Are There Any Geriatric Gynecologists?

By Karen and Erica

One of Lustre’s followers said she would love to find a geriatric gynecologist. We were a little confused at first, then we saw what she meant. A gynecologist who cares about post-menopausal women.

We can relate to that wish. We, and likely many of you, have had the experience of a gynecologist who loves pregnancy and babies, maybe is even interested in menopause, but seems faintly bored, or even repulsed, by the post-menopausal body. It is an uncomfortable feeling, and one that makes you wonder—do you really need a gynecologist, post-menopause?

Well, it seems you actually do. The Penn Medicine site says that lower hormone levels, combined with aging, put you at greater risk for specific health problems:

• Depression and anxiety;

• Heart disease;

• Hot flashes after menopause;

• Sexual problems;

• Sleep troubles;

• Weight issues.

The NIH National Library of Medicine agrees:

According to a Polish epidemiological forecast, in 2050 the average female life expectancy will be 87.5, which is 6.4 years longer than today. Thus, the life expectancy of women who will be 60 or older in 2050 will also extend. Therefore, strategies need to be optimized to maintain postreproductive health, in part because of increased longevity. The general gynecologist can expect to see more elderly female patients as the population continues to age. Office management of the gynecologic problems of geriatric women requires sensitivity to the special needs of this group. Nowadays, most women spend more than one-third of their lives after menopause; therefore there is plenty of opportunity for gynecologists to cater to the needs of postmenopausal women.

But finding a doctor who is interested in post-menopausal patients—and competent to address their needs—is difficult. Why? Probably because there are very few doctors trained in the field.

People over 65 use more health care than other age groups and make up nearly half of hospital admissions. But there are just 7,300 board-certified geriatricians in the United States, which is fewer than 1 percent of all physicians, according to the American Geriatrics Society. By contrast, more than 60,000 pediatricians were practicing in 2021, according to the Association of American Medical Colleges (AAMC).

And these numbers are expected to decrease.

We tried to find out how many gynecologists in the U.S. are trained in geriatrics, since there are estimated to be approximately 38 million women over 65 living in the U.S. today—a population that is expected to grow quickly. We were having difficulty. So, of course, we asked ChatGPT. ChatGPT had difficulty too.

Geriatrics as a specialty faces recruitment challenges due to factors such as lower salaries compared to other medical specialties, which makes it less appealing to new medical graduates who are often burdened with substantial student debt​. Additionally, the complexity and extra training required for geriatrics can be a deterrent.

Given these challenges, it’s likely that the number of gynecologists with specific training in geriatrics is very small, as the broader field of geriatrics itself struggles with workforce shortages.*

Medical schools are not required to teach geriatrics. Why would that be? Probably because they have not yet realized that life expectancies are longer that they were 100 years ago, and there are medical consequences that flow from that fact. And there is another possible cause described by an NIH book:

Several decades ago, discussions about the care of elderly people led to a striking dichotomy of views. The “social model” argued that aging was a social problem with primarily social solutions, such as improved housing, income, and social services. The “medical model” stressed that accurate diagnosis and problem identification with appropriate treatment would lead to improvements in the functional status of elderly people and lessen their dependency. The proponents of the social model clearly felt that the responsibility for the care of elderly people should not rest solely with physicians but, rather, should be directed by more socially oriented professionals who could call in physicians for technical assistance to address strictly medical problems.

We do hope academic questions like these—worthwhile as they are—are not keeping medical schools from offering training in geriatrics, since the U.S. population over 65 is growing fast. According to ChatGPT:

In terms of absolute numbers, this demographic shift means that the population aged 65 and older will rise from around 58 million today to about 83 million by 2034. This increase will have widespread implications for various sectors, particularly healthcare, where the demand for physicians and other healthcare services is anticipated to surge. By 2034, the U.S. could face a shortage of up to 124,000 physicians to meet the needs of the growing elderly population​ (AAMC)​​ (Fierce Healthcare)​.

It is past time to get on top of the breaking news that lives are longer than they used to be. And often healthier. We need professionals trained to deal with an aging population, and we need them now. A shortage of trained medical personnel will have repercussions. For example, like sex differences between men and women, physical differences as we age affect how our bodies metabolize drugs, so primary care physicians may prescribe in ways that cause harm to patients older than 65.

Some doctors “don’t understand that what they think is a new symptom or problem is actually an adverse effect of a drug, which in younger people wouldn’t cause that,” [Rosanne M. Leipzig, a professor and vice chair emerita in the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York] said.

And we also need better words—more precise and less pejorative. Many of us do not consider ourselves geriatric, or senior, or elderly, even though we are older than 65. We might not seek out geriatricians until we are much older. We also suspect that medical issues of people who are 65 are likely to be different than those of people who are 105.

It seems that the medical profession needs a bit of a push into the twenty-first century. Let’s do it, ladies. Talk to anyone you know about the need for progress.

And thanks to our follower for sparking our curiousity.

*Amusingly, ChatGPT gave the same answer when asked how many people in the US were post-menopausal, and how many people were over 65. Apparently the bot is unaware that the status of being post-menopausal is confined to women.