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More Doctors for Older Americans?

At the age of 87, Lloyd Brisk of Homewood, Ill., feels like a lucky man. True, he has battled an aneurism, carotid artery problems and prostate cancer. But he has lived through it all, he says, thanks to the help of a geriatrician—a primary care doctor trained in the special needs of older men and women. Brisk’s doctor, William Dale, M.D., tracks the subtle and not-so-subtle changes that happen to an aging body. “I wish everybody could have the quality of care I receive,” says Brisk, who visits Dale at least four times a year. Unfortunately, not nearly everyone can.

The Institute of Medicine of the National Academies warns that the nation’s health care workforce is too small—and unprepared—to handle the exploding number of older people. Today, of the more than 750,000 medical doctors in the United States, fewer than 7,200 are licensed geriatricians. By 2030, when the number of Americans age 65 and older will have nearly doubled to 77 million, experts estimate there could be just one geriatrician for every 10,866 of them if nothing is done to encourage more doctors to enter the field.

New incentives proposed

Luckily, many of the nation’s legislators are boomers themselves, and they’re diligently drafting a number of bills to address the shortage. “With our country aging at a rapid rate, and Americans living longer than ever before, we have got to provide more training in geriatrics to medical professionals and to direct-care workers on the frontlines,” says Sen. Herb Kohl, D-Wis., chairman of the Senate Special Committee on Aging, who has championed this issue for years.

Sens. Barbara Boxer, D-Calif., and Susan Collins, R-Maine, are sponsoring a bill that would allocate $130 million over five years to fund training and educational loan repayments for health care professionals who commit to caring for older Americans. Sen. Edward Kennedy, D-Mass., chair of the Senate Health, Education, Labor and Pensions Committee, recently endorsed Boxer’s bill as a nod to the issue’s importance, and his blockbuster health care reform bill includes scholarships and fellowships to bolster the geriatrics workforce.

Kennedy’s bill doesn’t include loan repayments, however, which Boxer believes are crucial to encouraging doctors, psychiatrists and pharmacists to take up geriatrics. A spokesman for Boxer said they hope to work such a provision into the health care reform bill when it hits the Senate floor, which may happen before the August break.

In the meantime, the Obama administration has proposed reducing some of the fees Medicare pays to high-priced specialists and pass the savings on to primary care physicians starting in January. The plan calls for boosting payments to geriatricians, internists, family doctors and general practitioners by 6 to 8 percent, according to the Centers for Medicare & Medicaid Services.

Geriatricians—who do for older patients what pediatricians do for children—fall near the bottom of the physician pay scale. They earn on average $171,000 a year versus $191,000 for general internists and, at the top end, $638,000 for neurosurgeons.

Shortchanged in medical schools

Making matters worse, only 11 of the nation’s 145 medical schools run full-fledged geriatric departments, says Robert Butler, M.D., president of the International Longevity Center-USA in New York. (Another 30 or so offer a geriatrics program.) This limitation makes it difficult to train a new generation of geriatricians, not to mention educate all medical students in aging. And without training, doctors may not know, for example, that heart attack patients over age 65 may experience confusion instead of chest pain.

Studies have shown that geriatric care increases patient and family satisfaction, shortens hospital stays, improves social functioning and decreases rates of depression.

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