Finding a geriatrician when you need one is genuinely difficult in most American cities. The shortage is real and structural: there are fewer than 8,000 practicing geriatricians in the United States, but an estimated 14 million people over age 75 who would benefit from their specialized care. In many regions, a patient contacting a geriatrics practice today might be placed on a waiting list that stretches months into the future. If you live in a rural area or mid-sized city outside major metropolitan centers, you may find that no geriatricians practice within a hundred miles, leaving you to choose between traveling long distances or working with a primary care physician who may lack geriatric expertise.
The core problem is simple: geriatrics is not a lucrative specialty, the training pipeline has been understaffed for decades, and many practicing geriatricians are reaching retirement age without enough younger physicians entering the field to replace them. This means that even if you have insurance, live in a decent-sized city, and have the resources to seek specialized care, you may still find access limited by geography, wait times, or whether a practice is accepting new patients at all. The good news is that you have realistic alternatives and strategies. You can work with geriatric nurse practitioners, seek out internists or family medicine doctors with geriatric training, use geriatrics consultants through academic medical centers via telemedicine, or coordinate more intensive support from your primary care doctor. The key is understanding the landscape so you can build the right care team for your situation rather than waiting passively for an appointment that may take a year to materialize.
Table of Contents
- Why Are Geriatricians So Difficult to Find in Most Cities?
- How the Shortage Affects Your Care and What It Means for Your Health
- Searching for a Geriatrician in Your Area
- Building a Strong Care Team Without a Geriatrician
- Strategies for Getting Geriatric Input When Direct Access Isn’t Available
- Using Telemedicine and Consultative Models
- Advocating for Better Geriatric Access in Your Community
- Conclusion
Why Are Geriatricians So Difficult to Find in Most Cities?
The geriatrician shortage is rooted in both economics and training capacity. Geriatrics is a cognitively demanding specialty with lower reimbursement rates than many other medical fields. An internist or family medicine physician who spends 30 minutes with a 30-year-old patient with a sinus infection might bill the same as one who spends 45 minutes with a complex 82-year-old managing diabetes, hypertension, kidney disease, and four medication interactions. Insurance companies pay for straightforward diagnoses and procedures at higher rates than they pay for the time-intensive, nuanced work of managing multiple chronic conditions in older adults. This financial reality discourages new physicians from pursuing geriatrics. The training bottleneck is equally important.
There are only about 325 geriatric fellowship positions across the United States each year, and many of those positions go unfilled. Medical schools and residency programs do not mandate geriatrics training, so many graduating physicians have received minimal education about the special needs of older adults despite the fact that a 2024 survey found that most practicing internists and family medicine doctors expect to care for large numbers of geriatric patients. The result is a compounding shortage: fewer geriatricians train new geriatricians, fewer medical students are exposed to geriatrics as an appealing career path, and the field shrinks further. Geographic maldistribution makes the shortage worse than national statistics suggest. If you live within 20 miles of a major academic medical center like Mayo Clinic, Johns Hopkins, or UCLA, you may have access to excellent geriatric services. If you live 50 miles away in a suburb, or in a smaller city entirely, your options may be almost nonexistent. States like Wyoming, Montana, and Vermont have essentially no geriatricians in private practice, and older adults in these areas must travel to neighboring states or rely entirely on generalists for their care.
How the Shortage Affects Your Care and What It Means for Your Health
The shortage of geriatricians has direct consequences for patient safety and quality of life. Without access to a physician who specializes in the medical and functional needs of older adults, you’re more likely to experience issues like medication interactions, overtreatment, undertreatment of depression or cognitive decline, or a failure to address fall risk and functional decline. A geriatrician notices things that a general internist might miss or deprioritize: whether your medications are contributing to your confusion, whether your depression is a side effect of a blood pressure medication, whether your falls are related to medication interactions rather than “just getting older,” or whether your current treatment plan makes sense given your actual life expectancy and functional goals. One limitation to keep in mind is that even when you do access a geriatrician, they often work in a consultative role rather than as your primary care physician. This is especially true in smaller cities where a single geriatrician might work part-time in a hospital or clinic and see patients referred by primary care doctors. In this model, your family medicine doctor or internist remains the quarterback of your care, and the geriatrician offers specialized input on complex medication management, cognitive assessment, or functional decline.
This works well if your primary care doctor is receptive to the geriatrician’s recommendations and willing to implement them. It works poorly if your primary care doctor dismisses the geriatrician as overthinking a straightforward problem, or if the geriatrician and primary doctor have conflicting approaches to care. Another challenge is that the specialization creates a coordination problem. A geriatrician might recommend that you discontinue a blood pressure medication that’s causing dizziness and falls, but your cardiologist (who prescribed that medication for your atrial fibrillation) might disagree. You’re then caught in the middle of a disagreement between specialists with different priorities. A well-functioning care team resolves these conflicts through communication and shared goals, but this requires time, systems, and cooperation that don’t always exist in fragmented U.S. healthcare.
Searching for a Geriatrician in Your Area
Start your search with realistic expectations about availability. Call your insurance company and ask for a list of in-network geriatricians, then call each practice directly to ask whether they‘re accepting new patients. Many practices will tell you they are not. If you have Medicare Advantage, your plan might have a directory of specialists, or you might use CMS.gov’s Physician Compare tool to search for doctors with the specialty code for geriatrics. If you have a major academic medical center nearby (a university hospital), call their geriatrics department and ask whether they accept outside referrals or offer consultations. Many do, even for patients whose primary care is elsewhere.
A concrete example: if you live in Charlotte, North Carolina, and search for a geriatrician, you might find that Duke Health (in Durham, about an hour away) has a robust geriatrics program accepting referrals. If you’re willing to make a monthly or quarterly trip to Durham, you can establish a relationship with a Duke geriatrician who coordinates with your local primary care doctor. For some people, this investment is worth it; for others, it’s simply not realistic to travel regularly. If you cannot find a geriatrician within a reasonable distance, consider geriatric consultation via telemedicine. Some academic medical centers and large health systems now offer geriatric telemedicine services to patients anywhere in their state or region. These consultations work well for medication management reviews, assessment of cognitive changes, or advice on functional decline, but they’re less effective for patients who need a full physical exam or who lack reliable Internet or a quiet place for a video visit.
Building a Strong Care Team Without a Geriatrician
If you can’t access a geriatrician, your next option is to work with a primary care physician who has specific training in geriatrics. Look for physicians who are board-certified in Family Medicine or Internal Medicine with “Added Qualification” in Geriatric Medicine (this credential is listed after their name, like “MD, ABFM with Added Qualification in Geriatrics”). These doctors have completed extra training in geriatric care and often think more like geriatricians than pure generalists. They understand polypharmacy, geriatric syndromes, and the importance of functional assessment. Geriatric nurse practitioners are another excellent option in many regions. An NP with geriatric certification has specialized training in older adult care and can often provide more detailed assessment and management than a busy generalist.
In some areas, geriatric nurse practitioners work independently or in practices focused on older adults. The tradeoff is that they may have less prescribing autonomy in some states, and some patients or healthcare systems prefer physician-led care. But a skilled geriatric nurse practitioner can manage medication reviews, coordinate specialist input, and help navigate complex medical decisions in a way that feels similar to geriatrician care. A concrete comparison: if you work with a geriatric NP in a nurse practitioner–led clinic, you might see her for 45-minute appointments scheduled every 6 to 8 weeks. If you see a regular internist, your appointments might be 15 minutes every 3 months. The difference in time and attention can be substantial, and it often translates into better catch of medication interactions, functional declines, and preventable problems.
Strategies for Getting Geriatric Input When Direct Access Isn’t Available
One useful strategy is to ask your primary care doctor to order a geriatric evaluation, even if a geriatrician isn’t readily available. Some hospitals and health systems employ geriatricians specifically to do consults on hospitalized or post-acute patients. If you’re recovering from an illness or hospital stay and are struggling with new functional decline, ask your doctor to request a geriatrics consultation while you’re still in the hospital or rehab setting. Geriatricians will provide recommendations that your primary care doctor can then implement on an outpatient basis. A warning: beware of assuming that a physician who works at a hospital or has geriatric-sounding qualifications actually specializes in geriatrics. Some doctors call themselves “geriatricians” without board certification in the field. Others have taken a single geriatrics course or worked briefly in geriatric care and include this in their marketing.
Board certification in geriatrics (through the American Board of Internal Medicine or the American Board of Family Medicine) is the reliable credential. You can verify a doctor’s board certification on the websites of these organizations. Another strategy is to connect with your local Area Agency on Aging. These agencies, funded by the federal Older Americans Act, maintain resources about senior health services in your region. They can often direct you to geriatric specialists, support programs, and community resources. They also sometimes maintain lists of physicians with geriatric training or interest. If you’re struggling to find a geriatrician, the Area Agency on Aging is a good first call.
Using Telemedicine and Consultative Models
Telemedicine has expanded geriatric access substantially in recent years. Several large telemedicine platforms and regional health systems now offer geriatric consultation visits via video. These consultations typically focus on medication management, cognitive assessment, or functional decline. A geriatrician can review your medication list, identify interactions or inappropriate medications, and recommend changes without seeing you in person.
This works particularly well if you have a regular primary care doctor who can handle the physical exams and coordinate implementation of recommendations. The reality is that telemedicine geriatric care is sometimes better than in-person care with a poor geriatrician and sometimes worse than excellent local primary care. It depends on the quality of the telemedicine provider, the complexity of your medical situation, and the coordination between the telemedicine geriatrician and your local primary care team. If your local doctor is skeptical of geriatric recommendations or doesn’t follow up with them, a telemedicine consultation won’t help much. If your local doctor is engaged and collaborative, telemedicine geriatric input can be extremely valuable.
Advocating for Better Geriatric Access in Your Community
The shortage of geriatricians is a healthcare system problem, not an individual problem. Communities, health systems, and policymakers have roles to play in improving access. Some hospitals and health systems have begun creating geriatric care models that rely more on nurse practitioners and physician assistants with geriatric training, supported by geriatrician oversight via consultations and caseload reviews. These models expand access beyond what traditional one-on-one geriatrician care allows. If you live in a community without good geriatric services, advocating for such models—through local hospital boards, primary care networks, or your representative in state government—can help create better systems for everyone.
Looking forward, the geriatrician shortage will likely worsen before it improves, because the physicians currently practicing geriatrics are aging out of the workforce faster than new geriatricians are trained. The U.S. healthcare system, policymakers, and medical schools are beginning to acknowledge this crisis, but change is slow. In the near term (the next 5 to 10 years), older adults should expect to work primarily with primary care doctors and geriatric specialists like nurse practitioners, using geriatrician consultation and telemedicine to supplement when possible. Building a strong primary care relationship and learning to self-advocate for your medical needs—asking questions, tracking medications, monitoring for side effects—becomes even more important when specialized expertise is scarce.
Conclusion
Finding a geriatrician in a city with a shortage is challenging, but it is not a dead end. The first step is to be honest about what’s available in your area, then move methodically through your options: call local practices and ask about wait lists and new patient acceptance; contact your insurance company or CMS.gov to identify in-network specialists; look for primary care doctors with geriatric training or certification; consider geriatric nurse practitioners; explore telemedicine consultation; and engage with your Area Agency on Aging for local resources and referrals. Understand that a geriatrician is a valuable resource, but primary care doctors, nurse practitioners, and coordinated specialist teams can also provide excellent geriatric care. The most important thing is to be proactive rather than passive. Don’t wait until you’ve had a serious fall or medication crisis to think about geriatric expertise.
Start building your care team now, identify the best primary care doctor you can access, and make clear to that doctor that you value geriatric-informed care. Bring a written medication list to appointments. Ask about side effects and drug interactions. If you’re struggling with a complex medical problem, don’t assume your doctor has thought about it from a geriatric perspective—ask directly. In a healthcare system with scarce geriatric specialists, the patients who do best are the ones who understand that they need to be actively involved in managing their own care and in advocating for the geriatric expertise that exists to be applied on their behalf.