Geriatric Medicine: Not Sexy; Not $ Lucrative

Finally, the last entry into the series of blogs that began with Anti-psychotic Drugs for the Elderly .  As I mentioned in that first entry, this all began because of a discussion I was involved in through LinkedIn “Elder Care Matters” on the care of older Americans and the use of anti-psychotic medicines.  Irene Teesdale CLC, a Gerontologist from North Carolina, had shared a lot of statistics with us, which I share below.  Bottom line, young pre-med students do not think going into Gerontological care is “sexy” and or financially lucrative.

There are currently 7,162 allopathic and osteopathic certified geriatricians in the US — one geriatrician for every 2,620 Americans 75 or older.  There are far fewer geriatric psychiatrists. …. – one for every 10,865 older Americans. That ratio is projected to decrease by 2030 to one geropsychiatrist for every 12,557 Americans 75 and older.

Over the last 5 years, a declining number of US medical school graduates have been choosing careers in internal medicine and family medicine — the two fields that are the source of applicants for geriatric fellowship programs.

Becoming a specialist these days is a much more financially lucrative path to follow than being a general practitioner.  Specialty doctors such as plastic surgeons, dermatologists, radiation oncologists are the popular career tracks.  According to studies, one reason for this is because internal medicine and family medicine, precursors to geriatric medicine, make less money and the hours are less predictable.   (oh, dear, there is that focus on money over service again!)

Irene’s input to our discussion continued:

A career focused on caring for older adults can be particularly financially unattractive for physicians with increasingly large medical school loan debts. Physicians graduating from U.S. medical schools in 2010 owed an average of $158,996 for their education. Thirty-nine percent of these graduates said that salary expectations were a moderate or strong influence in determining their specialty.

Since in some cases Medicare reimbursement can be lower than private insurance (interestingly, no one also recognizes that premiums for private insurance are larger than for Medicare when they complain about the smaller financial return of Medicare patients!) and since, obviously, geriatric medical providers mostly deal with Medicare, their incomes do tend to be lower than the above mentioned plastic surgeon, etc.

Last year, when so much politicization was going on about “Obama care” and killing grandma, we really did end up cutting our noses to spite our faces.  Not many people seemed to recognize that by even-ing out the playing field, we might get back to healthcare being a service rather than a lucrative business.  This, in turn, might allow health care to re-focus on its original purpose,  keeping people healthy, rather than, as the current focus on profits might suggest, keeping them unhealthy.

Only a small proportion of practicing healthcare providers have formal training in geriatrics, with less than 1% of doctors, dentists, pharmacists, and nurses, and only 5% of social workers having certification or advanced training in geriatrics or gerontology.

Thank you Irene for sharing these figures with us.  Clearly we need to encourage young Medical students to enter the field of geriatrics and the only way that is going to happen is by providing the same attractive financial returns that plastic surgeons or oncologists get.  This is why, again and again, I tell people that our medical system has it all wrong.  It is looked on as  a profit generating business (and boy is it that and getting more so every day!) rather than as a health care service.

Enhanced by Zemanta