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Gearing Up For Elderly by David Schmidt

Demographic Shifts Mean Docs Need to Learn Geriatric Care

Each year, more than 16,000 students graduate from one of the 125 accredited medical schools in the U.S. Each of these graduates is required to learn how to deliver a baby during their course of study, but in most instances, students can complete their residency, earn their degree and enter the medical profession without learning how to care for elderly.

Given the changing demographics of the American population, it is time for our country's medical schools to rethink their outdated curriculum and acknowledge both ends of the life-cycle continuum.

By the year 2030, one in every five Americans will be elderly, with the number of those 65 or older doubling from 35 million in 2000 to 71.5 million. The job of caring for the physical, mental and societal needs of these aging adults will fall on a great many of our citizens, including family members, professional caregivers, social workers, nurses and community agencies.

But locally based physicians will continue to be the backbone of our healthcare system as older adults will continue to receive their medical care from primary-care physicians in their own communities.

Despite these realities, training for physicians in geriatric care is lacking at every level. Less than 10% of all medical schools require any course at all in this specialty, and many of the nation's medical schools lack a dedicated geriatrics department.

As a result, only a small percentage of the more than 650,000 physicians in practice today received training and education in geriatrics. And, to exacerbate the situation, the Association of Directors of Geriatric Academic Programs warns that the number of certified geriatricians will fall from the current figure of 7,200 to 6,100 in the very near future because the number of geriatricians not seeking re- certification is larger than the number of young physicians completing their geriatric fellowships.

Not only do we need physicians, but if medical schools are to appropriately alter their curriculum, there will be an increased need for faculty in geriatrics.

In 2002, the International Longevity Center estimated that a minimum of 1,450 academic geriatricians will be required to prepare the physician workforce for their aging patients.

There is also the issue addressing older adults' mental health and psychiatric care. Here too, we are sorely lacking. Of the 35,000 psychiatrists in the U.S., only 5,000 identify geriatrics as one of their areas of interest.

Even if that number is doubled by 2030, the Public Policy & Aging Report of 2003 projects that we will barely succeed in preventing today’s shortage from worsening.

It appears that a perfect storm is approaching. I believe there are three things we must do to avoid a geriatric- healthcare workforce crisis from engulfing us all.

First, medical schools must immediately begin to revamp their educational requirements to make the study of geriatric care an essential element of education, regardless of the medical specialty in which a physician in training wishes to pursue.

Second, we must make caring for the elderly a part of residency training so physicians gain hands-on experience under the supervision of trained professionals before entering the workforce, not only in attending to the physical needs of a geriatric patient but in learning how to address their emotional requirements as well as those of their families. .

Third, we need to make geriatric care, including end-of-life care, a part of continuing medical education for physicians who are already practicing.

That means offering a complete array of online or in-person continuing medical education courses that expose physicians to the new realities of the market and require continuing learning in the field of geriatrics, particularly for those physicians who did not have such training during medical school.

The crisis of caring for the elderly will only worsen unless dramatic steps are taken immediately to assure that our present and future physicians are properly prepared to care for a changing nation.

David Schmidt is president and chief executive officer of SCAN Health Plan, a geriatric-focused health plan serving more than 75,000 seniors in Southern California and one of the fastest-growing Medicare Advantage Plans in the state.