Healthcare PolicyHuman Interest


Old folks, at least those over age 65, are an interesting lot. In 2020, the census determined that 17% of the US population was 65 years and older, and despite an overall shorter life expectancy, “the proportion of US residents older than 65 years continues [ed] to increase.” Senior citizens aren’t dying from fentanyl at the rate of young adults, but they have medical co-morbidities that demand the attention of primary care physicians. 

Once they retire, a lot of seniors head for warmer climes, if not permanently, for at least 3-6 months of the year. One example is The Villages, Florida. Located in north central Florida, between Ocala and Orlando, it occupies part of three counties (Marion, Sumter, Lake). The Villages opened in the early 1980’s with about 10,000 residents. By July, 2023, the population had increased to 151,565. From July, 2022 to July, 2023, alone, the population increased 4.7%. 

Most of these people have relocated from the northeast or midwest, and if they stay in Florida for six months and one day, are eligible to be Florida residents. Many opt to stay—Florida has no state income tax and much milder winters. 

The percentage increases in residents over 65 has occurred in the western US as well. Boise, Idaho’s senior population grew 60% from 2010 to 2019. Phoenix, New Mexico, and Texas all had major increases in residents over 65 over the last ten years. These are mostly baby-boomers who have enjoyed healthier lifestyles improved by more exercise, better dietary choices, and smoking cessation. Drugs like statins, beta blockers, and anti-hypertensives have   been available to them, and have proven their value again and again. 

These aging seniors are living longer, but they still have high blood pressure, high cholesterol, cardiovascular disease, and diabetes. Their increased longevity is clearly because they are taking better care of themselves. That puts extra pressure on the healthcare system to provide access to these seniors, and begs the need for primary care physicians in those areas heavily populated by aging adults. A study done in conjunction with the 2020 census showed that high seniors’ growth areas have not provided access to primary care physicians at the rate necessary to serve the growing population. This study clearly showed that areas with a “high ratio of patients to physicians” had “poor health outcomes.” There simply weren’t enough doctors to adequately care for the increasing number of patients. In 2021, Congress “expanded Medicare funding for residency training by 1000 positions,” but this a bandaid on a big wound. 

The map attached to this article gives an idea of where shortages of physicians exist. The blue areas are counties with high elderly population growth coupled with a low number of primary care physicians. As you can see shortages exist in Idaho, New Mexico, Texas, and the southeastern states, particularly, Georgia, Tennessee, Virginia, and the Carolinas. Florida has underserved areas, too. 

The American poster child for senior population growth is the Villages, Florida. I wrote about that already. The measurement used to determine if a county is adequately served medically is the ratio of physicians per 100,000 patients. From the numbers quoted below, it can be seen how The Villages is lagging in provider access:

     The average for the entire state of Florida is 261.0 physicians/100,000 people   

     The highest rate is for Alachua County (Gainesville area) at 745.6/100,000

     The rate for Miami-Dade County is 316/100,000

     The rate for St. Johns County (St. Augustine area) is 361.8/100,000

     The rate for Orange County (Orlando) is 328/100,000

     The Villages covers 3 Counties—Lake, Marion, Sumter. They average 155,164,146/100,000

          much lower than the statewide average.

These figures are consistent with the study’s conclusion: That high growth areas for Americans 65 and older are medically underserved. The other problem is that not all of the physicians in the ratio are primary care providers. Probably more than half of them are surgeons or other specialists so even if the number sounds adequate, it really isn’t.

The problem nearly everywhere is not so much a shortage of physicians, but a maldistribution of them. There are a lot of doctors; It’s just that too many are in the same place. Most doctors want to be busy, but still have some leisure time to enjoy their surroundings. They prefer to practice in more desirable places. Unless they are exceptionally altruistic, they would prefer to live, and practice, in an area where their children are safe and can get a good education, and they have access to cultural and entertainment activities. It’s a small minority of physicians who choose to practice in remote, rural, or poor areas. Many of those areas have physicians provided by government-funded agencies like the Indian Health Service or the National Health Service Corp.

It’s great that our population over 65 is growing as long as we can keep up with that growth by providing adequate access to primary care services. There’s a concerted effort to train more family physicians, which is a good thing. We just need to get them to practice in areas where they’re needed. That’s a bigger task.

References: Huffstetler A, Topmiller M., Primary Care Access in Areas of the United States With Aging Populations Am Fam Phys 2024 Apr;109(4):308-309.

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