Friday, September 28, 2007

The Next Huge Challenge

The next time you're in a large amphitheater with quite a few folks, try asking this unsolicited yet provocative request:

"Raise your hand if you are going to die."

Usually about one third of the people raise their hand, but the remainder sheepishly acknowledge that they really didn't want to think about it and hesitate.

But as we all know, we all will die. And before death comes aging late in life. One senior at my father's assisted living facility commented: "Getting old ain't for sissies."

But many of our population are living longer than ever.

It's great to that we're keeping older folks alive longer, isn't it?

Well, maybe.

Our next big challenge will be caring for the chronic health needs of the over-85 crowd. In England, they have noticed a record number of centenarians:
Dr Lorna Layward, from Help the Aged, said: "It's hard to know whether these extra years are providing extra years of good health.

"Hopefully, with better medical provision, these extra years can be happy and healthy."

Emma Soames, the editor of Saga Magazine, said: "The government has got to get its act together, because the care services in this country are really not fit for purpose at the moment.

"We have a whole generation in their 50s and 60s who are looking after elderly relatives."

Gordon Lishman, director general of Age Concern, said: "Demographic change presents a number of opportunities and challenges to public services and public spending.

"For example, most people living in care homes are over the age of 85. As the number of people over the age of 90 increases, so will the need for care home spaces.

"All too often we are failing to respond adequately to the changing demographic challenge facing the UK."
The US is in a similar predicament. I have been struck by the increasing number of 90 and 100-year olds I find on the hospital wards on the weekends. Which leads to the next important question.

With the current market pressures, will we have enough doctors to tend to these seniors? The yearly threats to shrink physician Medicare reimbursements by the Centers for Medicare & Medicaid Services (a.k.a. CMS) as they continue to follow Congressional guidelines intended to slow the rise of health-care costs leaves many a physician with little incentive to continue with the current rat race. After all, after expenses, some have estimated the average annual primary care physician earns about $80,000 per year - less take-home pay than many nurse practitioners.

To amplify staffing concerns, physician recruitment and retention has recently become a global issue. An Indian colleague of mine has commented that many foreign medical physicians who immigrated to the US to find profitable jobs are now moving back to their home countries. Why? Because technology in even remote towns has met or exceeded that of the US and the economics of their health care systems are far more lucrative for them. This, then, leaves many US hospitals and training programs woefully understaffed for many primary care specialties like internal medicine or family medicine. While some would counter that internal medicine training programs should increase the number of trainees, program directors are keenly aware that training extra doctors diminishes the collective bargaining power of current physicians as they struggle to thwart ongoing salary concessions mandated by Congress.

So what to do?

First, it goes without saying that Congress should avoid further Medicare cuts for physician reimbursement - after all, who will take care of them if they approve these cuts? But the outcome of negotiations is never certain. So we wait on the sidelines.

Secondly, civic and community leaders should look at their strategic plans and consider options to facilitate aging-at-home initiatives. What are communities providing in terms of transporation, home meals, distaster preparedness, and even financial planning assistance? Adequacy of assisted living facilities, nursing home facilites and staffing requirements should be carefully considered now as our seniors continue to age.

Finally, economic incentives for physicians to enter these much-needed fields of gerontology and internal medicine would go a long way to securing the health of all of our aging senior population.


Image credit.


Anonymous said...

Don't worry Wes the robots are coming... they will wipe grannies pooper - give her the meds, water the flowers and drive her to doctors office. Even carry her to the car if need be. Look for it at Bestbuy around 2012 - oh and one more thing -it will plug itself in for the night.

Shivakumar said...

Dr Wes, starting April 2006 the UK government stopped renewing work permits for almost 5000 doctors of non European origin. If conditons in India were as rosy as your friend points they would all be going back home. The truth is that a large number of them are applying for residency positions in primary care specialities after having worked in subspecialities for years. What the Indian colleague of yours points out to is , at best, an isolated urban phenomenon of corporate hospitals catering to the insured /super rich who can afford the bills. These constitute a miniscule percentage of people seeking health care. The Health Minister of the Union Government of India while addressing the annual convocation of the premier medical institute in India had this to say to the pass outs:" Please don't go abroad. Or if you do go for higher education, please come back when you finish that training."