Finding a geriatrician shouldn't require a miracle
James M. Berklan
So there I was the other night, flipping channels while taking care of holiday chores when I caught my third partial-viewing of "Miracle on 34th Street" this month. No matter how many times I see it, it seems like there's something new to notice — like its connection to long-term care.
I've been aware of the plot details and most of the characters for a long time, but this night the brief appearances of a doctor grabbed me by the collar like never before.
I am talking about the no-first-name Dr. Pierce from the fictional Brooks' Memorial Home for the Aged in Great Neck, NY. If geriatricians ever needed a poster boy for why they are needed, this would be a great place to start.
You see, Dr. Pierce, played by the durable, dependable James Seay is a subtle hero in this beloved Christmas movie. The classic notably starred Edmund Gwenn, who won a Best Supporting Actor Oscar as Kris Kringle, Maureen O'Hara as a skeptical mother and young Natalie Wood as her pragmatic young daughter.
Pierce is insightful, observant and kind in his discussion of Gwenn's character while others around him are losing their heads, or are at least prepared to. Perhaps most tellingly, one of Pierce's first lines involves explaining himself and what the field of geriatrics involves to several characters.
So there you have it: Even when the movie was released back in 1947 there was a lack of understanding about geriatricians and their roles. To the profession's good credit, Pierce was on top of his game and incredibly strong as a patient advocate. (Granted, he pegged Kringle as delusional, but he clearly was an advocate of compassionate, restraint-free, person-centered care.)
It leads to the question: What has happened in the ensuing 68 years? It seems that the general public, and even many provider personnel, need to be reminded of the value that geriatricians bring to the examination table. Seniors under a geriatrician's care routinely receive more timely, accurate diagnoses. That translates to quicker, better care, which leads to lower spending because there is less unnecessary testing and sampling of therapies.
Currently, there are fewer than 8,000 geriatricians in practice in the United States. The American Geriatrics Society estimates there 30,000 will be needed to adequately serve the aging population by 2030. That means the odds of developing that many, especially given the current reimbursement climate, are infinitesimal.
The pay gap is simply too big, creating just tepid interest from new or young physicians, experts agree. (If it's any consolation, the movie's Dr. Pierce also was a physician in need; the only thing is, he had Santa Claus on his side, which led to his finding a very expensive piece of diagnostic equipment under the Christmas tree near the end of the movie.)
There are a variety of opinions on how to handle the worsening geriatrician shortage, and fix compensation inequities. But they've mostly been out there for a while, so there's not a lot of optimism that the problem will be solved any time soon.
Yet it's important to keep revisiting this issue because sooner or later, people are going to realize that, just as in “Miracle on 34th Street,” the docs who make working with the elderly their full-time business are good for a lot of things — business among them.
James M. Berklan is McKnight's Editor. Follow him @JimBerklan.