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VOL. 10 | NO. 13 | Saturday, March 25, 2017

Expanding Baby Boomer Population Brings New Health Care Challenges

By Andy Meek

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Patients are having to wait longer to make appointments with new doctors in major U.S. cities, according to a new study that links the increased waits partly with an explosion of, well, new patients.

The report was issued by Merritt Hawkins, part of the health care staffing firm AMN Healthcare. Meanwhile, another report issued in recent days – this one from the Association of American Medical Colleges – found a similarly uncomfortable reality for patients: It projects a shortage of between 40,800 and 104,900 doctors by 2030.

The reports describe a kind of straining of the nation’s current health care infrastructure. One reason for that, among many, is the inexorable expansion of the country’s aging population – a population that is living longer and includes something of a demographic bulge health care experts say hasn’t been fully prepared for.

One example: By 2030, the number of U.S. adults age 65 and older will grow by 55 percent, according to AAMC president and CEO Dr. Darrell Kirch, as reported by Forbes. As those patients age, they need more care, including more intensive and specialty care that often is more expensive.

NOAM VANDERWALDE

The United States’ current health care infrastructure is probably inadequate to fully meet those needs, at least at the moment. That’s according to Dr. Noam VanderWalde, an assistant professor at the University of Tennessee Health Science Center and director of clinical research in the Department of Radiation Oncology at West Cancer Center.

“We probably don’t have the correct infrastructure to take care of these patients, for one thing, because there aren’t enough geriatric specialists,” VanderWalde said. “Not enough people go into geriatrics or internal medicine to take care of this population, so the burden then falls on primary care physicians or other doctors who are kind of taking care of their individual problems. And so if they don’t have geriatric expertise, which they don’t, you have a lot of things that can go unnoticed.”

It’s not just a lack of doctors. It’s the explosion of the number of baby boomer-age patients. U.S. Sen. Rob Portman put things in stark relief in a 2014 Wall Street Journal piece, in which he noted that some 10,000 baby boomers are retiring each day and starting to receive Medicare and Social Security benefits.

“There’s just no way the U.S. is really ready to take on these patients’ problems,” VanderWalde said. “There’s just too many of them.

“From a cancer perspective, it actually gets even more complicated. One reason is, do we have enough doctors and facilities to take care of all these cancer patients? The answer is – maybe? Unclear. The next problem becomes can the patients afford the care?”

Which VanderWalde said leads to an even more interesting question: What happens when all those older patients who are Medicare recipients begin to need those more expensive cancer treatments? Who’s going to pay for it: the patients or society?

FAST FACTS:

• U.S. patient population is expanding and aging, which is one reason doctor wait times are spiking

• The U.S. also doesn't have enough doctors - a projected shortage of as many as 104,900 by 2030

• Aging patient population will grow by an estimated 55 percent by 2030

That’s where politics enters the scrum of the unanswered questions surrounding this demographic quandary.

“It’s a difficult political situation,” said Dr. Teresa Waters, a professor and chair of the Department of Preventive Medicine at UTHSC whose research focuses largely on applying economic concepts and tools to health and health care delivery. “Everybody’s paid their Medicare taxes and expects Medicare to be there for them. But the fact of the matter is nobody’s paid as much as they’re going to cost the system. Everybody has contributed to this, and everybody will demand a solution.”

As far as a solution to the strain the boomer demographic is putting on the health care system’s infrastructure, VanderWalde says the answer is two-fold. First, more doctors need to be trained to specifically care for older patients. And second, not enough research into this patient population is currently being conducted, so more research needs to be done.

The political solutions are somewhat more elusive. Waters notes the current reality facing Medicare, in which current Medicare taxes – paid for by today’s workers – are supporting everyone covered by Medicare.

The way the system was set up, she says, anticipated a “relatively smooth flow of individuals” into both the workforce as well as the older population, but the country now is seeing a growing number of people moved onto Medicare supported by fewer workers.

The glass-half-full aspect to this problem, however, is something VanderWalde says is easy to overlook as these challenges are sorted through:

“Having said all this, the prospects for an older person today are absolutely better than they were 10, 20 years ago,” he said. “One reason we’re having these problems is people are living longer because of advances we’ve made with infectious disease and vascular issues. People aren’t dying as much from heart attacks and strokes.

“An older person definitely has a higher life expectancy now than they would have 20 years ago. It’s just that one of the challenges that comes along with that is an increase in problems like cancer, and having to figure out how to deal with that.”

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