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Health Care

Need Rising For More Regional Geriatricians

By Ken Little, posted Nov 27, 2009

As the population of seniors in southeastern North Carolina increases, the demand for geriatricians will also grow.

The challenge of training enough geriatric specialists to keep pace with millions of graying baby boomers is one with nationwide scope. Many new doctors are going into more lucrative, surgery-based specialties, and that’s just one reason there is a shortage of geriatricians, those close to the issue say.

Dr. Sam Spicer, vice president of medical affairs at New Hanover Regional Medical Center, said four geriatricians are currently on staff in the hospital system.

“Clearly, there is and will continue to be an increased need for family practice, internal medicine and, especially with the aging baby boomer population, physicians with specialized training in geriatrics,” Spicer said. “We’re fortunate at
New Hanover Regional Medical Center to have 36 board-certified family practice physicians who see many geriatric patients.”

Spicer said NHRMC internal medicine physicians also see geriatric patients. “We encourage physicians to open practices here, and our residency programs, including the family medicine residency program, is a critical component in helping to ensure we continue to meet the needs of the people of this region and beyond.”

As a cardiologist at Coastal Cardiology, Dr. Frank A. Hobart treats his share of elderly patients. Hobart, who serves as president of the New Hanover-Pender County Medical Society, recognizes the need for more geriatricians in the region.

“I think locally we’re possibly in a little better situation than some other areas of the country. We are in an area where people want to live and when you see areas where older people go to congregate, you’re going to see an increased need,” Hobart said. “I do think we have a shortage.”

Hobart said that internists and family practice doctors provide vital services to aging adults, but added the special training geriatricians receive make them important to the well-being of patients.

“Having some experts in the region is certainly something we should be striving for,” Hobart said.“There’s no secret there will be increased demands, not only on any physicians who take care of people in their older age, but certainly geriatricians.”

The American Geriatrics Society predicts that by 2030, more than 71 million aged baby boomers will remain in the U.S. population, and projects that there will be only one geriatrician for every 7,665 older adults.

Despite the growing demand, a declining number of medical students are choosing to specialize in geriatrics and family practice-style medicine.

Dr. Sharon A. Brangman, geriatrics division chief at SUNY Upstate Medical University in Syracuse, N.Y., and president-elect of the American Geriatrics Society, said other reasons contribute to the shortage of geriatricians. “That whole area of medicine is not popular because it deals with aging and aging means deaths. We have the whole stigma about aging and being old is considered taboo,” Brangman said.

The reach of popular culture extends to medical students and young doctors considering which specialty to make a career in.

“Like everyone else, they are part of the larger society and they can look at aging as an unattractive area of medicine,” Brangman said. “It’s only going to be amplified by the baby boomers because the baby boomers represent a huge percentage of the population.”

Specialization in surgical and other procedure-based specialties offers higher reimbursement than being a general practitioner or a geriatrician, Brangman said. Doctors can schedule surgeries and see more patients on any given day than a geriatrician.

A key component of geriatric medicine is the management of chronic conditions, often multiple and usually incurable. Care is given in a variety of settings, including homes, nursing homes and community-based long-term care sites.
 “In geriatrics, we tend to talk to patients and they have a lot of complex medical problems and they are taking a lot of medications,” Brangman said. “It takes more time to see them."

Current Medicaid reimbursement policies are another disincentive, according to the AGS.

“Cuts in Medicare reimbursement to physicians can have an absolutely chilling effect on all primary care specialties,” Hobart said.

It’s already difficult in this area for Medicaid recipients age 65 and over to find a primary care physician, Hobart said. Talk of health care reform in Washington isn’t particularly reassuring to the medical community or the patients it serves, he said.

“I don’t think anybody can know what’s in store,” Hobart said. “Where the rubber meets the road depends on how these bills come out of Congress.”

Some states provide incentives for medical school students to enter fields like geriatrics, or for young doctors to practice in rural areas with a pronounced shortage in a particular specialty. One method is student loan forgiveness, which South Carolina uses to attract geriatricians.

Incentives are good, Hobart said, “but if you incentivize one group it takes away from another.”

“These are not simple problems,” he said.

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