As aging population grows, number of geriatric physicians dwindles nationwide

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COLUMBIA - On a brisk November afternoon, Vicki Curby and Jack Andrews set off on a bike ride through Columbia.

By the end of that six-mile bike ride I was hurting and she was doing just fine,” Andrews, 26, said.

Curby bikes often and can ride up to 20 miles in a single day, an impressive feat for someone who celebrated her 70th birthday this past year.

“I’ve been really impressed by how active she is,” says Andrews.

Though her energy and physical fitness might not suggest it, Curby’s age places her in the medical category of “geriatric.” A geriatric patient is generally defined as an individual aged 65 and older. This age group accounted for 14.9 percent of the nation’s population in 2015, compared to 12.4 percent in 2000, according to the United States Census Bureau.

Despite this rapid increase in older patients, there is an extreme shortage of geriatricians – physicians specializing in the treatment of senior patients – according to numbers tracked by the American Geriatrics Society (AGS).

As of 2014, the AGS counted 7,428 board-certified geriatricians nationwide. That only breaks down to around 1 physician for every 6,000 adults over the age of 65 at the time, a gap that is only growing.

Curby and Andrews became friends this fall through the Heyssel Senior Teacher Educator Partnership, commonly referred to as the STEP program, under the MU School of Medicine. Andrews is a first-year medical student at MU. The program is aimed at establishing relationships between medical students and seniors in the local community in hopes of the students being able to interact with older patients outside of the doctor’s office.

“I think that’s been a really cool thing, too, to think about from a doctor’s perspective,” says Andrews. “You may be treating this person and they have may five, you know, different conditions that you’re worried about, but that’s not their whole life.”

Mitchell Heflin, associate professor of medicine at the Duke University School of Medicine, says the field of geriatrics simply doesn’t attract enough doctors to keep up with the need.

“Not everyone is cut out for it, it doesn’t pay as much as other specialties and the work is wonderfully rewarding, but not glamorous,” Heflin said.

According to Dr. David Mehr, a geriatrics physician in Columbia, students complete a three–year residency in either internal medicine or family medicine and an extra year of training in geriatrics in order to become a qualified geriatrician.

“The demand for those training positions is very low, they don’t even fill them up every year,” Mehr said. “The number of people leaving geriatrics, usually by retirement, is not being filled up by the people being trained.”

Mehr says healthcare for older patients will now have to be placed in the hands of other physicians due to the shortage.

“Geriatrics may help design systems to make that kind of thing better, other physicians may as well,” Mehr said, “but the increasing fragmentation that we see in healthcare is the real problem.”

Gerontology numbers decline in the U.S.

Individuals 65 years of age or older made up 14.5 percent of the U.S. population in 2014 with 46.2 million people. By 2060, it is expected that this number will more than double to 98 million. While the number of elderly people in America is rapidly increasing, there are only 7,428 board-certified geriatricians and 1,629 board-certified geriatric psychiatrists in the U.S.

Programs at medical schools across the country aim to encourage relationships between medical students and geriatric patients. MU began the STEP program in 2001 and, under the direction of Peggy Gray, the program currently involves 71 first-year medical students and 98 seniors from the Columbia community.

The program hosts luncheons throughout the semester, followed by seminars on topics relating to aging. Recent seminars have focused on issues related to falls and hearing loss. Pairings are also encouraged to spend time together outside of the scheduled activities, like playing games or having meals together.

“The goal of this program is to expose our students to older adults so that they’re prepared to take care of them when they graduate from medical school,” says Gray, regardless of whether the students specialize in geriatric medicine or not.

The Donald W. Reynolds Foundation launched the Faculty Development to Advance Geriatric Education (FD-AGE) grant program to promote similar goals and educate health professionals about geriatrics. Between 2004 and 2010 the program trained 82 fellows and hosted 899 faculty scholars at various institutions. An FD-AGE consortium was also implemented at Duke University School of Medicine, Johns Hopkins University School of Medicine, Mount Sinai School of Medicine and the David Geffen School of Medicine at the University of California – Los Angeles to teach skills without direct support from the Reynolds Foundation.

Heflin says the program has allowed a variety of audiences at Duke University Medical Center to learn more about the aging population.

“The larger part of the program offered weeklong mini-fellowships for faculty from across the country with an interest in teaching geriatrics.  This often included non-geriatricians in addition to geriatricians,” says Heflin.

As the baby boomer generation continues to grow older, the need for physicians specializing in geriatric care will only increase. Programs like STEP and FD-AGE work to turn the shortage into a positive, educating and building bridges between medical students and their future patients. These relationships allow the students to see seniors in an environment out of the hospital and as active individuals.

If you are interested in becoming part of the STEP program at MU, visit www.stepmu.com for more information.

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