It’s not just you. According to a new study in the Annals of Internal Medicine, older adults spend an average of 3 weeks each year devoted to obtaining routine healthcare- whether it’s a doctor’s appointment, a medical test, a procedure, or some other contact with the healthcare system. Even scarier is that 11% of adults 65 and over spend more than 50 days each year dealing with the healthcare system- essentially having to do something once a week. That would perhaps be tolerable if these interactions went smoothly and were free of wait times, logistical challenges, or other burdens. But for many of these visits with the healthcare system, the hassles, let alone the challenge of finding qualified and convenient providers, just add insult to injury. 

It seems our current healthcare system is not prepared to deal with the growing older patient population. Healthcare journalist Judith Graham recently noted that older adults with disabilities (a number growing exponentially), who may have vision, mobility, or hearing impairments, have special needs that are not often recognized or addressed by most healthcare providers. Whether it’s making accommodations so that such patients can comfortably and effectively be examined or arranging multiple services in a single visit and location for those who cannot easily get around, most offices are not in compliance with requirements from the Americans with Disabilities Act. Moreover, many older adults face ageism in their healthcare encounters, either dismissed or patronizingly addressed by providers who have very little training in supporting and caring for older patients.

As we’ve previously noted, qualified and accessible geriatricians, uniquely trained to understand what can happen in an aging body, are few and far between these days. Axios recently reported that in 2023, less than half of the fellowship openings for geriatric internal medicine doctors were filled. Despite a growing elderly population, there has not been a rise in the number of physicians trained to be geriatricians in five years. This is on top of a critical shortage of physicians more generally, including primary care physicians who typically accept Medicare and have large geriatric populations. As a result, many patients may be steered toward seeing nurse practitioners (NPs) or physician assistants (PAs) rather than trained physicians, who, in contrast to physicians, are growing in their numbers serving the healthcare system. NPs and PAs may have extensive training and be completely capable of effectively handling routine medical care, but there are questions you should ask when seeing one of these providers, and homework to be done before you accept these trained professionals as an appropriate substitute for a licensed physician. To find out more, jot down your health history and click here.

What about seeking medical attention through an online provider? Telemedicine, which became more popular during the pandemic, is now widely available, depending on your location, insurance, health needs, and technical prowess. Dozens of companies are now filling this need and for many, it may be an attractive alternative if finding a physician is difficult, or getting a ride to a doctor is challenging, or you need immediate attention and your doctor is not available. A recent article in the Wall Street Journal reports that more than ⅓ of Medicare patients are waiting more than a month to see a doctor, and a recent survey found that for those seeking an appointment with a new doctor, the wait time can also approach 1 month in 15 of the largest cities in the US. So easy access to an online physician might be tempting. However, it’s not without its complications. According to a recent poll from the University of Michigan’s National Poll on Health Aging, only 7.5% of people ages 50-80 have used one of the telemedicine services and nearly half of those polled over 65 said they’d never even heard of these companies. While the convenience of this service is unquestionable, there could be dangerous consequences if a medication is prescribed and the online physician lacks a full understanding of the patient’s medical history, or the regular physician is unaware that the patient has received a prescription elsewhere (the study reports that only ⅓ of those receiving a prescription online told their primary care provider).

Can the current, real-world healthcare system be made to work better for older patients? While the answer is emphatically yes, actually getting better services and strategies in place is not so easy. For those who go from appointment to appointment, often on different days and at different locations, the “treatment burden” of these ongoing medical appointments is not sustainable. Many patients may fall through the cracks through no fault of their own or may lack the technical prowess to negotiate electronic patient portals. There should be social workers or patient navigators who can proactively help coordinate and streamline this kind of care, but most systems currently lack that support. There are some promising pilot programs and intelligent computer systems in certain locations that make it easier to schedule appointments or cut back on wait times at physician offices. But in many ways, the system still relies on older patients (or their loved ones) to be their own advocates. Whether it’s speaking up to ask how the appointments or therapies can be prioritized or compressed, or whether it’s making the best use of the time you have with a physician by strategically preparing your questions to keep the conversation efficient and focused on your priorities, older patients currently have little choice but to navigate a less than perfect healthcare “system.” For some additional suggestions for how to be your own best advocate when receiving healthcare, refer back to the many excellent blog posts written by patient advocate Julie Buyon and published in agebuzz.