Why We Need Geriatricians: 'I Think Of Us As Detectives'

Nov 5, 2015

American seniors are growing in numbers. But the number of geriatricians, doctors who specialize in treating older patients, is actually shrinking.

And there aren’t enough in the pipeline to meet the growing need.

It’s tough to get young medical students interested in treating old people. Meena Chadvakumar once thought about becoming a geriatrician. “And whenever I talked to people about it before med school, it was usually met with a groan,” she says, “like, oh, but it’s so boring. It’s so uninteresting.”

Chadvakumar has since graduated from med school and has chosen to specialize in family medicine so she can see patients of all ages.

Besides the image problem, there’s the financial reality.

Kerry Jurges is finishing up her geriatrics fellowship. She says she has about $200,000 in student loans. She knows geriatrics doesn’t pay as well compared to other specialties, and that stops her peers. But she likes the challenges and the patients. She says, “Those are the people I feel learn the most from. They were the ones who had great stories about their life. So I enjoy spending time with them.”

According to the American Geriatrics Society, there are fewer than 7,500 geriatricians in the U.S. The country will need about 30,000 by the year 2030.

Why do we need geriatricians? For one, older adults have complex health issues.

Dr. Elizabeth Phelan is an internist and geriatrician at the University of Washington. When she’s not teaching, Phelan sees patients at Harborview Medical Center’s fall prevention clinic. Many of the patients are elderly.

“I think of us as detectives when we diagnose disease,” Phelan says. That’s because older adults tend to have accumulated a number of chronic conditions like high blood pressure or diabetes. “In addition they often have what we call geriatric syndromes.”

These are problems like falls, confusion or dementia. On top of that they develop disabilities that can affect their ability to do day-to-day stuff including housekeeping or managing their medications. Over time, these conditions can interact in different ways. Sorting all that out takes time and some probing.

“One patient came to clinic to see me for the first time, brought by two sons, and the chief complaint was that she was taking a lot longer to get her housework done,” says Phelan. “And they wanted to know why that was. She was 90-some years old and living independently.”

Phelan remembers the patient was frail. In cases like this, she would ask a lot of questions about pain, sleep quality, or mood to help make an assessment. “When there’s a behavioral change in an individual that’s sudden, we know to look for certain things that might be driving that. … So it could be pain, it could be an infection like a urinary tract infection.”

Phelan says geriatricians are trained to recognize patterns to figure out the underlying cause of the problem. Now she and her colleagues are sharing their knowledge with the next generation of primary care providers.

The University of Washington recently received a $2.5 million federal grant from the Health Resources and Services Administration to do that. It’s not going to boost the number of geriatricians, but it’s going to prepare incoming doctors, nurses and psychiatrists for the medical complexities of elder patients.

Phelan says, “My vision is really that all physicians in practice have a basic level of comfort and familiarity in treating a person who’s older — who encounters a patient who's 70, 80, 90, 100 — should be able to provide the same quality of care to that individual that they do to somebody who’s younger.”

One approach will be to use telemedicine so that doctors in clinical training who are grappling with challenging cases can consult with geriatricians at the university. The program is still in the planning stages, but Phelan hopes it’ll be ready to roll out this winter.