Fewer Doctors Specialize in Elder Care

WASHINGTON — When Marie Brown’s 97-year-old mother fell and broke her hip two years ago, it started the family on an often frustrating quest for appropriate medical care.

Doctors unfamiliar with the health issues of the elderly initially put Mary Holmes, then 94, on bed rest. That weakened her muscles so that her knees no longer could bend. The Washington, D.C., woman became permanently bedridden.

“I think she became pretty down,” said Brown, 65. Before the accident, she said, her mother loved to dote on her family and often would have her four children and a host of grandchildren over for dinner. “She just got depressed. She was just laying there.”

Frustrated with the care her mother was receiving, Brown began searching for medical professionals trained to deal with the elderly. For the last year, her mother has been working with a geriatric team from the Washington Hospital Center that provides medical care and therapy.

“Unfortunately when you go to a non-geriatric doctor, they give you a pill and send you home,” Brown said. “The people who are trained really pay attention to what’s happening to you.”

Geriatricians are doctors with expertise in caring for older people. Most are trained in family practice or internal medicine but have completed one additional year of fellowship training in geriatrics.

“Training in geriatric medicine can help save or improve the lives of people who still have much to give,” said Dr. Charles Cefalu, director of geriatric program development at Louisiana State University.

Health officials are sounding the alarm that, in a country where the number of elderly is on the rise, there are too few health providers knowledgeable about aging issues. They want Congress to address the shortage this year as lawmakers write far-reaching Medicare reform legislation.

“The shortage of geriatric-trained health-care professionals is reaching crisis levels,” said Sen. John B. Breaux (D-La.), chairman of the Senate’s Special Committee on Aging.

The United States should have 20,000 geriatric-trained physicians to adequately care for the 35 million older people in this country, says the Alliance for Aging Research, an advocacy group.

But fewer than 9,000 of the nation’s 650,000 licensed physicians have met the qualifying criteria in geriatrics, and that number is expected to drop to as few as 6,100 by 2004, the alliance said in a recent report.

Reasons for the shortage vary and include a lack of geriatric curriculum at medical schools. But officials say topping the list is Medicare’s paltry payments for doctors who care for the elderly. Just this year, doctors treating Medicare patients learned there would be a 5.4% cut in Medicare payments.

The cut would cost a geriatrician $30,630 a year, according to the American College of Physicians. A four-physician geriatrics practice would lose $122,520 a year, the group estimated.

Doctors are lobbying Congress to restore the money.

“It’s a real disincentive,” said Daniel Perry, executive director of the Alliance for Aging Research.

A geriatrician often does a complete assessment of a patient, bringing in nutritionists, pharmacists and social workers--a process that takes a considerable amount of time.

“When time comes to be recertified ... they have to ask themselves, ‘Why am I seeing all of these old people on Medicare because Medicare every year is paying me less and less,’” Perry said.

The problem is coming just as the number of older Americans--those 65 and older--is expected to more than double, to 70 million by the year 2030.

The alliance wants Congress to set goals for increasing the number of geriatric providers in all fields. It also is calling for financial incentives, such as loan forgiveness and continuing education funds, to entice professionals into the field.