Compensation For And Numbers Of Geriatricians Continue To Lag

Main Category: Seniors / Aging
Article Date: 15 May 2008 - 2:00 PDT

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Inadequate, noncompetitive compensation continues to discourage medical school graduates from pursuing careers in geriatrics, according to a new Association of Directors of Geriatric Academic Programs (ADGAP) study released this month.

Not only geriatricians in private practice, but also geriatrics faculty members in academic settings earn significantly less than private practitioners and faculty in other medical fields, according to the latest findings of ADGAP's The Status of Geriatrics Workforce Study.

Inadequate Medicare reimbursement and low compensation are leading contributors to the worsening shortage of geriatricians -- physicians with advanced training that prepares them to meet the unique healthcare needs of older patients -- and other geriatrics healthcare professionals in this country.

By 2050, when the number of older Americans (75 and older) reaches 48.8 million, there will be an estimated 1.6 geriatricians for every 10,000 older adults. That's a steep decline from the current ratio of roughly 4.7 geriatricians per 10,000 Americans 75 and older, according to the study, by the University of Cincinnati's Institute for the Study of Health. The institute has been studying training and practice in geriatric medicine for ADGAP since 2000, tracking progress in faculty development, growth of medical school-based academic programs, and teaching programs for medical students, residents, and fellows, as well as the practice of geriatrics.

In 2007, physicians graduating from US medical schools had an average of $138,608 in medical school debt to pay off, the study reports. To be certified in geriatrics, physicians must complete additional training - three years of residency training plus a year-long fellowship in geriatrics. Once certified, however, geriatricians can expect to earn far less than physicians completing fellowships in most other fields, the study finds. The 2006 median salary for a private practitioner in orthopedics, for example, was $425,000, in 2006. For dermatology, it was $335,899. For geriatrics it was $161,888.

Not surprisingly, 98% of fellowship openings in orthopedics and 99% of those in dermatology were filled that year, compared with 54% in geriatrics.

Faculty in geriatrics also earned considerably less than those in other fields, the study notes. Median compensation for orthopedics faculty was $353,000 in the 2006-2007 academic year. For dermatology faculty it was $213,0000 and for geriatrics faculty, it was $145,0000.

The new study, available at http://www.ADGAPstudy.uc.edu, updates previous information on compensation in the field. An earlier ADGAP report examining these trends was released in 2004.

"In the last five years geriatricians had the lowest median salary or next to lowest salary among all physicians," note the study's lead authors, the University of Cincinnati's Gregg A. Warshaw, MD, and Libbie Bragg, PhD, RN. "(The) median salary of combined ranks for academic geriatrics (also) remains one of the lowest for academic physicians."

Another recent study, from the Institute of Medicine (IOM), also warns of a severe and worsening shortage of geriatricians and geriatrics healthcare professionals and calls for a wide range of sweeping initiatives to increase recruitment into geriatrics and ensure that all healthcare providers who care for older adults are adequately trained to meet their unique healthcare needs. The IOM's April 14 report, "Retooling for An Aging America: Building the Health Care Workforce," recommends, among other things, that Medicare, Medicaid and private insurers offer higher compensation to healthcare providers caring for older adults; and state and federal governments offer loan forgiveness, scholarships and other financing incentives to professionals who specialize in geriatrics.

The American Geriatrics Society has long advocated for these and other measures integral to ensuring older Americans access to high quality, cost-effective care. Among other things, the Society is urging Congress to block a proposed 10.6% cut in Medicare payments to physicians that is slated to take effect July 1. It is also urging Congress to approve two bills that would create loan forgiveness programs for those pursuing careers in geriatrics and other geriatrics healthcare professions.

About the Association of Directors of Geriatric Academic Programs

For the past 15 years, the Association of Directors of Geriatric Academic Programs (ADGAP) has been committed to advancing academic geriatrics programs and supporting academic geriatrics program directors in order to benefit and aid patient care, research, and teaching programs in geriatric medicine within accredited medical schools located in the United States. ADGAP has built and fostered new methods of facilitating the development of leadership skills among academic geriatricians and has provided an ongoing forum for Program Directors and leaders in academic geriatrics to discuss the wide variety of issues that they encounter.

American Geriatrics Society