- Pumping Irony -

PUMPING IRONY: Is There a Doctor in the House?

A dwindling supply of geriatricians offers few options for elderly patients who are often ill served by physicians who are not trained to treat them.

Picture of a doctor's office

I’ve long operated under the slightly unconventional — some would call it delusional — assumption that there’s little to gain by bringing my various age-related afflictions to the attention of My Beleaguered Physician on those rare occasions when I show up at the clinic to get my ears cleaned. I don’t doubt his sincere interest in lowering my blood pressure and cholesterol numbers with a time-tested regimen of pharmaceuticals, nor do I question that my stubborn refusal to accept his advice during our seven-minute interactions gives him pause. But there are no non-drug tools in his toolbox (except his nifty ear-cleaning contraption) that I don’t have in mine.

He doesn’t need to tell me, for instance, to get plenty of exercise and sleep, to eat right, and to manage my stress. I know that already, and pursuing those goals probably has something to do with the fact that I remain ambulatory well into my seventh decade — despite avoiding doctors at all costs.

And even if I did visit MBP to clear up something other than my ears, recent research suggests that he, like most general practitioners, would be hard-pressed to understand what was actually going on inside this well-worn body of mine.

A University of Washington study, published in the Journal of the American Geriatrics Society, found that clinicians often overlooked multiple symptoms when consulting with their geezer clientele. That’s not just because seniors like me often head to the doctor with a single symptom and tend not to dwell on whatever else may be bugging us, but it also has to do with the fact that most physicians aren’t trained to treat the elderly.

Lead study author Kushang Patel, PhD, MPH, and his team identified six of the ailments most common to seniors — pain, fatigue, depression, anxiety, breathing difficulty, and sleep problems — and followed 7,609 Medicare patients over the course of six years to determine whether physicians were able to pinpoint the problems. They found that clinicians overlooked two or more of these ailments in nearly half of the participants, and three or more in another quarter of the group.

Any single symptom, Patel explained, may have multiple causes and reinforce each other. If I visit MBP complaining of some lingering pain, for instance, I may also be suffering from poor sleep and general fatigue. But, because he’s not trained to look beyond the presenting symptom, I’ll likely be ushered off to the pharmacy for some opioids, which will do little to address my other issues.

“Our results indicate that the overall burden of symptoms is something the clinician should consider, as it may have an impact that is not apparent when just dealing with diseases and symptoms individually, one at a time,” Patel said in a statement. “For many older adults, symptoms often interfere with accomplishing daily activities. Addressing symptoms gives clinicians an opportunity to identify the patient’s goals and priorities, which can then help guide treatment decisions.”

But unless you’ve been trained in geriatric care, you’re not going to be prepared to make that call. And the vast majority of medical-school graduates skip those classes; only about a quarter of U.S. medicine residencies require geriatric rotations. As Ramy Sedhom, MD, and David Barile, MD, note in a 2017 Gerontology & Geriatric Medicine editorial, “Although most medical schools offer training in some aspect of geriatrics and palliative care, it is nearly universally inadequate.”

That leaves it up to a dwindling supply of geriatricians to take up the slack. And the numbers do not inspire optimism: Patel estimates there are only about 7,200 of these specialists currently practicing in the United States. And there’s no evidence to suggest that population is going to increase much in the future. The National Resident Matching Program reports that only 35 of the 139 geriatric fellowship programs were filled last year. By comparison, prospective cardiologists filled 198 of 203 fellowship programs.

You need only look at the salary disparities to at least partially explain those numbers: Geriatricians can expect to earn, on average, around $190,000 a year — not a bad wage, but it’s less than half what a cardiologist will bank. That’s because those who treat seniors depend on Medicare payments, which are typically lower than the private-insurance reimbursements paid to other specialists.

But it’s not just about the Benjamins. Sedhom and Barile suggest that the unique challenges of treating the elderly are simply too daunting for most aspiring physicians. “The healthcare needs of older adults differ substantially from younger patients,” they write. “The physical, social, and behavioral effects of aging are often occurring simultaneously to both acute and chronic illnesses. The synergistic effects are often debilitating.”

I’ve never inquired whether MBP took a class in geriatrics — those seven minutes fly by — but I have no reason to question his commitment to patient care. General practitioners earn even less than geriatricians, after all. But when this old body of mine begins to break down, it’s pretty clear I’ll be looking elsewhere for advice.

I can’t imagine he’d be disappointed.

is an Experience Life deputy editor who explores the joys and challenges of aging well.

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