Geriatric Physicians (Or Geriatric Nurse Practitioners)
There is currently little incentive to encourage established doctors or students in medical school to specialize in geriatric medicine. Even though it is a recognized specialty, according to the American Geriatrics Society, there are only about 9,000 M.D. Geriatricians and several hundred osteopathic physicians (DO) certified in geriatrics, as well as some 2,400 board-certified geropsychiatrists in the United States . (A geropsychiatrists it is a psychiatrist trained to deal with the mental health needs and specific syndromes faced by older adults).
According to the statistical abstract of the United States there are approximately 770,000 practicing doctors of medicine in the United States . This means there is roughly 1 doctor, including specialists, for every 300 persons in the United States . Based on the numbers above there is only about 1 Geriatrician for every 3,000 elderly persons in this country. Because there are so few of them, it may be impossible to find a physician specializing in geriatric care in some areas of the country.
There are probably many more family physicians or internists who specialize in treating older people and from experience they have probably learned many of the issues associated with treating the elderly, but many of these practitioners could probably benefit from more specialized geriatric training if it were available.
Out of 145 medical schools in the United States only five have geriatric care departments. Many more medical schools offer elective courses in geriatrics but only 3% of all medical students ever enroll for such classes.
Helping elderly people who are nearing the end of their lives and who suffer from multiple, incurable and chronic disorders is often not an appealing prospect to family doctors or to young medical students. Besides, geriatric care typically does not produce as much income as other specialties.
Most doctors who treat the elderly are reimbursed either through Medicare or sometimes through Medicaid or sometimes a combination of both. These government programs have become more and more stingy over the years. Many doctors who in the past have accepted Medicare find that they have better paying opportunities treating younger patients and they will no longer accept new Medicare patients. And as long as those younger patients are available for treatment, few doctors are going to go out of their way to seek out Medicare or Medicaid reimbursement.
There are doctors, geriatric nurse practitioners or physicians assistants who derive satisfaction from working with older people. And they may be taking a cut in pay by doing this. These practitioners are most likely going to be Geriatricians. An older person or his or her family should seek to find these geriatric care specialists in their area or if that is not possible, an effort should be made to locate a geriatric clinic in the area. Geriatric clinics are becoming more popular and even though the doctors who staff them may not always be geriatric physicians they are likely to be more aware of the problems associated with treating elderly people. Many geriatric clinics include a team of specialists to help older people. Here are some of the specialists who may be available in a geriatric clinic.
- Geriatrician
- Nurse
- Social worker
- Nutritionist
- Physical therapist
- Occupational therapist
- Consultant pharmacist
- Geropsychiatrist
If there are no Geriatricians or geriatric clinics in the area, an attempt should be made to find those doctors who specialize in elderly care. This can be done by making phone calls to various doctor's offices or by checking in the Yellow Pages. Too often, the elderly or their family is content to work with the doctor whom they like but who has little experience in geriatric care. Personality is an important issue but it is more important to find a qualified doctor to care for an aged loved one.
Home Visiting Doctors
Many doctors are returning to the practice of medicine a hundred years ago and are making house calls. Health insurance plans including Medicare will now reimburse a doctor and possibly a staff member -- if test equipment is involved -- to visit homebound patients in their homes.
To qualify for a home visit the patient must experience great difficulty in leaving the home in order meet with the doctor in his or her office. This does not however mean the care recipient need be totally disabled. It simply means that transportation requirements or help needed to get to a doctor might be very expensive or difficult to provide or the patient's safety might be jeopardized by leaving the home.
Doctors are willing to visit in the home and provide service because they are paid more money by health insurance providers to compensate them for their time and their loss of efficiency in meeting patients in their offices. Probably the insurance providers reason that the additional cost of meeting with patients at home, before major medical problems evolve, is more cost effective than paying for ambulances and treatment in emergency rooms.
Doctors who make home visits are more likely to be experienced in geriatric care. This is because most homebound patients are typically older. This is a positive advantage for a family using a home visiting physician since we have been making a point that it is better for the older person to be treated by a doctor with experience in this area. It will typically result in better care.
There are also a number of advantages to using home visits as opposed to office visits. The patient will be more relaxed and cooperative in familiar surroundings. Older people are thrilled that a doctor would take time to visit them in their homes. They will be more compliant, more open and as a result receive better treatment as opposed to receiving care in the doctor's office. Typically the doctor will take more time and be able to establish a better rapport with his patient. The idea of the doctor not having to hurry off to another patient in another room is comforting to an older person.
Another very important benefit is that the physician can see the environment in which his patient is living and have a better understanding of how that environment may affect his patient's health. By seeing it first-hand, he can make recommendations for care that would have been impossible in his office. In essence the doctor learns much more about a patient in her home and he can achieve a personal connection that would have been difficult to establish in the office. The ultimate outcome of a house call is that the doctor can provide a greater degree of holistic medicine.
A home visit patient can receive house calls on a periodic or ongoing basis. The patient need not give up other doctors if the reason for being homebound is temporary. Testing equipment in the past few years has become more portable and the doctor can bring an assistant who might provide tests on site. Heart function, lung function and simple blood tests performed on site can give the doctor an immediate feedback on the needs of his patient and allow him to make treatment decisions without the delay of waiting for test results.
Health Care Advocates
Sometimes it's easier for a person to hire someone to walk through the maze of finding doctors, making sure treatments are appropriate and working with insurance companies. There is a growing industry designed to help people in this area. It is also important to remember that area agencies on aging can provide counseling services for Medicare at no cost. But the services of health-care advocates are typically broader and can save a great deal of time for people who have the money to hire someone to be their advocate.
