The Ministry of Health proposes to change the procedure for providing medical care to older patients. The department plans to create a geriatric office in each hospital with a capacity of more than 400 beds. And in geriatric departments, reduce the workload on doctors: from 20 to 13 beds per specialist. Experts point to a shortage of geriatricians and an increase in their demand as the population ages and life expectancy increases.
The Ministry of Health published draft order No. 38n on amendments to the procedure for providing medical care in the “geriatrics” profile. The current version of the order provides for the recommended staffing standards for the geriatric department to have one geriatrician for 20 beds. Now the department proposes to reduce this norm to 13 beds. In addition, the Ministry of Health requires the opening of a geriatric office in all hospitals with a capacity of more than 400 beds. It is planned that it will have one geriatrician for 400 beds and one nurse for one specialist doctor.
Let us recall that, according to the standards of the Ministry of Health, medical care in the “geriatrics” profile is provided to patients of elderly (60–74 years) and senile (75 years and older) age “in order to preserve or restore their ability to self-care, physical and functional activity, autonomy, that is independence from outside help in everyday life.” Geriatric care is also provided to patients of “other ages in the presence of senile asthenia.” In turn, gerontologists deal only with information and educational support for older people.
According to a study by the HeadHunter service, which Medvestnik wrote about, geriatricians and gerontologists became the most scarce medical specialties in Russia in January-February 2023: there are only 0.1 resumes per such vacancy. At the same time, the number of geriatricians in Russia has increased by almost 25% since 2021 and amounts to more than 1.6 thousand, said Russian Minister of Health Mikhail Murashko at the VII All-Russian Congress on Gerontology and Geriatrics in May 2023. And the chief freelance geriatrician of the Russian Ministry of Health, Olga Tkacheva, said at a press conference on March 20, 2019 that a few years ago there were only 200 geriatricians in the country. At the same time, Mrs. Tkacheva pointed out that 37 departments were already training geriatricians. And Deputy Minister of Health of the Russian Federation Evgeny Kamkin stated in July 2023: if in 2017 there were only three geriatric centers, then by June 1, 2023, 84 of them had already been opened in 83 constituent entities of the Russian Federation; the number of geriatric offices has increased almost 6.5 times since 2017.
Co-chairman of the All-Russian Patients' Union Yan Vlasov notes that the population of Russia is aging, like the population of all of Europe. In addition, life expectancy generally increases. “So it’s not news that we need geriatricians. Since 2018, when national projects were being formed, the “Demography” project included blocks related to active longevity,” recalls Mr. Vlasov. “Active longevity involves the creation of special conditions, including for medical examination and prevention of deterioration in the condition of people in the older age group. And since this project has been extended until 2030, even on a formal basis it must be implemented.”
Yan Vlasov points to another reason for the demand for geriatricians - this is the issue of the lack of professional personnel in industry and production in general. “Due to different types of educational concepts, a couple of generations were lost,” he believes, which is why key industries are now headed by age-specific specialists. Geriatrics is faced with the task of preserving their potential “for another 10 years, so that they have time to pass on their experience to future generations.” At the same time, Mr. Vlasov believes that the geriatric area “requires a reboot, rethinking, and new specialists.”
Geriatrician, founder of the nocode drug dosing service Dozator.io Gleb Krasnov approves of the initiative of the Ministry of Health to create geriatric rooms in hospitals. He points out that then specialists will have the opportunity to influence inpatient treatment - for example, help endocrinologists and oncologists in determining treatment targets and the prognosis for rehabilitation. But the provision to reduce the number of beds per specialist in geriatric departments, in his opinion, is unlikely to be implemented. Gleb Krasnov notes that in some hospitals, doctors manage 30 beds when the current norm is 20 beds: “It seems unlikely that, given the shortage of specialists, it will be possible to reduce the workload on doctors by one and a half times.”
Olga Shuppo, scientific director of the Grand Clinic network of immunorehabilitation and preventive medicine clinics, points out: historically, few doctors went into geriatrics, so it did not receive much development. “Over the past few years, many diseases associated with old age have become younger. Therefore, geriatrics is being “absorbed” by preventive medicine, aimed at early detection and rehabilitation of diseases, and healthy longevity,” she says. “This process will intensify against the backdrop of a paradigm shift in the healthcare system, which aims to prevent people from getting sick, rather than treating the sick. And geriatrics will firmly enter the field of preventive medicine.”
Gleb Krasnov emphasizes the importance of geriatric specialists. Unlike therapists, who have 12–15 minutes per appointment, they can conduct an outpatient appointment for 45 minutes. In addition, geriatricians are able to work with conditions that cause difficulties for internists and other specialists: dementia, hypertension, multimorbidity (more than five chronic diseases) and polypharmacy (when a patient takes five or more medications). However, he agrees with Ms. Schuppo that older people need to be “included in the diagnostic process even before they enter the geriatrician’s office.” “Elderly patients take up the majority of appointments with general practitioners and medical specialists in clinics. And in principle, the problems of elderly patients outweigh the productivity of doctors,” he explains. “Therefore, when we talk about total geriatrics for the entire population, it must be modified. The Dozator team and I are now, among other things, engaged in the digitization of a comprehensive geriatric assessment - those questionnaires that are in the arsenal of a geriatrician. And adapting them to patients so that they can go through them even before they enter the doctor’s office. This approach and automation will help relieve the burden on the healthcare system.”