The Doctor Dilemma We Boomers Pass On To Our Children and Grandchildren Part I: The State of Medicine, Doctor Issues, and Prevention

It took this Grandma one year to get an appointment with a well-regarded ophthalmologist who specializes in cataract surgery at Bascom Palmer Eye Institute, a world-renowned ophthalmic care, research, and education center affiliated with the University of Miami. It is consistently ranked as one of the best eye hospitals and vision research centers in the nation. I was told cataract surgery is a given as you age. I was advised to make the appointment before I needed the surgery so that I would not be a new patient when I needed the surgery.  Then, I would be able to get in for the surgery with this specific specialist when I needed it. 

When I explained this to my daughters, the generation below me, I said I guess I really should explain the doctor dilemma that is facing us Boomers that has several facets, so you are aware of what is coming as you age. 

Part I of the Doctor Dilemma We Boomers Pass on to Our Children and Grandchildren addresses the state of medicine, doctor, and preventative issues.  Part II of the Doctor Dilemma We Boomers Pass on to Our Children and Grandchildren addresses treatment, insurance, and Medicare.

FINDING A DOCTOR WHO WILL TAKE US AS A PATIENT IS A CHALLENGE. . . AND A WAIT.  We love and have confidence in our doctors, more than other professionals.   The number of medical school applicants has declined for the third consecutive year, but the rate of decline has slowed down. For 2024-2025, there was a 1.2% decrease in the number of applicants, compared to a 4.7% decrease the previous year, according to the contents of an article by the American Hospital Association.

As is of we, of the Boomer generation, my daughter’s doctors are about her age. Most of my doctors have been my doctors for over thirty or more years. As I have recently retired, my biggest concern is their retirement. It’s not that my daughters can really do much about it at their ages as if my daughters goes down thirty years, they are not doctors yet.  But I have advised them, that if they’re going to switch doctors or going to add a new specialist to their existing doctors, which you tend to do as you get older, to look for younger doctors. I surely do now, but then again, that is a given for a 78 year old! 

The next issue I brought to their attention is the dearth of doctors, even Internists and general practitioners. Most of all, for us Boomers, it’s gerontologists, or as they are also known, geriatricians. In South Florida, where I live, a wait of six to eight months or more to get an appointment with a new specialist is now becoming standard. Yes, we Boomers make up an enormous segment of the population, especially in a retirement state, such as Florida, but I think we are not alone.

I understand that medical school, which, in my generation, was a favored profession, is less so now.  Read what I perceive is a death quell in this article from The National Center for Biotechnology Information, National Institutes of Health on the “Future of Profession.”

Now, the recommendation: find a doctor before you need them and become a patient of the office.  Think primary care physician first, then opthamologist, ENT, gastroenterologist. When I am looking for a new specialist, which again, as you get older, more specialists are added to your roster of doctors, I am finding their practices are closed. That means they are no longer taking new patients. Or there is a long wait for an appointment as a new patient. Or you are scuttled off to a patient of a physician assistant who will be in charge of your case, as no doctor in the practice is taking new patients.

CONCIERGE DOCTORS. Which brings me to the next issue— the trend to concierge doctors. When you are looking for a new general practitioner, I find that you are encouraged to have a concierge doctor who supposedly can get you an appointment with a specialist that you might need. A concierge doctor, also known as a personal physician or VIP doctor, is a primary care doctor, who offers a more personalized and accessible form of care, supposedly to a smaller group of patients, and is one to whom you pay a flat annual fee out of pocket in advance for the privilege of becoming what is supposed to be a privileged patient.  It is supposed to provide you access, even a cell phone number, in some cases, to consult with the doctor whenever you need the doctor.  Is that 24 hours a day?

I personally think it is a physician who is in high demand because of reputation of quality of care, as well, but there is no guarantee of that, nor is there guarantee that the concierge doctor can provide greater and faster access to specialists.  In Florida, even concierge doctors have closed practices. Here is a link to considerations about moving to a concierge doctor. See, “A literature review on the impact of concierge medicine services on individual healthcare.” 

A tip I have heard from a specialist is that if you are considering a concierge doctor that you should not consider a generalist, but consider having the concierge doctor in a field that you have your most issues. For example, if you are diabetic, you might want an endocrinologist to be your concierge doctor, as you need this specialist the most.  My endocrinologist, who I love, has been my endocrinologist for enough years for me to be grandfathered or I should say grandmothered in as his patient, as he is now a concierge doctor and no longer taking new patients except as concierge. This is definitely one advantage of loyalty to a specialist in advanced age.

When you finally get into your doctor, you start to wonder if you should switch to another specialist. For example, at some point when you’re no longer having children, you want to switch an obstetrician gynecologist to a gynecologist that is no longer delivering babies. That means they’re more available to you and you’re not going to get your appointments canceled for the delivery of a baby. That is if their practice is not closed when you’re ready to do so, so you may consider it earlier than you might otherwise.

GERONTOLOGISTS OR GERIATRICIANS. The next major issue in Part I is gerontologists or geriatricians. When does one switch from an internist or general practitioner to a gerontologist or geriatrician? See, “Defining the role and reach of a geriatrician.”

This Grandma was lucky because her internist became a gerontologist.  

Next recommendation: case manager.  One would hope that your gerontologist becomes similar to a case manager, a team leader, who manages all of your specialists that you begin to need as you get older. I bet you never considered all the possibilities! The roster is never ending: dermatologist, gastroenterologist, cardiologist, endocrinologist, rheumatologist, ENT, orthopedist, urologist, gynecologist, urogynocologist, retina specialist, ophthalmologist and one who specializes in cataracts, optometrist, podiatrist, acupuncturist, physical therapist, massage therapist, hand therapist, and a new one several of my retired friends have added, wound specialist.  Remember, at some point there is going to be a caregiver, and the caregiver must be part of the team. See, “When Do Paid Caregivers Support the Health of Older Adults? Geriatrician Perspectives”

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SCREENING AND PREVENTIONS . . . and CANCER. I have written about cancer as a journey, in prior blog posts.  Where you get cancer treatment first can mean survival.  Always get a second opinion as to any major issue, including cancer, preferably at a national cancer center that specializes in the type of cancer, BEFORE YOU START ANY TREATMENT.  A cancer center will not take you as a patient if you have already started treatment.  If the word cancer is given to you, consider immediately hiring a cancer advocate, like Jaye Seidlin, (telephone number 212-748-9053 jayeseidlin@gmail.com) to advise you and assist you, as she has assisted family and friends on several occasions all around the country.

Prevention against disease is best. Know your genetics and be vigilant to watch for the signs of a genetic condition.  Be proactive with regular testing, especially in the four areas for which there is accessible cancer screening right now:  lung cancer (low dose CT scan); breast cancer (mammogram annually—do not stop at 74, see prior blog); colorectal cancer (colonoscopy or at home stool tests); cervical cancer (pap smear or potentially a human papillovmavirus test). Listen to your body.  Pay attention to how you feel.  Get regular checkups with an excellent primary care physician in your corner.

Dear daughters, I hope you have learned at least one new thing from this blog post. I think it is unfortunate that I have to give you the heads up, especially because as you get older, you both shall be or are considering being in Florida for at least part of the year.  I cannot talk about the rest of the country, but somehow I do not think that the problems that we of the Boomer generation are struggling with, this doctor dilemma, are finding it only in Florida.  

Please pass this along to our other family members, and especially my beloved grandchildren. Pass this along to those you care about.

What is most important is that all of the above impacts our health as we age.  It is detrimental to my and Boomers’ goal, of staying forever young, as well as healthy with

Joy, 

Mema

*By the way, my daughters, if you have to research something medical, I found PubMed to be a great resource.  As always, the key words you input are important.