You probably have a primary care physician — maybe a gynecologist or even a dermatologist, too. But there’s another specialist you may want to consider adding to your roster as you get older.
Geriatricians specialize in guiding patients through the unique challenges that come with aging, from maintaining mobility and independence to managing their brain health and screening for cognitive decline.
But if you haven’t heard of these medical professionals, we don’t blame you. Despite the growing number of older Americans, there’s a major shortage of geriatricians, with roughly 7,000 working across the U.S. today. We spoke with one of them, Stephanie Rogers, MD, a professor of medicine at the University of California San Francisco’s division of geriatrics, about this overlooked field of medicine, how these doctors differ from your PCP, and who may want to consider seeing one.
What exactly is a geriatrician?
Dr. Stephanie Rogers: Geriatrics is a subspeciality of medicine. Geriatricians either complete an internal medicine or a family medicine residency, and on top of that, they do a fellowship training in geriatrics. They also train in all healthcare settings, from nursing facilities to emergency departments, and they even see patients in their homes.
We help older adults make medical decisions around their values and goals, helping them focus on things like maintaining their function, mobility, and cognition. We also can provide care for any complex medical problems they have.
How does that care differ from what a primary care physician can offer?
Most primary care providers will help with preventative health and tend to any diseases, but they likely won’t have conversations about function, independence, and how patients can maintain, improve, or adjust their lives for their capacity. So, how would they adapt their house so they can move around safely? How they can adapt how they walk? We also pay attention to their mind and are on the lookout for changes like dementia, and we will support them through all of that.
Another big focus for us is de-prescribing medications. Often, as people get older, the medications they’re prescribed really add up, and they're rarely taken off of them. In medical school, we’re taught how to start a patient on a drug when they get sick, but we’re not taught how to take them off. As geriatricians, we’re experts at evaluating medications to see what a patient really still needs.
Is there a certain age at which people should start thinking about seeing a geriatrician?
We don’t have a specific age cutoff. If I had to pick one, I would say 70 and up, but the way I think about it is that we are experts in frailty. If someone is functionally frail, cognitively frail, socially frail, that’s where our expertise really comes in — and that can occur at 50, 90, or anywhere in between. Because of that, we're also experts in preventing frailty and can provide a lot in terms of longevity care.
There’s a major shortage of geriatricians in the U.S. Why is that?
I think one of the main reasons is the reimbursement rate. As you can imagine, when we do these comprehensive geriatric assessments, they take a long time, and not a lot of money is reimbursed for those visits. So we’re not paid as much, and on top of that, we train for longer than most other specialities.
I also think there’s an ageism aspect to it. When I went into geriatrics, a lot of people said to me, “Ew, I wouldn’t want to work with old people. How can you do that?” Of course, I think it’s the best job in the world, but there are a lot of people who are afraid of aging.
What advice do you have for people looking for an aging specialist, either for themselves or an older parent?
There’s a database of geriatricians in the U.S. that patients can use to search for a specialist. But for many people, there may not be one in their area or someone who’s accepting new patients. I think a lot of what has to happen is that other specialties need to get more geriatrics training, and more students need to be encouraged to go into this field. On the policy side, Medicare and some of the other insurers need to pay better for this type of care.
When it comes to aging well, what’s the one piece you’d give someone?
There’s a lot of specific advice out there, but I like to step back and think about it in more general terms. There’s this concept called hormesis, which is when you challenge your body, causing it a little bit of stress but not enough that it causes any harm. You want to do this physically and mentally, pushing yourself.
If you’re someone who uses a walker, make sure you’re walking everyday to challenge your body. If you’re a runner, make sure to challenge your body in other ways — maybe yoga or lifting. And the same thing goes for your mind: Always try to expose yourself to new ideas, new people, new activities. This is something you can do at any age.
This interview has been edited and condensed for clarity.
