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Preparing for an aging boom
By Anita Martin

These future physicians will have more elderly patients than they may realize, according to an Institute of Medicine study released in April. By 2030, the IOM reports, roughly one in five Americans will be 65 or older (now it’s about one in ten). The senior population will reach 71 million in that year, making it the fastest growing national age demographic.

Despite the impending demand, there will be only about 8,000 geriatricians (up slightly from the 7,100 in practice today) in 2030. The Alliance for Aging Research estimates that the nation will need 36,000.

There are a number of reasons for the discrepancy. According to a 2006 study by the Association of Directors of Geriatric Academic Programs (ADGAP), geriatricians are the lowest paid physicians in the United States—and the only medical specialists who are actually paid less after completing additional training.

“Geriatric medicine is largely exempt from the usual supply-demand economics, since Medicare reimbursement is set by the federal government,” says Wayne Carlsen, D.O., chair of geriatric medicine and gerontology. “When all other expenses in the practice go up and Medicare reimbursements either stay the same or get cut, physician salaries go down.”

Meanwhile, medical students typically incur between $120,000 and $160,000 in educational debt, as reported by the Association of American Colleges of Medicine in 2007.

“With the rising costs of medical school, students are worried about repaying loans, which can deter even very interested students from becoming geriatricians,” says Katie Wehri, OMS III, who served as president of the OU-COM Geriatric Medicine Club last year.

Wehri adds that because elderly patients often have multiple chronic conditions and can present symptoms differently, medical students may find it overwhelming to care for this population.

It doesn’t help that few American medical schools actually require geriatric coursework. In 2006, the New York Times reported that of the 145 U.S. medical schools at the time, only nine percent had a distinct department of geriatric medicine.

“We’re pretty far ahead of the game at OU-COM in terms of what we offer,” says Meyer, pointing out that the college’s former Geriatric Medicine/Gerontology Section (then in the Department of Family Medicine) gained departmental status in 1998. The three-week intensive Geriatrics Block of coursework began one year later.

OU-COM students received distinctive geriatric medical training long before that. The Sensory Changes Lab dates back almost as far as the college itself, as does the required two- to four-week geriatrics rotation, which can be completed through any site in the Centers for Osteopathic Research and Education (CORE) system. And for 23 years, OU-COM medical students have chosen to study international policy issues related to geriatric medicine in Edinburgh, Scotland, through the Charles J. Cannon Edinburgh Geriatric Tutorial.

Meyer adds that OU-COM students begin thinking about geriatric medicine from the start. In the 2007-08 year, geriatric medicine faculty facilitated 350 hours in small-group, case-based studies, 80 hours in classroom and lab time, and another 432 hours supervising students’ early clinical contact—all of which takes place within the first two years of medical school.

“This is so important, because (physicians) will encounter more and more elderly patients in every area of medicine,” Meyer says. Especially in primary care, she adds, the field of choice for 54 percent of OU-COM graduates.  continue

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