5 Frightening States for Elderly Access to Doctors

As your baby boomer clients are heading into their “oldest old” years, the U.S. shortage of physicians certified in geriatrics is getting worse. That could turn any post-retirement health care funding plans you have helped your clients create into works of financial fantasy.

Only 34.3% of U.S. states had enough certified geriatricians to meet American Geriatrics Society supply standards in 2016, down from 34.9% in 2015, according to society data included in the 2017 America’s Health Rankings Senior Report.

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Analysts at an affiliate of the Minnetonka, Minnesota-based United Health Foundation create the rankings reports, using many different private and government data sources, to provide a state-by-state look at senior population health.

The analysts who compiled the new report found that some indicators they track look better this year. One example is the number of preventable hospital admissions per 1,000 Medicare enrollees. The number fell to 49.9 discharges per 1,000 enrollees this year, from 53.8 discharges per 1,000 enrollees last year.

Since 2013, the rate of hospitalization for hip fractures fell per 1,000 Medicare enrollees has fallen to 5.8, from 7.3.

A gerontologist is a professional, coming from any scientific field, who studies the effects of aging on a society or on individual people.

A geriatrician is a physician who has spent one or two years learning about the needs of older patients in a fellowship program. Health policy watchers point out that physicians in most specialists treat many elderly patients, and that physicians in fields such as cardiology may get the equivalent of geriatric training through personal experience with treating large numbers of older patients.

The analysts at the United Health Foundation, however, are affiliated with UnitedHealth Group Inc., a health insurer that faces strong financial incentives to minimize any unnecessary use of specialty care, including geriatric care.

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The foundation analysts made a conscious choice to include a geriatrician shortfall indicator in their report.

“Geriatricians are specially trained to meet the unique needs of older adults in both outpatient and inpatient settings,” the analysts write in a discussion of the geriatrician shortfall data. “In inpatient settings, seniors receiving care in special geriatric units have better function at the time of discharge, and inpatient rehabilitative services involving geriatricians result in lower nursing home admissions and improved function at follow-up compared with standard care.”

The United States needs about 20,000 certified geriatricians to serve the 45 million most vulnerable U.S. residents over 65, and, in 2016, it had just 6,874, according to the American Geriatrics Society.

The geriatrician shortfall indicator may be a rough indicator of the percentage of phyisicans, nurses and other health care providers who have received any kind of formal elder care training. If the ratio of certified geriatricians per 1,000 older U.S. residents is falling, it’s possible that the ratio of providers with other types of formal and informal training is also falling.

One obstacle to expanding the supply of certified geriatricians is that traditional fee-for-service Medicare reimbursement arrangements have paid geriatricians poorly, partly because successful geriatricians often reduce the number of services patients get, according to the American Geriatrics Society. New geriatricians come out of fellowship programs with about as much debt as other new physicians, but they have less capacity to pay back the loans.

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In absolute percentage terms, the size of the 2016 geriatrician gap ranged from a low of 23% in Hawaii, the state with the best geriatrician supply, to 89%, in Montana. Montana had only eight certified geriatricians. The American Geriatrics Society thought it should have 74.

To find out how the shortfall situation is changing, we compared the senior health rankings geriatrician shortfall percentages for 2015 and 2016. Here’s a list of the five states with worst deterioration, ranked in terms of the change in their geriatrician shortfall percentage.

South Dakota flag (Photo: Thinkstock)

5. New Hampshire