We need to solve the family doctor shortage for an aging America

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, who is also past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

Our country is aging.

Dr. StreamEvery month, 250,000 Americans turn 65 years old. The number of older adults will more than double between 2010 and 2040. More than 1 in 5 Americans will be 65 or older in 2040, up from 1 in 8 in 2010. And by then the country’s population will look a lot like Florida’s where today nearly 19% of the residents are 65 or older.

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This new demography raises the question of whether we’re prepared to meet the healthcare needs of an aging America.  The answer, experts agree, is no.

Several years ago, the Institute of Medicine charged the ad hoc Committee on the Future Health Care Workforce for Older Americans to determine the healthcare needs of the over-65 population. Its report, Retooling for An Aging America:  Building the Health Care Workforce,“ issued in 2008, painted a picture of a country that is experiencing rapid change and detailed the challenges the nation will face in meeting the needs of older Americans.

“This generation of older adults,” the report concluded, “will be the most diverse the nation has ever seen with more education, increased longevity, more widely dispersed families, and more racial and ethnic diversity, making their needs much different than previous generations.

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“Another problem is the dramatic shortage of all types of health care workers, especially those in long-term care settings. Finally, the overall health care workforce is inadequately trained to care for older adults.”

Next: Older Americans put heavier demands on the healthcare system

One reason is there aren’t enough doctors who specialize in geriatrics. And – like for all adult primary care specialties – the shortage is expected to worsen. The American Geriatrics Society says we need one geriatrician for every 700 people 65 and older, but projects that by 2030 there will be only one for every 4,484 people 75 and over. And projections are that the number of geriatricians will decline from about 7,500 today to 7,380 in 2040 when there will be 48.4 million Americans over 75.

The shortage of health professionals trained to treat the elderly also extends to the nation’s 255,000 advanced practice nurses, only 5% of whom are specifically trained in geriatrics.

Older Americans also put heavier demands on the healthcare system. In 2014, 6.8 million people 65 and older stayed in a hospital at least one night during the year, double the number of overnight stays for those 45 to 64 years old, according to the U.S. Department of Health and Human Services. They also visit the doctor’s office more often than younger people.

Among those 75 and older, 20% had 10 or more visits to a doctor or other healthcare professional in 2014, compared to 13% among people 45 to 64 years old.

All of this will come as no surprise to family physicians who already are taking care of more and more older patients. Given the shortage of physicians trained in geriatric care, their role in caring for the elderly will only grow despite the well-documented shortage of family doctors.

A report in the journal Family Practice Management noted, “geriatric patients with complex health problems are increasingly dominating primary care practices. Their challenging conditions stretch the time limits of a typical visit and tax a clinic’s staff,” often frustrating the primary care physician as well as the patient and his or her caregivers.

Next: “Little has been done” to meet the demands

The report found that “little has been done” to meet the demands on the nation’s healthcare system and called for a “fundamental reform” in training healthcare professionals to care for older adults. It recommended a three-pronged approach: improve the geriatric competency of all healthcare professionals, develop new models of care delivery and increase the recruitment and retention of geriatric specialists and caregivers.

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Experts have also called for payment reform to improve the capacity of family physicians to address the needs of over-65 patients. Further adding to the financial pressure are the lower reimbursement rates physicians receive from Medicare and Medicaid, the insurance programs most older Americans rely on to cover their healthcare expenses.

Despite the challenges, David Reuben,MD, a physician at the UCLA Medical Center, says caring for older patients can be an “incredibly gratifying” career.

“We can’t always cure them,” he says, “(but) we can always care and we can always demonstrate compassion and advocacy for them.”

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As they do today, family physicians will continue to play an increasingly vital role in providing care to an aging population. Family physicians working in a team based setting are in an ideal position to coordinate and manage care for America’s seniors.  We must invest in these critical primary care specialties to ensure we can meet the growing health care needs of our aging society.

Glen R. Stream is a family physician in La Quinta, CA and president of Family Medicine for America’s Health, which sponsors Health is Primary.