Workforce scrambles to keep up with aging population

A shot of stethoscope with EKG
A shot of stethoscope with EKG

The region's health care industry is greeting an influx of older adults at the same time it's bidding a significant portion of its workforce farewell, creating opportunities for youngsters to enter the arena - if they can be trained fast enough.

But, according to data, the college graduation rate, particularly within the tech and health care professions, isn't matching projected growth.

"That is about to be a huge issue," said Dr. Wayne Scott, a longtime internist in the Chattanooga area who retired from private practice three years ago. "Older physicians are bailing, and there's more and more patients with the aging of the population, and their problems are more complicated."

Last year, there were about 137,000 adults age 65 or older in the nine Tennessee counties that surround Hamilton County plus Dade, Walker and Catoosa counties in Georgia, according to a Southeast Tennessee Development District report. That number is projected to increase to over 212,000 by 2030.


The trend calls for more services and thousands of new providers, including doctors, surgeons, nurses, social workers, personal care aides and dentists.

An additional 675 physicians and surgeons are needed to keep up with the growth in the region, according to estimates from the Southeast Tennessee Development District's report, and the need for registered nurses and personal care aides is even greater.

As of 2016, the region employed about 6,500 registered nurses and 2,500 personal care aides, and of those workers more than 2,300 already are or will reach 65 years old in the next 10 years. When taking into consideration the projected number of new jobs, more than 2,300 nurses and 1,400 aides are needed to replace retirees and meet demand.

But there's more than the baby boomers to blame for provider shortage.

Although nursing school enrollment is up slightly, it's insufficient and compounded by limited class openings because of funding, program capacity and a nationwide shortage of nursing faculty, who typically require more education and make less money than clinical nurses. As a result, more than 64,000 nursing school applicants were turned away from undergrad and graduate programs in 2016, according to a report from the American Association of Colleges of Nursing.

Other factors include high turnover and burnout in a profession already straining to keep pace. Scott said that for him, and many of his colleagues, the frustration over impersonal, modern medical practices prompted an early retirement from the career he loved.

"It's a totally number- driven, electronic, how many screens you have looked through practice now," he said. "To be fair, you can't teach an old dog new tricks - the 25- and 30-year-old doctors who were born with iPods in their hands have less problems with this system than physicians my age."


The health-related needs of seniors are complex, which will place additional stress on the workforce and require more individuals trained to care for older adults.

"When you get older, your whole body changes," said Dr. Alycia Cleinman, a geriatrician at the CHI Memorial Center for Healthy Aging. "They do need to be treated differently than a 40-year-old patient."

Cleinman said older adults have a higher prevalence of one or more medical conditions - called comorbidities - that often require multiple medications, and these must be carefully managed because of changes in how the body processes drugs as it ages.

But geriatricians, the doctors who train to specialize in senior health care, are in especially short supply. While it's not completely necessary for older patients to see a geriatrician, Cleinman said, more primary care providers should learn to care for this demographic.

Seniors' mental health and the growing prevalence of brain diseases associated with age, such as Alzheimer's and dementia, will also impact the future of health care systems.

"We're going to have a very substantial portion of people who are going to develop memory problems in the coming decades," said Dr. Berneet Kaur, a neurologist specializing in dementia at Erlanger Health System. "This is going to be a major economic force for not only the Chattanooga area, but the country as a whole."


But the future isn't all doom-and-gloom, as long as certain changes are made to improve efficiency and patient experience, said Scott, now 63 years old and working as a volunteer physician treating the medically underserved.

He suggests targeting the pervasive "medical merry-go-round" system of multiple specialists and transitioning to a "patient-centered, medical home" system where primary care is centralized in one location.

"If the model stays fragmented in silos like it is now, patients become pinballs and not people," he said, adding that the medical home model would improve patient care and reduce cost as people aren't bouncing between providers who don't communicate.

Industry leaders such as Andrew McGill, senior vice president of strategy and business development at CHI Memorial, say adapting to the changing demographic by minimizing distance, complexity and inpatient status is crucial for the health care system to remain sustainable.

"We're all living longer, which is a great thing, but that really requires you to rethink your model," he said. "That's what every health system in the country is having to address, and it starts at the primary care office."

Both McGill and Scott emphasized the importance of non-physician providers, including nurse practitioners, physician assistants, psychologists, social workers and pharmacists.

Britt Cusack, assistant professor and endowed chair of gerontology at the University of Tennessee at Chattanooga School of Nursing, came to campus in 2015 to address some of these pressing issues.

"Even as a nursing student, I could see the deficit of providers who were specialized in geriatric medicine," Cusack said. That fact, along with a promise she made to her grandfather, inspired her to pursue a career training others and researching issues in gerontology.

Now, she's building new programs at UTC focused on senior care - an interdisciplinary minor in gerontology for undergraduate students and an adult-geriatric acute care nurse practitioner program for graduate students.

"There's plenty of hope if you use non-physician providers that are supervised in a patient-centered medical home," Scott said. "Then we can take care of the aging population with the physician manpower that we have."

Contact staff writer Elizabeth Fite at or 423-757-6673.

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