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December 2008 Issue

Gregg Warshaw, MD, and Libbie Bragg, PhD, conducted a survey that shows that geriatricians should care for the frailest patients first.
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Lack of Trained Geriatricians Creates New Focus for Providers

By Katie Pence
Published December 2008

A shortage of trained health care providers is upon us.

This means care for all ages—including the elderly.

A new survey conducted by UC researchers shows that because of this shortage, trained geriatricians may need to focus on the frailest of patients first, referring younger, healthier patients to other health care specialists.

An article on this subject was published in the October 2008 edition of the Journal of the American Geriatrics Society.

According to the article, there are about 7,130 geriatricians currently in the United States, but by 2030, the need will grow to about 36,000.

“The results of this survey suggest that because of the predicted shortage of geriatricians, these subspecialists may provide the most benefit when caring for the most vulnerable older adults,” says Gregg Warshaw, MD, co-author of the survey and chair of the office of geriatrics within UC’s family medicine department.

Researchers surveyed academic geriatric program directors at 145 medical schools nationally, asking which patient groups would benefit most from the care of a geriatrician.

Seventy-five percent or more of respondents said patients would greatly benefit from care by a geriatrician if they were 85 years or older, frail, experienced “geriatric syndromes,” required end-of-life care or had severe functional impairment.

Libbie Bragg, PhD, co-author of the study and research associate professor in the department of public health sciences, says geriatricians are some of the lowest-paid specialists within the medical field.

“On average, in 2006 total medical student debt was around $113,000,” she says, adding that geriatric students must also take an extra one to three years of training on top of their normal residencies.

“Geriatric doctors’ salaries are much lower than many other medical specialties, and students with considerable debt are more likely to choose a higher paying specialty,” says Bragg.

“Students see better pay and more predictable work schedules as an incentive to stay away from geriatrics.”

Warshaw says the study findings offer insight into the role of geriatricians within the American medical care system.

“Health care professionals and patients need to know when to seek out such specialized care, and geriatricians need to know where they are positioned in caring for an aging population,” he says.

However, he notes the importance of geriatric expertise.
“Older people make up a very unique subgroup and need special care,” he says.

“They have different conditions and respond differently to medications. “If we treat them like middleaged adults, we will end up harming them.”

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