Brown University News Bureau

The Brown University Op-Ed Service
Tracie Sweeney, Editor
Distributed June 1998
Copyright ©1998 by John Murphy, M.D.

The nation's aging population deserves better medical care

By John Murphy, M.D.

John Murphy, M.D., is an associate professor, residency director and director of the Division of Geriatrics at the Brown University School of Medicine.

"Today, there are fewer than 9,000 certified geriatricians in the United States. This number is expected to drop by the year 2000, just as baby boomers begin to reach Medicare eligibility"

U.S. health care is ill-prepared to meet the challenges of the nation's aging population.

In 1900, there were 3.1 million Americans 65 and older. Today, that figure is roughly 35 million; by 2030, one of every five Americans will be 65 or older. The fastest growing segment of the elderly, in fact, is people 85 and older - 4 million today; 19 million by 2050.

This population's health care needs are bound to be unmet. Today, there are fewer than 9,000 certified geriatricians in the United States. This number is expected to drop by the year 2000, just as baby boomers begin to reach Medicare eligibility.

But the problem goes beyond statistics. Geriatrics is a relatively new field. Medical science has learned a lot about aging and how to prevent and manage disease and chronic illness. Unfortunately, this geriatric research and knowledge is not being spread to medical students and through the health care work force.

For example, in academic year 1994-95, only 10 percent of all U.S. medical schools required their students to complete a separate required course in geriatrics. The majority of current physicians and other health care professionals have never had geriatrics training.

Too often, illnesses in older people are misdiagnosed, overlooked or dismissed as the normal process of aging, simply because health care professionals lack training to recognize how diseases and drugs affect older patients. This translates into needless suffering, unnecessary costs from inappropriate hospitalizations, multiple visits to specialists who may order conflicting treatment, and avoidable admissions to nursing homes.

Geriatric medicine promotes wellness and preventive care, with emphasis on care management and coordination that help patients maintain functional independence and improve their overall quality of life. With their interdisciplinary approach to medicine, geriatricians work with a coordinated team of nurses, geriatric psychiatrists, physician assistants, pharmacists and others. Geriatricians strive to balance the use of expensive high-tech interventions with the potential harm these procedures can cause in older persons with multiple chronic illnesses.

A bleak financial picture, however, steers most physicians away from a career in geriatrics. Geriatricians depend almost entirely on Medicare revenues. Although money is available to pay for hundreds of separate costly procedures, the system won't reimburse for coordinated assessment and case management provided by geriatricians and an interdisciplinary team focused on an elderly patient's overall well-being.

This is the real problem in recruiting physicians to geriatrics. The Medicare reimbursement system makes it difficult to provide effective care. What health care professional would find fulfillment in doing a lousy job?

Clearly, there is a need to train all health care professionals - students as well as current professionals - about the special needs of older adults, and to find ways to increase the number of geriatricians.

As a member of the American Geriatrics Society, I recently testified before the Senate Special Committee on Aging and urged Congress to adopt several recommendations, including:

Our challenge is to reform the way we approach medical care for older Americans in general. Failure to do so may result in billions of dollars being spent for ineffective services on a population of Americans that ultimately includes ourselves.