Same Old Song by Pat Conrad MD


Maybe this is meant to be a humor column, a parody of the state of geriatric primary care so subtle that I didn’t get the joke. Medical Economics has an online article titled, “We need to solve the family doctor shortage for an aging America.”

Oh wait, the author Glen Stream, MD is a past president of the AAFP, which I guess means he’s serious. Stream is worried about the quarter million-plus citizens hitting early-bird discount age annually, leading to 20% of the total population by 2040. He references the Institute of Medicine – haven’t they done enough damage? – which predicts a retiree class that “will be the most diverse the nation has ever seen with more education, increased longevity, more widely dispersed families, and more racial and ethnic diversity, making their needs much different than previous generations” (Stream checked so many PC boxes I’m surprised he didn’t give a nod to the growing trans-geriatric community).

This former president of an organization that had led the fight in running its own members out of the profession bemoans the increasing shortage in geriatricians, and delivers this plum: “The shortage of health professionals trained to treat the elderly also extends to the nation’s 255,000 advanced practice nurses, only 5% of whom are specifically trained in geriatrics.” That’s a curious way to recruit more physicians. Stream reminds us that the shuffleboard set is more complicated, more expensive, and sicker, and tend to “stretch the time limits of a typical visit and tax a clinic’s staff.”

Stream quotes the IOM report that “little has been done” to meet the rising elderly demand, and that “fundamental reform” is needed to:

  • improve geriatric competency among providers
  • increase recruitment/retention of those who provide geriatrics

Stream does briefly mention the lousy reimbursement rates, which we all know are not going to improve as Medicare expenditures soar. He also quotes a doc who works at UCLA Medical Center, who says from the financial safety of an academic center that caring for the elderly can be “incredibly gratifying.”

The piece closes out straight-faced with a cheer to family physicians working in “a team based setting … to coordinate and manage.” Damn, sign me up!

91430cookie-checkSame Old Song by Pat Conrad MD