By 2030, it is estimated that about one in five Americans, 20%, will be age 65 or older. That will be a larger portion of the general population than that made up by children. This Health Resources and Services Administration projection of the aging population shows a significant need for focus on the future of geriatric medicine.
The American Geriatrics Society claims that one geriatrician can care for up to 700 patients and estimates that about 30% of the elderly population will require geriatric care. By that metric, the United States will need over 12,000 full-time geriatricians by 2030, and American Geriatrics Society counted under 7,500 full-time geriatricians in the US as of 2021, and the number is not projected to grow much within the decade.
A big change is needed in the field of elder care. To ensure the future of geriatric medicine, younger people need to be better incentivized to pursue a career in geriatric medicine. The quality of studies on older persons with multiple chronic conditions needs to be improved, and public policy will need to make addressing the aging population a priority.
Working in Geriatric Care
For a few reasons, the field of geriatrics is not drawing in as many medical students as other specialties might, with less than one percent of ACGME first-year residents and fellows going into geriatric care according to the Association of American Medical Colleges. Understanding the deterrents to the field of geriatrics will be the first step in addressing why there are not enough geriatricians.
One of these reasons is simply the stigma which surrounds working with older adults and in nursing homes. Geriatrics is not seen with the same air of glamor as some specialties are and working in geriatric care also requires an additional year or more of specialized studies compared to other sub-fields of medicine.
Aside from this perception, geriatric medicine is also one of the lowest paying specialties. A 2016 study for the Southern Medical Journal compared the average career income progression of a geriatrician versus that of a nurse practitioner, finding that the graduates who pursue a career in geriatrics would take almost until age 40 to match the income of the graduates who would find work as a primary care nurse practitioner.
In this scenario, by age 65 the geriatrician's income would still be only about 30% higher than that of the nurse practitioner. While this in itself is still considered a decent income to many, when considering the amount owed in tuition and loan repayment, especially for a specialty that requires additional years of study, the incentive to work in a lower paying specialty is not high enough to attract more students.
According to Glassdoor estimates as of February 2023, the median yearly salary for a geriatrician in the US is just over $173,000. By comparison, the average cariologist's income annually in the US is just over $396,000. With such a start difference in salary, it is no wonder that fewer and fewer medical students choose geriatrics as their specialty.
A greater issue tied into this salary difference is simply that there is little money to draw on for increased financial incentives. Long term care facilities have had a significant decrease in revenue due to the impact of the COVID-19 pandemic on nursing homes. Also, most health care for older adults is covered by Medicare and does not often sufficiently cover care-planning and preventive care.
One way to attract more students to the field of geriatric medicine may be to offer greater debt forgiveness incentives for geriatricians. Another could be to find ways to include specialized geriatric training in the general primary health care curriculum so that new doctors are not forced to spend more time in the education system than those who go into other specialties.
Whatever the solution may prove to be, steps need to be taken now before the health care system finds itself overwhelmed. The American Medical Directors Association (also called The Foundation for Post-Acute and Long-Term Care Medicine) has addressed the lack of geriatricians with the Futures Program, founded in 2001.
The program's aim is to introduce residents and fellows to long-term care settings like nursing homes and other long-term care facilities. As the program continues to grow, it will allow more interdisciplinary options for nurse practitioners, physician assistants, and social workers, ultimately increasing the number of health care professionals who have experience with long-term care and geriatrics.
Preparing for Future Technological Advancements
As with all aspects of modern life, rapid advancements in human technology will have some unforeseeable impacts on the field of geriatrics. It is important to consider and plan for these possibilities in order to ensure that any advancements that may come to the field are safe and ethical.
As a current example, smart home devices have been lauded as helpful appliances for older adults to have. These devices help the older person to control their other household devices to play music, watch TV, search for information, and more. At the same time, these devices have been widely criticized for collecting massive amounts of data on their users for use in advertising and occasionally 3rd-party sales.
Technology can be a gamechanger in improving communication and quality of life for older adults in need of care, decreasing some of the loneliness that is all too common in the older population. But by the same token, future technological implementations could have the opposite effect.
A recently new field discussed in the American Journal of Geriatric Psychology, socially assistive robotics, will likely become far more intertwined with geriatrics in the future. These robots aid in performing daily needs like eating and drinking, personal hygiene, and keeping up with medication.
Machine learning, already coming to popularity in tech industries, is a form of artificial intelligence that excels in large-scale pattern recognition. Moving forward, machine learning can help determine how individuals may respond to particular treatment options and care methods, and ultimately find usable data from situations with many variables.
Motion mapping can also be used to find patterns in behavior for geriatric syndromes such as dementia by tracking patient's pace, spatial location, sleep patterns, and more. This can also be helpful in quick response times for patients who get injured and are otherwise unable to call for help.
With all of these examples, however, comes a significant lack of privacy, a major concern as these technologies develop. Robotics and artificial intelligence could become the greatest tools available to geriatric physicians, and primary care physicians as a whole for that matter, but the issues of personal privacy, and ultimately patient autonomy, will have to be addressed.
Geriatric Care in Less Developed Countries
The issues faced by the field of geriatric medicine in the US have been seen around the world, and it has been a long time coming. A 2002 paper in the Journal of Gerontology, "Looking at the Future of Geriatric Care in Developing Countries," by Doctor Gutiérrez-Robledo of the Geriatric Institute in Mexico, expressed these same concerns.
Two thirds of the world's population of older adults live in developing nations, the majority of those living in poverty and with lower literacy levels, making finding appropriate care even more difficult. While these less developed nations may not have the infrastructure to support as many long term care or government-run nursing homes, there are fewer legal or bureaucratic barriers to creating developing community care systems.
Training healthy adults to provide home care for older adults in their neighborhoods and local communities would be far more feasible in developing nations, as well as improving community involvement.
Expanding Elder Health Care
One solution that could prove most effective in correcting the geriatric health care models may be as simple as delegating the responsibilities among other physicians and caregivers. As it is, a geriatric physician is solely responsible for ideally 700 patients, though that number is often much higher.
Development of community programs could allow geriatricians to provide geriatric consultation on more severe cases that require their involvement, geriatric social workers, primary care physicians, and geriatric nurse practitioners could replace geriatricians in the majority of their tasks. This would both lower the strain on geriatricians and improve care efficiency and quality for patients.
Not only that, but more regular home health care from other caregivers will help to better manage chronic health problems, as well as making geriatrics a more desirable field for incoming medical students. Ultimately, society will have to find a way to adopt community-based care options in more places to adequately support all those who will soon need it.
Keystone Health is Idaho's only independent geriatric clinic, and Idaho's leading house call provider since 2013. Keystone provides medical care for older patients in the greater Boise area, providing primary care options, in-home visits, and physical therapy. To learn more about services available to you and your loved ones, click here.
