If you’ve read health-related articles here on the Blog, or listened to Rajiv Nagaich discuss senior health issues on the radio or in his popular workshops, you’re familiar with the term “geriatrician.” A geriatrician is a medical doctor who specializes in the prevention, diagnosis and treatment of health conditions in older seniors, typically those 65-plus.  

Geriatricians who are board-certified possess the kind of specialized knowledge that can help seniors stay healthier longer. That’s why Rajiv has consistently urged older patients to entrust their health care to an MD who “gets it” when it comes to senior health issues.  

But there’s a serious supply-and-demand problem aging patients must contend with: at a time when the population is aging, the number of physicians opting to become certified geriatricians is shrinking. In response, as this recent Washington Post article explains, a different group of healthcare providers is stepping into the breach: nurse practitioners. They’re not trying to replace doctors, said one expert – instead they’re trying to meet patients’ needs, wherever those patients are. 

Can these professionals provide the same level of care as a geriatric physician? Perhaps not, but as the article explains, nurse practitioners trained in geriatric medicine (gerontology) may be a surprising key to meeting the needs of a burgeoning population of seniors at a time when young doctors are gravitating to “sexier” specialties with far higher income potential.  

Let’s look deeper at the Washington Post article, produced by KFF Health News and written by health reporter Jariel Arvin. 

Nurse Practitioners Treat Both Patient and Family 

Arvin begins his article with the story of a nurse practitioner who treats older adults, outlining her typical day-in-the-life.  

“On Fridays, Stephanie Johnson has a busy schedule, driving her navy-blue Jeep from one patient’s home to the next, seeing eight people in all,” Arvin writes. “Pregnant with her second child, she schleps a backpack instead of a traditional black bag to carry a laptop and essential medical supplies — stethoscope, blood pressure cuff and pulse oximeter.” 

This schedule doesn’t allow for anything in the way of breaks, not even for lunch. She often eats in between visits. There’s simply too much to do.  

“Our patient isn’t just the older adult,” Johnson says. “It’s also often the family member or the person helping to manage them.” 

She’s certainly not the only nurse practitioner stepping into this role, Arvin tells us. “Today, nurse practitioners are increasingly filling a gap that is expected to widen as the senior population explodes and the number of geriatricians declines,” he writes.  

Demand for Care Grows as Ranks of Geriatricians Decline 

This reflects an increasing imbalance in supply and demand when it comes to geriatric care.  

Arvin explains that the Health Resources and Services Administration projects a 50 percent increase in demand for geriatricians from 2018 to 2030, by which time the entire baby boom generation will be older than 65. “By then, hundreds of geriatricians are expected to retire or leave the specialty, reducing their number to fewer than 7,600, with relatively few young doctors joining the field,” Arvin writes.  

The result is that many older adults will rely solely on their primary care physicians—a population already overworked—and nurse practitioners, whose “ranks are booming”, Arvin says. He writes, “The number of nurse practitioners specializing in geriatrics has more than tripled since 2010, increasing the availability of care to the current population of seniors,” according to a recent study in JAMA Network Open. 

Nearly 65,000 Nurse Practitioners Certified for Elder Care 

A 2024 survey of the roughly 431,000 licensed nurse practitioners reports that 15 percent are—like Stephanie Johnson—certified to treat older adults. 

“Johnson and her husband, Dustin, operate a nurse practitioner-led private practice in greater Seattle, [in] a state where she can practice independently,” Arvin explains. “She and her team, which includes five additional nurse practitioners, each try to see about 10 patients a day, visiting each one every five to six weeks. Visits typically last 30 minutes to an hour.” 

Johnson says, “There are so many housebound older adults, and we’re barely reaching them. For those still in their private homes, there’s such a huge need.” 

Nurse Practitioners Step In Where Others Don’t 

Despite the need, nurse practitioners are not intended to “replace” doctors, according to University of California professor Laura Wagner. The goal instead is to meet the full range of patients’ needs.  

“One of the things I’m most proud of is the role of nurse practitioners,” Wagner says. “We step into places where other providers may not, and geriatrics is a prime example of that.” 

Arvin defines nurse practitioners as “registered nurses with advanced training that enables them to diagnose diseases, analyze diagnostic tests and prescribe medicine.” They can also specialize in particular branches of medicine (like Johnson, who has advanced training in gerontology).  

“If we have a geriatrician shortage, then hiring more nurse practitioners trained in geriatrics is an ideal solution,” Wagner says, “but there are a lot of barriers in place.” 

Arvin elaborates: “In 27 states and Washington, D.C., nurse practitioners can practice independently. But in other states, they need to have a collaborative agreement with or be under the supervision of another health care provider to provide care to older adults. Medicare generally reimburses for nurse practitioner services at 85 percent of the amount it pays physicians.” 

AMA Opposes Expanded Role for Nurse Practitioners 

Part of the challenge nurse practitioners face is a perceived “scope creep” in the expanded roles of nurse practitioners compared with MDs and other health workers.  

Last year, in more than 40 states, the American Medical Association and its partners lobbied against this expansion, noting that doctors must have “more schooling” and “significantly more clinical experience” than other healthcare workers, including nurse practitioners.  

But that’s not the whole story. As Arvin writes, “While the AMA says physician-led teams keep costs lower, a study published in 2020 in Health Services Research found similar patient outcomes and lower costs for nurse practitioner patients. Other studies, including one published in 2023 in the journal Medical Care Research and Review, have found health care models including nurse practitioners had better outcomes for patients with multiple chronic conditions than teams without a nurse practitioner.” 

The coordination of care is already a critical consideration and will become even more vital as Americans age. Individuals over 65 years old make up 18 percent of the current American population. In the next thirty years—as medical technology allows us to live longer—that share is expected to climb to 23 percent.  

One Family’s Story: Compassionate Care at End of Life 

Arvin concludes his article with an example of Stephanie Johnson’s expertise in action.  

In January, she had a hospice consultation with a patient in her 90s who had been diagnosed with vascular dementia, peripheral vascular disease, and Type 2 diabetes. The woman was in declining health, her enthusiasm for meals and socializing swiftly waning.  

After thoroughly examining the patient, Johnson decided it was time to discuss the woman’s prognosis with her sisters, who had power of attorney for her.  

Arvin writes, “After the exam, Johnson called the woman’s younger sister, Margaret Watt, to recommend that her sister enter hospice care. Johnson said the older woman had developed pneumonia and her body wasn’t coping. Watt appreciated that Johnson had kept the family apprised of her sister’s condition for several years, saying she was a good communicator.” 

Watt says, “She was accurate. What she said would happen, happened.” In fact, a month after the consult, the woman died peacefully in her sleep. 

“I do feel sadness,” Johnson says, and her compassionate words conclude the article, “but there’s also a sense of relief that I’ve been with her through her suffering to try to alleviate it, and I’ve helped her meet her and her family’s priorities in that time.” 

Rajiv Nagaich – Your Retirement Planning Coach and Guide 

The long-awaited book by Rajiv Nagaich, called Your Retirement: Dream or Disaster, has been released and is now available to the public. Retirement: Dream or Disaster joins Rajiv’s ground-breaking DVD series and workbook, Master Your Future, as a powerful planning tool in your retirement toolbox. As a friend of AgingOptions, we know you’ll want to get your copy and spread the word.  

You’ve heard Rajiv say it repeatedly: 70 percent of retirement plans will fail. If you know someone whose retirement turned into a nightmare when they were forced into a nursing home, went broke paying for care, or became a burden to their families – and you want to make sure it doesn’t happen to you – then this book is must-read. 

Through stories, examples, and personal insights, Rajiv takes us along on his journey of expanding awareness about a problem that few are willing to talk about, yet it’s one that results in millions of Americans sleepwalking their way into their worst nightmares about aging. Rajiv lays bare the shortcomings of traditional retirement planning advice, exposes the biases many professionals have about what is best for older adults, and much more. 

Rajiv then offers a solution: LifePlanning, his groundbreaking approach to retirement planning. Rajiv explains the essential planning steps and, most importantly, how to develop the framework for these elements to work in concert toward your most deeply held retirement goals.  

Your retirement can be the exciting and fulfilling life you’ve always wanted it to be. Start by reading and sharing Rajiv’s important message. And remember, Age On, everyone! 

(originally reported at www.washingtonpost.com)