Geriatrics & Geriatricians

Despite the fact that the senior demographic in America has been on the rise for many years, the number of geriatricians is in no way coming near to meeting this demand. Indeed, according to an article in The New York Times by Katie Hafner, the subject of geriatrics in medical school “now ranks right at the bottom of the list of specialties that internal medicine residents choose to pursue.”

Although this sounds like bad news, regarded from a different perspective it’s actually extremely positive. President of the John A. Hartford Foundation (that funds programs to enhance senior care), Terry Fulmer pointed out that “One of the greatest stories of the 20th century was that we doubled the life expectancy of adults [adding that the next task is for this generation to] make sure [it has] all the supports in place to assure not just a long life but a high quality of that long life.”

Just taking a case study of one US state, Oregon, there is a mere one geriatrician to serve 3,000 adults over 75 years old (with a total of 7,000 geriatricians nationwide). What’s worse is that this number will increase because our population continues to age (i.e., life expectancy grows). Indeed, it is protected that by 2030 “roughly 31 million Americans will be older than 75, the largest such population in American history.” In other words, notes the American Geriatrics Society, there is a need for the training of “at least 6,250 additional geriatricians between now and 2030, or about 450 more a year than the current rate.”

So what’s the solution? In an article in Medical Economics, by Lisa Price, MD, it was suggested that the Program of All-inclusive Care for the Elderly (PACE) might be able to assist this situation. This Medicare/Medicaid care model is “designed to improve care coordination and outcomes for underserved older adults, PACE takes place in a single facility housing medical, dental, occupational and rehabilitation therapy, adult day, pharmacy and more. The care coordination afforded participants typically leads to improved outcomes for participants.”

The PACE program sees a collaboration between the payment system, care delivery system, physician and patient. This takes away the concern of the entire team regarding reimbursement issues. Once these programs become mainstream the result is the availability of additional ways for certified geriatricians and primary care physicians with eldercare experience.

Geriatricians will also be drawn to PACE programs as they allow them to spend time with each participant without worrying about bureaucracy and getting them through the system as fast as possible. Given that there is a team working together, the end result? “greater support and more comprehensive care.” This makes things much easier for geriatricians who get more time to spend with patients, resulting in a “refuge for those physicians looking to continue providing hands-on, high-quality care to older adults.

Perhaps medical students can take a lesson from Dr. Jenny Ingram, winner of the 2016 Glenn Sawyer Service Award, which was established in 1972 in recognition of top service to the OMA and medical profession. She is founder and principal investigator at Kawartha Regional Memory Clinic (a center enabling patients to participate in worldwide clinical research trials investigating new drugs to treat Alzheimer ’s disease). According to the Executive Director of Seniors Care Network, Kelly Kay, Dr. Ingram has worked tirelessly to build knowledge of geriatric medicine and expand the capacity of primary care physicians and interprofessional teams across the Central East LHIN.”

Other achievements Ingram has under her belt in the geriatrics field include: being head of the Division of Geriatric Medicine at Peterborough Regional Health Centre; chairperson of the Seniors Care Network board of the Central East LHIN; a founding member of the Geriatric Assessment and Intervention Network (GAIN); a consulting geriatrician, a participant a national CIHR funded study through the Canadian Consortium on Neurodegeneration in Aging examining care models in Primary Care Memory Clinics in Ontario and Quebec; a key member of the founding team of the local chapter of the Osteoporosis Society; a leader in efforts to launch an Osteoporosis Co-ordinator at PRHC, to name but a few.

Let’s hope the direction of the work of Ingram is continued for many years to come.