America's geriatrician shortage is everyone's problem — here's how primary care can step up

America's geriatrician shortage is everyone's problem — here's how primary care can step up

The U.S. is getting older fast, but the pipeline of geriatricians isn't keeping pace. With higher-paying specialties like cardiology and gastroenterology drawing more trainees, geriatrics remains chronically understaffed — leaving primary care providers to pick up the slack for an increasingly complex, aging patient population.

Dr. Fred Pelzman argues that until the workforce catches up, every provider needs to get more comfortable with the core work of geriatric care: having honest, timely conversations about end-of-life wishes. Right now, advanced directives are often an afterthought — buried in Medicare Annual Wellness Visit templates or raised only when a crisis has already arrived.

Key Takeaways:

• Advanced directive discussions should be embedded at every patient encounter, not reserved for the elderly or critically ill
• Practices should require patients to upload or complete advance directive documents — just as they scan insurance cards at every visit
• Tools like MOLST forms, Living Wills, and Medical Power of Attorney should be proactively shared with patients alongside supporting education
• Bureaucratic barriers to hospice enrollment and Medical Aid in Dying programs need to be reduced

Why it matters: With millions of aging Americans and too few geriatric specialists to care for them, the burden falls on the broader healthcare system. Building smarter, less burdensome workflows around end-of-life planning isn't just good medicine — it's a systemic necessity.