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Where Are the Doctors You'll Need?

A shortage of geriatricians is leading to a major public health concern

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A geriatrician is a medical doctor who is trained to meet the special health issues of older people.

As her husband's health issues multiplied, Joan Thayer Yazmir tried to keep on top of every detail — doctors' appointments, prescriptions, what problems to watch out for.

Yazmir, 76, was a careful consumer of health care, but there was a lot to juggle. "They are all excellent physicians," she said of the specialists treating her 83-year-old husband. "The cardiologist looks at the heart. The oncologist and urologist deal with the prostate. The pulmonologist deals with his lungs. The hematologist deals with anemia."

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But none was in a position to grasp all the issues her spouse was dealing with. So she reached out to a doctor who specializes in older patients — the geriatrician who had treated her mother years earlier. It took four months to get an appointment, but Yazmir said she is glad she did. Now the geriatrician helps watch over everything, and checks in with other doctors if questions arise.

"You need a quarterback," said Yazmir, "someone who understands the whole process."

A geriatrician is a medical doctor who is trained to meet the special health issues of older people. As people age, it becomes more common for them to have a number of health issues at the same time, and to be taking several medications to deal with those problems. And diseases and medicines can have a different impact on older people. Geriatricians manage all the health issues of an older patient, designing care plans to deal with the whole person.

They are doctors who are board-certified in either family medicine or internal medicine and have completed the additional training necessary to become certified in geriatric medicine. Geriatricians often work as part of a team that might include registered nurses, pharmacists and physical therapists.

A shortage becoming severe

spinner image Where Are the Doctors? The Flight of Geriatricians
Kim Batcheller's visits with a geriatrician improved his mobility.
Jose Mandojana

It's a critical role, becoming increasingly important as America ages. Yet these specialists are in short supply, and the shortage is becoming more severe. The United States will need more than 23,000 new geriatricians by 2030, according to the American Geriatrics Society.

One reason that the gap is not closing is that geriatricians are among the lowest paid of medical specialists, an issue that may be a big problem for students who graduate with large amounts of debt. Many new doctors may be drawn to younger patients who have a greater chance of being cured. Others are attracted to specialties that will allow them to work with flashy new technologies.

Still others may not want their practices to be so dependent on Medicare and the red tape that goes with it.

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Limited access to geriatric care "is going to be the major public health concern of the next 50 years," predicts Heather E. Whitson, a geriatrician at Duke University School of Medicine.

Compassionate care

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Kim Batcheller, a retired lawyer who lives in Portland, Ore., recalled how his right leg weakened as he aged. Walking became painful. His limp became more pronounced. He feared that one day he would no longer be able to get around on his own. The cause was an old sports injury, and doctors gave him little hope of improvement. Finally, as his worries mounted, he sought out a geriatrician. The new doctor imposed a whole regimen of care, including strengthening exercises and electricity to stimulate nerves in the weaker leg.

And remarkably, it worked: "Six years ago I would have difficulty walking for a block," said Batcheller, now 76. "My back would hurt. I didn't have any energy. I didn't want to go out. Now I can walk three miles." One caregiver said that after her mother's memory went downhill, the most compassionate care came from a geriatrician. "A lot of doctors just ignored her and talked around her, and that disturbed me," recalled Deanne Groves.

An aging specialist at a local college referred her to the sole geriatrician practicing at that time in their northeast Louisiana town of Monroe. "I was so excited to find out we actually had one," she said. "Not many people I encounter are even familiar with the term."

The geriatrician could not solve her mother's memory problems, but he treated her with respect. "He would sit down beside her and ask how she was doing today. He would say, 'I want to try to make you feel better. I want to try to make you have good days as much as possible.' "

Jane Potter, the head of geriatrics at the University of Nebraska Medical Center, said that when a new person walks into her office, she seeks answers to certain questions: "Who is this patient? What do they care about? What's bothering them? What are their goals?"

How to find a geriatrician

Even with a shortage, more than 7,000 geriatricians are licensed in the United States. But how do you find one?

The Internet is a good place to start. The American Geriatrics Society offers online information. And you can get general knowledge about the field by checking the society's website.

A separate online search for a local geriatrician can be conducted.

If you are still having difficulty finding someone, you might check with the nearest hospital or university medical center, which may have geriatricians on staff. Or you could call a local medical society.

(Video) How to Talk to Your Doctor: Experts share their best tips on how to talk to your doctor, make sure your concerns are heard and get the best care on your visits.

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