Groups Move to Ease Shortage of Doctors in Geriatrics

Warning that the nation faces a severe shortage of doctors familiar with the medical problems of older people, the American Geriatrics Society and the Blue Cross and Blue Shield Assn. Tuesday announced an unprecedented alliance to train family physicians in geriatrics.

About 10,000 doctors in Blue Cross or Blue Shield insurance plans can obtain special training materials prepared by the society as part of its first formal pact with an insurance carrier. The society is the medical organization for doctors specializing in treatment of older people.

“We recognize that the majority of care [for the elderly] will be given by general internists and family physicians, and our mission is to reach these doctors,” said Dr. Gregg Warshaw, chairman of the society.

Of the nation’s 670,000 doctors, only 8,000 are formally certified in geriatrics and just a few hundred specialists in the field are graduated from medical schools each year, according to the society. But with the population aging rapidly--the number of Americans over 65 is expected to more than double by 2030, totaling 70 million--many doctors will be coping with the special health issues of the elderly.

“It is hard to generalize about older adults,” said Warshaw. At age 75, he noted, “some are in nursing homes with Alzheimer’s disease and others spend the winter skiing in Aspen.”

But Warshaw said his group is concerned that without training, doctors may have difficulty recognizing and treating some of the common health problems among the elderly. These include:

* Drug reactions among patients with multiple pharmaceutical prescriptions from different specialists.

* Urinary incontinence, a condition that often forces people to use adult diapers but in some cases is treatable without the use of such devices or surgery. Many patients can be trained in exercises to control the problem; other patients can be helped with medications.

* Memory loss. Some elderly patients under care for pneumonia or heart failure develop delirium and are misclassified as having senility or dementia. When these patients get out of the hospital, “they successfully get back to normal,” Warshaw said.

Information about dealing with medical problems of the elderly will be contained in documents and reference guides available for purchase by local Blue Cross or Blue Shield plans to supply their doctors.

Blue Cross and Blue Shield have 56 independent insurance plans with 40 million patients, including 600,000 enrolled in Medicare health maintenance organizations.

“Our doctors were asking for this sort of help,” said Scott Serota, executive vice president for system development at the Blue Cross and Blue Shield Assn.

The health plan membership “reflects society as a whole as it ages,” he said.

Initial enrollment will include about 10,000 doctors in 25 Blue Cross and Blue Shield plans that sponsor Medicare HMOs. Under the HMO concept, patients agree to stay within the plan network of doctors and hospitals.

Medicare HMOs, if working correctly, should enable doctors to plan and coordinate care more effectively, he said.

The geriatric training materials also will be available later to other doctors throughout the Blue Cross and Blue Shield system who see patients covered by Medicare, the federal program for those 65 and over and the disabled of all ages.

The standard Medicare system allows free choice among all doctors and hospitals that participate.

“Care in traditional Medicare is extremely fragmented,” Serota said.

“Older patients are referred from one specialist to another, often with no one coordinating the different services.”