The potential problem of widespread physician shortages in the era of health reform, noted by the Association of American Medical Colleges, the American Academy of Family Physicians and others, becomes even more challenging when we look beyond mere numbers and consider factors such as what kind of physicians are needed for whom and where. In particular, the increased needs of aging baby boomers expose a dire shortage of geriatricians.
As a snapshot, the Sacramento Bee reports that across four counties in the country's most populous state, just 15 physicians boast credentials to care for the nation's fastest-growing age group, according to the California Medical Board. Nationwide, the number of geriatricians has dropped by a quarter since 2000, down to 7,000; yet the American Geriatrics Society estimates 36,000 will be needed by 2030.
The difference between geriatric specialists and other primary-care physicians, also in short supply, is that they may be more in tune to seniors' lifestyle and the treatment of chronic conditions that require management rather than a cure.
For example, when an older person breaks a hip, an orthopedist treats the fracture and an internist tests for osteoporosis, Dr. Michael McCloud, a University of California Davis geriatrician known widely for his annual Mini Medical School on healthy aging, tells the newspaper. "But the geriatrician says, 'Why did this person fall and how will we keep them from falling next time?'" McCloud said. "Has anybody taken the blood pressure, not just sitting but standing up and after a meal, when it's likely to be lower? Has anybody taken a look at the number of medications this person takes?"
And not only will people over 65--a population that will double between 2000 and 2030--seek more preventive and comprehensive care, but they'll also need more cardiologists, urologists, endocrinologists and other specialists to deal with issues such as heart disease, diabetes and respiratory problems, Dr. Atul Grover, chief advocacy officer for the AAMC, told the Los Angeles Times.
As with the shortages in primary care, potential ways to fill the gaps include increased use of telemedicine and supporting providers. But, as The Times points out, both of those strategies bring their own set of controversies and challenges.