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Shortage of geriatric doctors

Compensation needs to change to meet growing demand for services; country needs to learn to sacrifice again

Every eight seconds, another American turns 65. Currently, about 12 percent of the population is over 65 years of age, but longer lifespans will increase that number to 19 percent in the next 20 years.

Who will care for our seniors? During the 2008-2009 academic year, nearly 40 percent of first-year openings for doctors specializing in geriatric medicine went unfilled. The Medical School of Wisconsin recently shut down a model geriatric care center that provided services for 1,500 patients because it was losing more than $1 million a year.

According to Dr. Jerald Winakur, in an opinion piece this week, more doctors specializing in the elderly are retiring each year than are being trained in medical schools.

Winakur points out that geriatrics is the lowest paying specialty, and when you consider the massive debt load most medical students assume upon graduation, it’s no wonder it’s become an unpopular career path – even at a time when the need for it is exploding.

A large part of the problem is that health insurers, including the government’s single-payer Medicare, compensate doctors based on the number of procedures they perform and the volume of patients run through their practices. That isn’t a good fit with treatment of seniors, where doctors often need to spend more time with an older patients whose aging bodies have more complexities to treat –  and often with consultation and not procedures.

Another part of the problem is Congress’ reluctance to find a permanent fix to the Medicare doctor-reimbursement formulas. It just provided another quick fix to prevent a 23 percent cut in doctors fees for 2011, but will need to apply another bandage next December to extend it again. It’s hard to attract doctors to commit to a career in senior care when its future is so fragile.

Congress looked at making a permanent fix when designing its health reform package last year, but balked at the price. That’s not surprising in an America in which no one is asked to make sacrifices for the common good anymore.

It started back when President Reagan dropped the top marginal tax rates from 70 percent to 28 percent back in the 80s and continued through the Bush years when that President handed out generous tax cuts while fighting two wars – a clueless don’t-worry-about-tomorrow attitude unmatched by any other occupant of the Oval Office.

No one should make the mistake of calling the Baby Boomers our greatest generation. Every other generation has done without so its children would do better. This generation steals from its children, and now from its parents, to finance its needs of the moment.

Shame on President Obama and members of Congress from both parties, for this recent tax bill. Perhaps the economy needs the shot in the arm – and extension of these cuts to the first $250,000 of household income – but there is no excuse for not capping it there; anything above that is just a giveaway to those who are already the most successful in our society. They aren’t the ones that need the help, but they are the folks who should feel the biggest obligation to pay back to society.

Maybe I’m just a cranky old middle aged guy, but I think paying taxes should be considered a patriotic act. If we all consumed a little bit less, and secured the social safety net by paying a tiny bit more in taxes, we would have a stronger, prouder country.

Or maybe I’m just as selfish as the rest of my generation, because I’m worried there won’t be any geriatric doctors in a dozen years when I’ll start to need them!

Either way, America needs to shrug off its short attention span and fix the Medicare reimbursement problem. To do otherwise is both selfish, and shortsighted.

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