Pennsylvania's population is aging into a medical system that may not be ready for it. As older adults make up a growing share of the state, physicians with specialized geriatric training remain in critically short supply.
The number of doctors certified in geriatrics — the specialized care of older adults — has dwindled over the last two decades. Nationally, there are fewer than 7,500 board-certified geriatricians, according to The American Geriatrics Society. That's about one for every 10,000 older adults.
Experts estimate the need for these specialty providers is closer to 30,000.
" I think it's going to take some kind of tipping point, crisis situation where it will become painfully apparent that we as a society cannot support the needs of the aging population," said Dr. Lyn Weinberg, geriatrics division director at Allegheny Health Network.
As the supply of geriatricians disappears, the number of people over the age of 65 is skyrocketing. In the Pittsburgh region, deaths outnumber births and one in five residents are over the age of 65.
The drop in geriatricians is part of a larger dip in the number of people who choose primary care as a specialty. One issue driving the squeeze is a lower earning potential for primary care doctors and geriatricians compared to other medical or surgical subspecialties.
The primary care workforce itself is older than other occupations, too. That means higher rates of providers will be retiring from the labor force in the coming decades.
Though it's a speciality field, UPMC geriatric medicine chief Dr. David Nace said many physicians without formalized geriatrics training assume the title of geriatrician based on the age of their patients.
"I've had cardiologists tell me, 'I take care of older adults, so I'm, that makes me a geriatrician,'" Nace said. "And my response back is 'I take care of people with a heart, so that makes me a cardiologist, right?'"
Nace stressed that geriatrics requires more than a familiarity with the aging process.
"You have to understand the science and the principles of the field," Nace said. "What we do to take care of heart disease, as an example, in a 30-year-old will be different than an 85-year-old or a 90-year-old."
Medical schools don't often prioritize geriatrics education over other specialties like gastroenterology or cardiology, according to Nace. And he contends that less exposure to the field means fewer applicants to residency programs.
"I had 45 minutes with a geriatrician in my training," he said. "I thought, 'I'll never do geriatrics.'" (That changed once Nace got to UPMC for a cardiology residency and had another encounter with geriatrics providers, he said.)
Without enough geriatrics providers, many people rely on their primary care doctors for aging care. But Weinberg cautioned that a shortage of primary care doctors and geriatrics expertise is a recipe for physician burnout.
"The workload is just too much," she said. At AHN, patients maintain their primary care doctors while Weinberg's department specializes in aging care and geriatric conditions including frailty, cognitive decline and falls.
"We co-manage [patients]," she explained. "We focus our skills to reach the people that have the highest need."
She suggested AHN's model could be a way forward for more health systems grappling with rising demand for aging care.
Weinberg said geriatrics programs are "not a money maker" which could disincentivize major health systems from investing in them. Still, AHN announced last month that it has expanded its geriatrics division with two new physicians.
Nace stressed that the pipeline of elder care physicians is under crisis. He, Weinberg and other geriatrics providers have urged lawmakers to take action to reverse the trend of disappearing physicians by expanding student loan forgiveness and financial incentive programs designed to attract more people to the field.
Despite lower compensation and fewer incentives to become a geriatrics health care provider, surveys consistently rank the field among the highest for job satisfaction rates; something Nace agrees with wholeheartedly.
"I have never been bored," Nace said. "It's been exciting and it's been the most rewarding doggone career that I can possibly imagine."
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