…AND WHERE TO LOOK

 

Gary S. Moak, M.D.

Public awareness of geriatric psychiatry has been increasing over the last decade.  Not long ago, few people knew about geriatric psychiatry, and family members commonly were appalled by the suggestion that they take an elderly relative to a psychiatrist.  At the Moak Center for Healthy Aging, we often heard the refrain “I wouldn’t do that to my mother!” as if seeing a geriatric psychiatrist was some form of medieval torture (to learn more about what geriatric psychiatrists actually do, see the article What is the Expertise of Geriatric Psychiatrists? also in the Free Articles section of the Moak Geriatric Psychiatry Information Center). 

Fortunately, a sea change has begun over the last few years.  Every year more and more older patients call for an appointment because they, or someone close to them, has decided that they need to see a geriatric psychiatrist.  People struggling with late-life mental health problems are becoming more aware that there is a medical sub-specialty that can help.  Unfortunately, all over the country, people also are discovering that there is a critical shortage of geriatric psychiatrists, so the help they need often is not available. This article will help you understand why this is so and give you tips about finding a geriatric psychiatrist.

Geriatric psychiatry has existed as a recognized field since the 1940s.  The American Association for Geriatric Psychiatry, a national professional association of geriatric psychiatrists (www.aagpgpa.org), was formed thirty years ago to advocate for the needs of older patients and to promote recruitment of physicians into geriatric psychiatry.   There are dozens of geriatric psychiatry fellowship training programs all over the United States and throughout the world, and several prestigious medical journals devoted to the field.  Since 1981, psychiatrists have been able to become board-certified in geriatric psychiatry. 

So why is it so hard to find a geriatric psychiatrist?  According to the Association of Directors of Geriatric Academic Programs, at present there are less than 1600 actively board certified geriatric psychiatrists in the United States.   We need about 5000.  By the year 2030, 70 million Americans will be 65 or older, and we will need about 7000 geriatric psychiatrists.   Unfortunately, only about 75 new geriatric psychiatrists are trained per year.  Thus, we face a critical shortage in the present and rather than gaining ground we are falling further behind.

The major obstacle to improving the supply of geriatric psychiatrists is financial.  According to the Institute of Medicine and the Medicare Payment Advisory Commission (the latter advises Congress about Medicare policy), inadequate reimbursement is the single greatest limitation restricting growth of the geriatric workforce.  Payment from Medicare, Medicaid and other health insurance plans is not enough to cover the highly complex and intensive services needed by older people with psychiatric problems. The bottom line is that very few people specialize in geriatric psychiatry because few people can afford to practice this specialty.  So far, the healthcare system has not identified this as a priority; nor has not adopted policies to encourage more physicians to become geriatric psychiatrists.  This means that, if you can find a geriatric psychiatrist, you may have to pay for services that insurance does not cover.   

 

FINDING A GERIATRIC PSYCHIATRIST

 

So what can you do to find a geriatric psychiatrist in your area?  First, start by contacting community providers in your area.  Start with your primary care physician, who may know of a geriatric psychiatrist in the area.  Your PCP’s recommendation is the best place to start.   Local visiting nurse associations, home healthcare agencies, councils on aging, or senior centers are other good sources of information about the availability of a geriatric psychiatrist in the area. 

Another good resource is your state’s chapter of the Alzheimer’s Disease and Related Disorders Association.  These advocacy organizations are repositories of all kinds of helpful information related to the management of dementia, so they often know about geriatric psychiatrists practicing in the region.  You do not need to have dementia for the Alzheimer’s Association to be helpful.  Geriatric psychiatrists whom the Alzheimer’s Association recommends probably see older people with other types of mental health problems.

If there is a nearby medical school or medical center, try calling its department of psychiatry or geriatrics.   They may have a geriatric psychiatry program that accepts new patients.  Even if the hospital or medical school does not have a program of its own, these departments’ personnel usually know whether there is a geriatric psychiatrist practicing in the community.  Finally, you can try psychiatric professional associations.  Your state psychiatric society may be able to help you find a geriatric psychiatrist.  Or visit the Geriatric Mental Health Foundation’s website at http://www.gmhfonline.org/gmhf/find.asp and use the online find-a-geriatric-psychiatrist service.

Do not be afraid to ask around.  Word-of-mouth referrals can be very helpful. You may need to widen your search radius.  The nearest geriatric psychiatrist may be more than an hour away.  For most people, this is too far for frequent, repeat visits.  But it may be worth making the trip for a one-time consultation.

If you are looking for help with Alzheimer’s Disease or a related disorder, then, rather than asking whether someone can recommend a geriatric psychiatrist, try asking whether they know a specialist who is good with dementia.  Invariably, if there is a geriatric psychiatrist practicing in the area, his or her name will come up.

If you take all of the above steps, and the same name keeps coming up, then you may have found the specialist you are looking for.   Once you find a geriatric psychiatrist, is important to be flexible.  You may encounter unexpected insurance barriers.   The geriatric psychiatrist may not accept your health insurance and might even have opted out of Medicare.  You may have to pay out-of-pocket for some or all of the services you need.   Find out what the fees are.  They may be less prohibitive than you expect.  It may be worth paying for a one-time consultation to get pointed in the right direction. 

 

Updated January 2009

Moak Geriatric Psychiatry Information Center ©