. While the physician has some geriatric training, she’s not completely satisfied.
“When it was time to get my blood work done, I just accepted one that was available,” Arias said. “I’m not too happy with that person, but that’s all I can get at the moment.”
Arias hopes more medical students commit to geriatrics as their specialty.
“We need to have someone that is aware of elderly needs. We are living a lot longer at this time,” she said. “What happens if there’s nobody that feels like going down that field?”
David Moreno is the health reporter for the Fort Worth Report. His position is supported by a grant from Texas Health Resources. Contact him at david.moreno@fortworthreport.org or @davidmreports.
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