As its population ages, Georgia remains woefully short of geriatricians

Short of Geriatricians
J.R. Green, 64, would like to see more physicians available for the Athens community.

J.R. Green will be 65 next June, and he drives a van for the Athens Council on Aging. Like many other military veterans in the Athens area, he gets some of his medical care at the VA satellite clinic on U.S. Highway 29 and the rest 100 miles away in Augusta.

At a large VA medical facility, the aging of baby boomers — and their parents — is hard to miss.

“Let me tell you, there’s a lot of old guys out at the VA,” Green said, noting that World War II veterans, the youngest of whom are now well into their 80s, are a frequent sight at the medical facility in Augusta.

Most of Green’s clients and friends at the Council on Aging, however, do not have the option of going to the large VA hospital. Many are not veterans, and many who do have veterans’ benefits cannot travel such a long distance for care.

For such seniors, good care may be increasingly hard to find.

The baby boomers, the immediate post-World War II generation, are one of the largest population blocs in U.S. history. And on Jan. 1, 2011, the first members of this generation turned 65.

The U.S. Census Bureau estimates that the number of Americans over 65 will increase from 40 million to more than 88 million by 2050. By then, one in every five Americans will be 65 or older.

Last year, more than a million Georgians were over  65. But the state had only 124 certified geriatricians — specialists in the care of older patients, according to a 2012 report by the American Geriatrics Society. That means the state is short by 318 geriatricians. Nationwide, the shortage is 10,315.

Just as pediatricians have special skills to care for the very young, geriatricians are specially trained to care for the oldest adults, says Dr. Sharon Brangman, who is a geriatrician and past president of the American Geriatrics Society.

Geriatricians complete residencies in internal medicine or family medicine, followed by an additional year of training in geriatrics to prepare them to address the medical, social and psychological issues that concern older adults, such as management of multiple chronic diseases and multiple medications.

“Geriatricians have a distinct set of skills for taking care of older adults, especially the frail ones who have complex medical problems,” said Brangman. “You can’t just give the same doses to a 90-year-old that you would give to a 40-year-old. Even within geriatrics, a 65-year-old and a 90-year-old have very different issues.”

An often neglected specialty

[youtube][/youtube]As the average American’s lifespan grows longer –- most geriatricians care for patients 80 and older –- Brangman sees a culture that’s overly focused on youth.

“We have a perspective in our society that everything that’s young and youth-oriented is cool,” she said.

That’s why geriatricians like Don Scott, a faculty member at the Georgia Health Sciences University-University of Georgia Medical Partnership in Athens, are trying to shine a brighter light on geriatrics for medical students.

“Geriatrics is definitely not what you would call one of the ‘sexy’ specialties,” he said. “Many medical schools have electives in geriatrics, but very few have any required geriatrics rotations in the third and the fourth year,” said Scott. “So, I’m in the process of getting a geriatrics interest group started here, trying to promote the geriatric perspective a little bit.”

Georgia med student Ashley Austin agrees that there’s currently very little focus on the field at the Medical Partnership.

“We ‘graze’ geriatrics in school,” said Austin, a third-year student. “We did one or two lectures, maybe, and a physical exam. People would have to go out of their way to pick an elective rotation in that, and there are just so many other fields out there.”

Geriatrics is absent from med school curricula and residency training nationwide, Brangman said.

“Many of the general internists and family doctors working now received very little training in taking care of older adults. And far too many medical students are graduating without any geriatrics experience,” she said.

“It’s not a required part of the curriculum in residency,” she said, “yet we know that all residents –- except for pediatrics –- are going to be taking care of older adults. So it should be integrated into the training of surgical residents and medical residents.”

If geriatrics gets more attention at The Medical Partnership in Athens, aging residents of the community, like Green, will certainly reap the benefits. Until then, he is glad to see an increase in doctors of any specialty right in his hometown.

“The medical school, in the long run, will be good for the community,” said Green. “More doctors will come to the area now and stay and have to do their internship and maybe do it at one of the two hospitals here. The fact that there’ll be more doctors available in the community will be good for the city.”

Amanda Dickey is a second-year graduate student at the University of Georgia studying health and medical journalism. She is interested in mental health and the growing population of older adults in our society.