January 31, 2025
McKnight's Long-Term Care News
Remarkably few nursing homes patients see geriatricians, even though they’re among the physicians most likely to spend the majority of their workday in long-term care facilities, a new study found.
Across more than 14,000 physicians treating Medicare patients in nursing homes, geriatricians managed just 4% of cases from 2012 to 2019. Internal medicine specialists, meanwhile, accounted for 47%, and family practitioners cared for 43%.
Geriatricians’ expertise is particularly valuable in LTC settings where managing complex, chronic conditions is essential, the study’s authors told McKnight’s Long-Term Care News Wednesday.
“While fewer geriatricians provide care in nursing homes, our findings show that they dedicate the highest proportion [63.8%] of their services to nursing home residents, second only to physical medicine and rehabilitation physicians,” said lead researcher Hye-Young Jung, of Cornell Medicine. “Geriatricians primarily focus on residents with complex care needs, including those with the highest rates of moderate to severe cognitive impairment.”
A full 42% of geriatricians were specialized nursing home physicians.
The study, featured in JAMDA - The Journal of the American Medical Directors Association, was co-authored by researchers from several US universities, including Penn Medicine, Cornell Medicine and Johns Hopkins University. The sample group comprised physicians who cared for residents enrolled in Medicare Part A and B and who were also 65-year or older.
Creating a more supportive workplace environment could make nursing homes more attractive to geriatricians and other primary care physicians, ultimately enhancing quality, researchers said.
“Aligning workplace resources and staffing levels with the specific needs of these specialists could improve physician satisfaction and encourage more geriatricians to practice in nursing homes,” Seiyoun Kim, a researcher from Penn Medicine, told McKnight’s.
The authors said that further research is needed to determine whether geriatrician shortages and other factors play a role in the level of care provided to LTC residents, and the demographics of residents treated in nursing homes.
Outsiders often need to be reminded that geriatric medicine is very different from other disciplines, Michael Wasserman, geriatrician and member board member of PALTMed, wrote in a June 2024 McKnight’s column.
He also has noted the need for geriatricians to be positioned as leaders inside of nursing homes, where vulnerable populations require tailored care.
“Geriatricians are specially trained to evaluate highly complex individuals and situations,” he said. “Those lacking this type of training and experience are at a distinct disadvantage, which is why I am a fierce advocate for having geriatricians hold accountable positions of authority in organizations that are responsible for the health and well-being of frail older adults and other seriously and chronically ill patients.”
