The need for specialists in the field of geriatrics is only expected to skyrocket as one in five Americans will be over age 65 by 2030. Photo via Matthew Bennett on unsplash.com
Written by Breanna Hardy
Some experts in medicine call geriatrics a hidden gem of a specialty, but with the growing aging population and shrinking physician pool to care for the elderly, they’re calling for more physicians and health care workers to the field.
Michelle DiBuduo, executive director of Valley Caregiver Resource Center, started in her position at 40 years old as a volunteer. She’s now 63.
Valley Caregiver Resource Center acts as an advocate for those taking care of a loved one with dementia or chronic illness, or for those in skilled nursing facilities.
“Everyone knows how they were impacted with Covid – not being seen, not being visited. It was a huge issue,” DiBuduo said.
There are 45 million Americans who are 65 years or older, and that number is expected to grow by 2030 to 73 million Americans. One in five Americans will be older than 65 by 2030, and there might not be enough physicians or employees to care for the population.
It’s an issue that DiBuduo says needs to be addressed before it’s too late.
“It will be the first time ever the country will be comprised of more older adults than of children, and it doesn’t take much to look around and see how unprepared we are for that,” she said.
There is not a community effort to help our seniors or family caregivers, many of whom are unpaid if it’s for a relative.
The challenges are overwhelming, she said, with cost, lack of support, isolation and lack of education.
Alzheimer’s disease is something many people are concerned about, but not many people are equipped to deal with it, she said.
“It’s a challenge getting people on board to help people who are going through it,” she said.
Many people think senior issues are already taken care of by family, but burdens rest on these same family members to care for loved ones amidst trying to work a job
Even getting people in the community to stand behind senior caregiving and donate is a challenge. And the cost of placing a family member in a senior living facility can be prohibitive for most people, DiBuduo said.
“So now you have all these family members who are bringing their loved one to get help and now they are limited,” she said.
The Public Policy Institute of California reported in 2016 that the occupancy of nursing facilities could be overcome by 2030, with the demand in San Joaquin Valley projected to grow 60% from 2014.
But Dr. Alex Sherriffs, medical director at UCSF Fresno Alzheimer’s & Memory Care Center, said the demand is already much, much greater than the supply.
“It’s only going to increase,” he said.
“When you think about the generation and all they’ve done for everyone, and then just to be left alone is sad — even for the person who is a senior or the person taking care of them,” DiBuduo said.
There have been more skilled nursing facilities built since then, but there needs to be employees to meet the need.
Mindy Wilds, executive director of Sequoia PACE, an at-home senior care entity, says she hasn’t had a problem employing nurses. She believes it’s possibly due to burnout in hospitals during Covid-19. When nurses learn of the 9 to 5 work model, it attracts new hires, she said.
“I think there is definitely the potential for us to be short staffed,” Wilds said.
Though this may be true of the future, she said they’ve hired more than 100 people in the past year.
DiBuduo said the state of California’s Master Plan for Aging helps, but is only scratching the surface when it comes to caring for seniors. The Master Plan for Aging was born out of an executive order by Gov. Gavin Newsom in 2019. It outlines goals and strategies for building a “California for All Ages by 2030.”
The life expectancy has trended upward, making it even more important to access geriatricians. The amount of geriatricians is expected to grow by 2025, but not at the rate of demand. The American Geriatrics Society reports that there will have been a total 45% increase in demand for geriatricians between 2013 and 2025.
Dr. Loren Alving is the director of the San Joaquin Valley PRIME program, and of the UCSF Fresno Alzheimer’s and Memory Center.
“Much of the work that I do in neurology is really geriatric neurology in general,” she said.
The PRIME program (Programs In Medical Education), is a track of the UCSF School of Medicine. Students spend a year and a half in San Francisco doing pre-clerkship work, then transfer back to the Valley to do clinicals in the hospital.
Though there are other regional PRIME programs, the Central Valley’s was made specifically to train up more physicians here.
“I think the need for physicians in the Valley is so great, that it’s hard to overestimate,” Alving said. “We have to find a way to make geriatrics the kind of career that people want to choose.”
There are very few geriatricians who are board certified in the Central Valley. It affects the specialized care for the elderly, but it also makes it hard to train upcoming doctors, she said.
“If you don’t even look at the elderly, just look at everybody in general, we have far fewer docs than are in the rest of the state, particularly the Bay Area, particularly LA,” she said. “And then if you look at geriatrics – well that’s even more problematic.”
Training is mandated, meaning residents go through a unit of geriatrics to know the basics of care. However there are limited geriatric fellowships and robust experiences available for residents interested in geriatrics.
She said the reward of caring for elderly patients is hearing their stories.
Alving thinks that people are understanding what needs to happen to meet the demand of geriatric care, but it doesn’t just include physicians. It involves proper transportation, putting meaning in people’s lives and allowing them to socialize. She said these components will add more to life than even medicine can.
“We’re not going to be able to keep up with the need. We already don’t keep up with the need, and it doesn’t put us in a position to overcome that deficit,” Alving said.
While people can recruit students who are interested in geriatrics, Alving said there’s not a robust pipeline in place.
Alving said exposure would help students understand the value of the field.
“It’s kind of the best kept secret,” Alving said.
Sherriffs said the Valley in general has a shortage of physicians of many kinds compared to the rest of the state and country.
Sherriffs said in his work at the UCSF Fresno Alzheimer & Memory Center that people want a generalist who can treat a breadth of issues, like a family medicine geriatrician, as opposed to a specialist — unless it’s really necessary.
“It is a real need and a problem,” he said. “If we look at how much money the United States spends on health care and, in fact, the poor medical outcomes that we get compared to many other countries — well, it’s in part because of our underappreciation, our under-reliance on primary care.”
While family medicine practitioners can provide geriatric care, not everyone’s training has equipped them with tools to care for the aging population. But the importance of care for the aging population is to keep expertise in managing multiple health diagnoses and multiple causes for the diagnoses.
Patients really appreciate someone who’s been trained to listen, and listen carefully. Someone who is more attuned to try and understand the patient’s values and how that drives their priorities and decision-making, he said.
“Geriatric training, I think, emphasizes more quality rather than quantity, which is what most older patients want,” Sherriffs added.
Treatment has changed over the years during his practice, particularly in how the medical field manages diseases.
Many diseases that used to be killers have become chronic diseases, so the work is about maintaining functionality in older patients. However, he said, the interest of younger generations of upcoming physicians might shy away from “maintenance treatment” because it doesn’t always produce direct results.
“We’re not managing things to cure. We’re managing things to maintain function and help people be comfortable,” he said.
He said that he doesn’t see the workforce moving strongly toward primary care or geriatrics, with minimal interest among medical students for geriatrics. There’s many factors, including student debt and getting satisfaction out of curing things – two things that geriatrics doesn’t always lend to.
Historically, the American health care system rewards procedures, he said. Chronic disease management is generally not about procedures, but about weighing different treatments.
“There is clearly a financial issue, and people are coming out of medical school with increasing debt and it looks daunting,” Sherriffs said.
People are aware when they’ve been cured, and they’re grateful. But when sickness is prevented, no one knows and doctors aren’t necessarily recognized for it.
“It’s very satisfying to cure somebody. Job done, onto the next job. It’s a different kind of satisfaction to have prevented something and, you know, what do you know that you’ve prevented? You don’t… it’s hard to know what we did and didn’t prevent,” Sherriffs said.