Family physician Richard Madden, M.D., has been practicing in the small town of Belen, N.M., since 1985. During the past 27 years, he has seen first-hand the aging of his town's population -- the children who have grown into adulthood and the adults who are now senior citizens. As a consequence, Madden now takes care of more patients who are in the elderly age group. And this has added to the complexity of patient care, forcing Madden and his staff to address and treat conditions that are more prevalent among geriatric patients.
"I have patients who come in and they don't have two problems, they have six problems," says Madden.
Madden's experience with the changing demographics of his practice's patient panel is a scenario being played out in thousands of family physician practices throughout the United States. And it is a trend that has profound repercussions for the nation's family physician workforce.
"The percentage of older people in everybody's practice is going up," says Gregg Warshaw, M.D., a professor of family medicine in the Department of Family and Community Medicine at the University of Cincinnati's College of Medicine. "That is just the way it is."
In fact, the proportion of Americans 65 and older is projected to increase from 12 percent in 2005 to 20 percent by 2030, according to Family Physicians' Present and Future Role in Caring for Older Patients(www.graham-center.org), which was produced by the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care. That percentage will be even higher in rural areas, which already have a greater proportion of geriatric patients, according to the report.
- Family physicians often are the key caregivers for geriatric patients, serving as a linchpin for care coordination and management.
- With the aging of the nation's population, family physician practices are caring for more geriatric patients.
- The aging of the patient population presents both opportunities and challenges for the family physician workforce.
The result is that family physicians will need to take care of many of these patients because, although the shortage of family physicians in the United States is well known, there are even fewer physicians certified in geriatric care. In March of 2011, there were about 7,162 certified geriatricians in the United States -- including many family physicians -- hardly enough to take care of a burgeoning geriatric population, according to the American Geriatrics Society.
The shortage of physicians specifically identified as geriatricians leaves most of the care of elderly patients up to family physicians, who are well-suited to caring for this age group because of their training in treating patients from birth to death. This has created both opportunities and challenges for family physicians.
"I enjoy the challenge of working with older patients," says Warshaw. "They usually have more than one problem. They are frequently on a lot of medications, and they need to be carefully managed. They go to the hospital and the nursing home more often. There are a lot of things to juggle. But I find that they are a challenging and exciting group of people to take care of."
Family physician Jerome Epplin, M.D., a physician partner with Litchfield Family Practice Center in Litchfield, Ill., agrees with the sentiments expressed by Warshaw. "I find it actually kind of challenging to keep people going," he says, but he also acknowledges that for some physicians, "the concept of geriatric preventive care is almost foreign." And for some physicians, taking care of geriatric patients can be a cumbersome and even daunting task.
In addition, most geriatric patients are on Medicare, which poses specific coding challenges when it comes to getting paid for caring for geriatric patients.
The combination of payment and treatment challenges tends to discourage physicians, residents and medical students from pursuing further training in geriatric care. But this can be rectified by payment reform and widespread adoption of innovative care and delivery models, such as the patient-centered medical home (PCMH), according to Epplin and others.
Adoption of the PCMH model also can make it easier for family physicians to meet the needs of their older patients by giving FPs a platform to practice medicine in the way it should be practiced, says Warshaw.
If nothing else, the PCMH is ideally suited to the care of geriatric patients, notes Warshaw, who employs PCMH concepts in his practice. "With the PCMH, you are focusing more on care management and care coordination. I have a staff in the office that helps me care for the patient. I am not doing it all myself. And that makes care of older patients more enjoyable, while also improving the quality of care."
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Aging in America: FPs Prepare for a Wave of Elderly Patients