Q. My husband, a retired physician and professor, was recently diagnosed with dementia. We were surprised by how difficult it was to find a board-certified geriatrician. I might add, we felt dismissed by one of the specialists who had his hand on the door of the examining room to leave as we were continuing with our question. What’s going on? B.T.

A lot is going on. Finding a geriatrician, particularly one that is board-certified, can be a challenge. It’s not a new story. “The medical profession has been troubled for years by a persistent shortage of doctors who treat the oldest and sickest patients,” as noted in the New York Times (January 3, 2020). Here is the problem: The current inadequate number of geriatricians has remained static while the number of aging Americans is increasing. 

Choosing a geriatrician for your husband’s condition is wise for several reasons. As your physician-husband knows, these are medical doctors trained to meet the unique healthcare needs of older adults. Typically, they are primary-care physicians who see patients in their mid-70s and older. However, this is not a steadfast rule. Most become certified in internal or family medicine and then pursue additional training to become board certified. 

Their niche is the diagnosis, treatment and subsequent care for patients dealing with diseases of later life. If they suspect a serious health problem such as cancer or neurological problem, they refer the patient to a specialist and often remain involved in the patient’s care, monitoring and coordinating their treatments as well as helping to determine what’s most important for their well-being and quality of life. 

Currently, there are about 7,300 geriatricians practicing in the U.S. Assuming one geriatrician can treat 700 patients, we are going to need approximately 30,000 geriatricians by the year 2030. 

California seems to be doing well, leading the nation with 736 such specialists. We are not doing well when considering that California has over six million adults age 65 and older and 1.5 million age 75 plus. 

There are many reasons for the shortage. We have few geriatric fellowship programs. More than one-third of the 384 slots – excluding geriatric psychiatry – went vacant in 2019, according to data from the American Geriatrics Society. Also, geriatricians are paid less than other specialists. Their average base salary is $199,731 per year according to 2021 data. Orthopedics has the highest annual compensation of $511,000. 

Not only do geriatricians earn less, they have less predictable work schedules and spend a longer time with their patients, meaning they can see fewer patients per day. That translates into fewer fees. Medicare payments also are a financial disincentive since payments often are lower than many commercial insurance rates for the same type of service. Add to that the average 2020 medical school debt of $207,000. These shortages occur in spite of geriatricians reporting greater career satisfaction than most other specialists. 

In a 2011 San Francisco Chronicle story, geriatrician Dr. William Thomas attributed some of the shortages to ageism suggesting that some doctors do not want to treat older people because of our religious zeal for a youth culture.

Then there is the word “geriatrics.” We even have a problem with that word according to Dr. Louise Aronson, noted geriatrician at University of California, San Francisco. In her book “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life” (2019, Bloomsbury Publishing), she writes, “If you want patients, funders, institutional support and referrals from colleagues, you must replace “aging” and “geriatrics” with “wellness” and “longevity.” She noted that there is debate within the field to substitute geriatrician with words such as “complexivisits” and “transitionalists.” She considers it “absurd.” 

Should others need a geriatrician, we do have that specialty in the greater Los Angeles area. Contact your local hospital and UCLA’s or USC’s Department of Geriatric Medicine. To find one in the South Bay, contact Torrance Memorial Medical Center’s physician referral line at 310- 517-4700 and Providence Health Resource Center at 800-618-6659. Given the short supply, also inquire about physicians who are board-certified in internal or family medicine and specialize in treating older adults. 

Regarding feeling dismissed – that’s the time to find another doctor. 

Thank you, T.B., for your important question. There are reasons for difficulty in finding a geriatrician. It’s a search that most of us at some time are likely to undertake – if not for ourselves, then for a loved one. Stay safe and well, and be kind to yourself and others. 

Helen Dennis is a nationally recognized leader on issues of aging, employment and the new retirement with academic, corporate and nonprofit experience. Contact Helen with your questions and comments at [email protected]. Visit Helen at HelenMdennis.com and follow her on facebook.com/SuccessfulagingCommunity