MORGANTOWN – West Virginia ranks third for the nation’s oldest population – after Florida and Delaware – and people are living longer. But there are not enough geriatric specialists to take care of them, WVU Medicine’s Dr. Osvaldo Navia told The Dominion Post.
The state, and nation, also don’t have enough people interested in entering the field, he said. Prospective physicians are more interested in other specialties. “That’s a big challenge we are facing right now.”
Navia is WVUM’s Division Chief of Geriatrics, Palliative Medicine and Hospice, Grace Kinney Mead Chair of Geriatrics, and program director of WVU medical school’s Geriatric Medicine Fellowship.
Geriatricians may receive lower pay than other specialists, he said, while the profession has its own special qualifications and challenges. “Taking care of people over 65 need a special personality,” he said, and different goals and ideas about how you think about medicine.
Geriatric care is always complex, he said. Patients may have multiple medical issues and perhaps a long list of medications.
“It’s quite difficult just to put things together and coordinate care of this patient,” he said. “We’re not going to be able to cure them. We’re going to have to have a different approach, to improve their quality of life.
“We geriatricians love to talk to families,” he said. Patients my have memory issues, face challenges processing information. “We realize it is a great help if somebody has a family member next to them, which is not always the case. Every time we see a family member we see the opportunity to improve the health of the patient.” And sometimes the patient and their family caregiver – a son or daughter – are both over 65 and they can care for both, he noted.
A geriatrician may perhaps see things a regular PCP won’t see or be trained to deal with, he said.
“We treat patients, I would say, in a very proactive way. We are trying to just be ahead of any complications in terms of health.”
WVUM has six geriatricians and three physicians in family medicine who deal with geriatric patients. Marshall Health’s website shows about 20 providers who deal mainly or in part with geriatric patients. The American Geriatrics Society did not provide statewide and national numbers in time for this story.
Navia said that by 2030, the nation will have 20 million people over 65, explaining the U.S. will probably need 27,000 geriatricians nationwide, and right now we have about one third of what’s needed. West Virginia needs at least seven- to 10-times more than it has, and even that might not be enough.
He said he has taken some steps to try to grow the numbers at WVU and WVUM, and to care for the state’s aging population. Within the last six to seven years, he said, Geriatrics has organized an outpatient clinic and offers inpatient consulting service at Ruby. Geriatrics providers visit nursing homes in area. Rockefeller Neuroscience Institute has a memory clinic.
In the last two years, he said, he’s organized a geriatrics fellowship to train residents interested in the field. The first fellow just completed his training and has been hired as a clinician. “It’s always a challenge. It’s not like a very popular specialty for us.”
The American Geriatrics Society (AGS) agrees with Navia about the shortage. “In the U.S. there is a workforce crisis, with a disappearing supply of primary care physicians, including geriatricians.”
According to the U.S. Health Resources and Services Administration, AGS said, there will only be 6,230 geriatricians by 2025, or approximately one for every 3,000 older adults that require geriatric care, “leaving thousands without access to these services.” Additionally, rural populations have more limited access to primary care physicians than residents of urban areas, and generally are older, have a higher incidence of poor health, and face greater socioeconomic barriers to receiving care.
In May, AGS sent a letter to several U.S. Senate Appropriations leaders, including Sen. Shelley Moore Capito, requesting more funding for Geriatrics Workforce Enhancement Programs and Geriatrics Academic Career Awards.
“Given the increasing diversity among older people and rapid growth of the older population, the need for a diverse workforce as well as training in geriatrics and gerontology will continue to increase,” AGS wrote. “The only federal programs that focus on training the workforce to care for older Americans must keep pace with that growth.”
AGS explained that Geriatrics Workforce Enhancement Programs educate and engage primary care physicians, nurses, social workers, the caregiving workforce and other health care professionals as well as family caregivers and focus on opportunities to improve the quality of care delivered to older adults, particularly in underserved and rural areas. In academic year 2021-22, GWEPs trained over 1 million health care professionals, students, patients and caregivers.
Geriatrics Academic Career Awards complement the GWEPs. “GACAs ensure we can equip early-career clinician educators to become leaders in geriatrics education and research. It is the only federal program designed to increase the number of faculty with geriatrics expertise in a variety of disciplines, providing training in opioid use treatment, health equity/social determinants of health, and more”
The Dominion Post sent questions to Capito about this letter but she was visiting the state Capitol on broadband issues and unavailable to respond.
Navia said that at the state level, West Virginia needs a good plan to engage residents and offer support for those who want to enter the field. That might include help covering training debts.
The state also needs new new specialized clinics, he said. “We need to get more engaged with the community,” the community at large but also the medical community about what geriatrics means.
Some states, such as New York, he said, have initiatives to care for the elderly – such things as medical assistance at home to help with daily living, administering medications, feeding, transportation to appointments. He understands money is a constraint.
We either need to train more geriatricians or teach more geriatrics to regular PCPs, he said. And we need a solid way to teach geriatrics to mid-levels – physician assistants and nurse practitioners.
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