A New York Times op-ed warns about a shortage of geriatricians and blames the problem on low reimbursement rates by Medicare and Medicaid:
Currently there are fewer than 8,000 geriatricians in practice nationwide — and that number is shrinking. "We are an endangered species," said Dr. Rosanne Leipzig, a geriatrician at Mt. Sinai Medical Center in New York.
At the same time, the nation's fastest-growing age group is over 65. Government projections hold that in 2050 there will be 90 million Americans 65 and older, and 19 million people over age 85. The American Geriatrics Society argues that, ideally, the United States should have one geriatrician for every 300 aging people. But with the looming shortage of geriatricians, the society projects that by 2030 there will be only one geriatrician for every 3,798 older adults.
Why such a growing gap between an increasing number of patients and a decreasing number of doctors required to treat them? Geriatrics is a low-paying field of medicine, even though it requires years of intensive specialization. Most geriatricians are reimbursed solely by Medicare and Medicaid, whose rates make it unsustainable to keep an office running. Many medical clinics and geriatric hospital units nationwide are closing down.
The median salary for a geriatrician in private practice in 2010 was $183,523, according to the American Geriatrics Society. One possible policy response to the "looming shortage of geriatricians" would be to raise the reimbursement rates so that geriatricians are paid more money. A commenter here reports that in Ontario, Canada, "in 2012 the guaranteed pay was $375K per year for each geriatrician involved in geriatric services there. Canadian dollar was at par with US dollar in 2012. Does it surprise you that there is no problem in convincing medical residents to select geriatrics in Canada."
But there's an alternative. Rather than look to increase the number of geriatricians by engaging in bidding wars for people who would otherwise become $400,000 a year dermatologists or $1 million a year surgeons, why not increase the number of medical school and residency slots (now capped by either regulation or cartel) so that some people who otherwise would be nurses or medical researchers earning less than $183,523 would now become geriatricians?