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“Policymakers and educators can introduce incentives and new educational programs to recruit more physicians to fill the care gaps for elderly patients. Perhaps one solution is raising Medicare reimbursements to doctors at the same rate that private insurance pays. Another avenue might be recruiting doctors that are licensed in other countries offering citizenship opportunities.

Health care professionals and pharmacists may help address the gaps in care for elderly individuals by using innovative approaches involving collaboration between physicians, pharmacists, and sometimes nurses have demonstrated reductions in inappropriate medications. These approaches build on growing evidence that highlights the importance of team-based care delivery in ensuring that care practices are patient-centered, safer, timelier, and more effective.

Providing the aging adult population with high-level care is crucial in building a just and equal society where all vulnerable categories of people are protected, and their needs are recognized.”

Michael Pessman is a gerontologist.

He shares his story and discusses his KevinMD article, “The forgotten crisis: a shortage of geriatric doctors in the U.S.”

This episode is sponsored by the American College of Lifestyle Medicine (ACLM). 

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show we have Michael Pessman. He is a gerontologist, and his KevinMD article is titled “The forgotten crisis: a shortage of geriatric doctors in the U.S.” Michael, welcome to the show.

Michael Pessman: Thank you, Kevin. Thrilled to be here. Appreciate the opportunity.

Kevin Pho: We’ll get into your article in a little bit. First off, briefly share your story and journey to where you are today.

Michael Pessman: I’m a gerontologist, and I’m not a medical doctor. I am someone who has a master of arts degree in gerontology and really just champions the life of our older adults in this country and around the world. So the betterment of older adults is something I’m focused on, not only personally but professionally, and really one of the problems I see down the road, and actually even today, is the shortage of doctors that specialize in older adult health care. I’ll get to the nuts and bolts of that in a bit.

But to step back, before my education, I had grandparents that I loved, that loved me unconditionally, and so it really just sparked my interest in this field at a young age. I can say without a doubt that my job satisfaction, what I do every day, is just wonderful, and I don’t see my job as a job. It’s just something I’m passionate about, and I wish that for everyone in the world, certainly people in the medical profession.

Kevin Pho: So one of the things that you said is that as a gerontologist you champion the field of geriatrics, which is fantastic, because we certainly do need more champions in geriatrics. What are some of the ways that you do that?

Michael Pessman: Well, that’s a good question, Kevin. I appreciate you asking. Besides being a gerontologist, I am a community engagement coordinator. I work at Rush University Medical Center. I specifically work in the Rush Alzheimer’s Disease Center. I give a lot of presentations in the community about Alzheimer’s disease and dementia, and I also recruit for our clinical trials that we have.

And I like to equate aging to weather. While this is a sunny, bright, wonderful time to be alive in America, with people living much longer lives, aging in place, and having just exponentially positive experiences, there’s this dark cloud that we can’t control, and that is dementia, Alzheimer’s. And that dark cloud is getting bigger and bigger and bigger. Baby boomers are aging, and the biggest factor in developing the disease, at any spectrum, is age. So because people are living longer, this is a bigger problem.

And I’d like to use my skills every day to recruit people from the public into our clinical trials. I envision a world without this awful disease. I talk to families who, you know, lose their loved one first mentally and then physically, and it’s just heartbreaking. Some of what I do is hard work, because a lot of it is experimental medication, and people are kind of shy of that. But we need that. We need people to help us figure out a preventative or a cure. So I really just like using my skills every single day to make a difference.

Kevin Pho: All right. So let’s talk more about some of the challenges facing the field of geriatrics, which you do in your KevinMD article. It’s titled “The forgotten crisis: a shortage of geriatric doctors in the U.S.” Now, for those who didn’t get a chance to read your article, just walk my audience through it and share the story of why you decided to write it.

Michael Pessman: Oh, sure. I think that it’s often a forgotten topic. In the United States, we don’t revere our older adult population. In comparison to other countries or nations, we’re kind of last with the older adult population, and it’s crisis proportion already. My parents live rurally, and 25 percent of the adult population are in rural settings. I happen to live here in Chicago and work for an urban hospital, so I see kind of the opposite end, but we’re still at a shortage here in Chicago.

So, you know, it’s so important to get that proper health care as we age, especially if people have two or three or more comorbidities, and that could be diabetes. People are sedentary, so it leads to a lot of inactivity, heart disease, a whole host of things, and with older adults, to manage all these different obstacles, doctors who are trained to do that have better outcomes. And so it’s so important that, A, they get to the right doctor and, B, there’s access to that right doctor.

And so I just dived into why there’s a shortage, and I found some interesting things I did not expect. So there are some positives, but I would really like to encourage, you know, more younger people to consider this field, the specialty, and to look to their family, look to what inspired them in their life, because it’s a crisis. We need more geriatricians, as they’re actually called. There are only about 7,000 of them currently in the United States, and that averages one geriatrician for every 700 patients, and that is just in 2019 statistics. So baby boomers are aging exponentially, and that is just going to be more dire as the years go by. It is a crisis.

This kind of looming crisis started 32 years ago, in my research. I didn’t expect that. I thought it would be more recent, but it’s been an ongoing issue for quite some time.

Kevin Pho: Now, through your experience, and I’m sure that you’ve seen a lot of interactions between geriatricians and their patients, can you tell us a story or case study about how a geriatrician specifically has changed the life of one of the patients that they see?

Michael Pessman: Oftentimes, and this is the case with many older adults, they have arthritis, and some of these medications can affect people differently. One that comes to mind is Celebrex. It can interact with different medications in ways that it doesn’t with someone who’s younger.

And I talked to, I like to call her a young lady, she’s 82 years old, and she had a lot of issues with taking this medication. She came to work with one of our geriatricians at Rush and got off that medication that was really affecting her quality of life. So it’s not just being able to live longer for older adults, but also that quality of life that’s so important, that day-to-day worth living. And, you know, she reported she’s hopeful. She’s less depressive. She feels better. She still has good and bad days, but her life has been fundamentally changed.

And as a gerontologist, I love hearing that story and talking about that. And my hope is that other people can experience that as well, that everyone in America deserves that health care experience.

Kevin Pho: Now, one of the statistics that you brought up in your piece was that in 2019, there were 384 open positions for graduate fellowships in the field of geriatrics that went unfilled. So comment on why you think a lot of the graduating residents are not going into the field of geriatrics.

Michael Pessman: Sure. It has long been known that this is the least-paid discipline in medicine. So, unfortunately, and, you know, I dived into a little bit about that, as to why, in the article. It’s very important that people realize, and it just makes sense, that geriatricians are mostly billed through Medicare, and Medicare does not reimburse at the rate of private insurance. It is something that’s wrong.

I think that Medicare should make concessions for inflation. It has never been updated for many, many years. So we’re at a low rate, a low reimbursement rate, and nothing makes me more angry. I think that people have paid into the system their whole life, and we should not treat our older adults like this. This is something that should be reimbursed to match private insurance. In my opinion, you know, these are precious lives, just like people in their 30s, and it should be commensurate; they should match up better. So the pay is the biggest thing that is a deterrent.

Kevin Pho: What about the field itself? Is there anything about the field of geriatrics that you would change to perhaps make it more attractive to graduating residents, other than the pay?

Michael Pessman: I do. I’ve given this a lot of thought, and this is not in the article, but I’ve thought about it since then. I would like to see, because I go back to my own experience and my own connection with my grandparents that I had, I would love to see, like, a mentorship, even as young as junior high, where we bring kids in. We have to look to the future, to the next generations of geriatric physicians, and really spark that interest at a young age, bringing them to a hospital setting to see what the doctor interaction looks like with the older adult population. I think that could be a really good thing. Seeing is believing.

Also, I believe that we should relax our immigration policies and recruit from around the world. I’m a big believer in that. It is needed. It is crisis proportion here now and certainly going into the near future. So those are two things that we can do.

Also, perhaps, you know, maybe some more student loan forgiveness. Doctors borrow an incredible amount of money to get their education, and, you know, offering faster payoffs if they work for public organizations such as Rush, we’re nonprofit, could attract a lot of doctors in the field. Those are just my opinions, but I think it just makes the most sense.

Kevin Pho: We’re talking to Michael Pessman. He’s a gerontologist. His KevinMD article is titled “The forgotten crisis: a shortage of geriatric doctors in the U.S.” Michael, you have a platform here where I have a lot of medical students and residents who listen to you. Why should they consider the field of geriatrics? What are some of the biggest rewards that you can share with them?

Michael Pessman: I’m happy to report that. Thank you for asking. Great question. The biggest reward is that, of all the disciplines in medicine, and I didn’t learn this until my research for this article, and I was thrilled to hear it, geriatrics has the highest satisfaction rates for doctors who choose this field. For me personally, I love what I do. And I want that for everyone in the medical field, because at the end of the day, it’s about what we do. It’s not about money. It’s not about making money from shareholders of companies, private organizations. It’s about what we do.

We transform the lives of this underserved population, and I get really great satisfaction, and I was thrilled to hear that that is the biggest draw, and that certainly is a positive. They’re just gentle people to work with, and they are appreciative of everything. I myself love to interact with older adults and look at the successful life that they’ve had, and sort of the insight that they have, what they would recommend as their success in aging.

And, you know, I think it’s an important piece. Health care is not all about money. It’s about that satisfaction at the end of the day when you go home, the feeling that you’ve made a difference. And so that is the biggest draw, in my opinion.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Michael Pessman: I think that it’s going to take a scorched-earth approach to deal with this crisis, and just having new ideas, presenting them on a platform, you know, such as the mentorship program that I mentioned, which is kind of off the wall, but that could be something that our government could fund. And just hearing from stakeholders that have skin in this game, that have new ideas. We need new ideas that are radical. And our older adult population is worth that.

And so I would challenge anyone, any clinician in the field that has any big or minor idea to help rectify this problem, this looming crisis that we’re already in, to step forward with your voice on your platform, your idea, and at least make sure that it’s shared, that we’re starting this conversation, and that we are leaving nothing off the table. Because it’s going to take that kind of ingenuity. And we have that in America. We can do this, but it’s going to take effort.

Kevin Pho: Michael, thank you so much for sharing your time and insight, and thanks again for being on the show.

Michael Pessman: Thank you, Kevin. Enjoy the rest of your day.