Senior citizens make up the fastest growing age demographic in the San Joaquin Valley. And they need more doctors.
Members of the Baby Boomer generation – people born in the post-World War II era from 1946 to 1964 – are rapidly joining the ranks of senior citizens. The oldest members of the cohort reached age 65 in 2011, and the youngest boomers will become seniors before the end of this decade. At the same time, the San Joaquin Valley is confronting a shortage of doctors and other health professionals who specialize in geriatric medicine – the branch of health care that involves caring for the aged.
All of this creates a problem. Researchers who study the aging population say there are too few geriatric physicians to keep up, whether in the Valley, the state or throughout the U.S.
“The healthcare system, as currently constructed, is underprepared for the onslaught of demands this aging population will impose,” Pfizer Inc. researchers Charles H. Jones and Mikael Dolsten stated in a 2024 article in the international journal npj Aging. “The system is also fragmented, inefficient, and costly, with gaps in coordination, quality and access.”
According to U.S. Census Bureau data, the senior population in the eight-county San Joaquin Valley is growing faster than the region as a whole, thanks to the aging members of the Baby Boom and increased life expectancy. The Valley’s overall population rose by about 110% over the last 40 years. But the number of people age 65 and older climbed by about 164%, growing from about 210,000 in 1980 to almost 556,000 by 2020.
Within the Valley’s senior population, the fastest growth has been among those ages 85 and older – a group that is even more prone to a wide range of chronic health issues, from Alzheimer’s disease, diabetes and hypertension to falls and broken bones. The 85-and-older segment of the region’s population more than tripled – and even quadrupled in two counties – between 1980 and 2020.
“People today live longer than they used to,” said Dr. Bill Redmond, medical director for IIH PACE, a nonprofit medical-care program for seniors with locations in Fresno, Bakersfield and southern California. “We have a chance to see people in that ‘super-geriatric’ age more often than we used to...and so you have that longer and longer time for more things to show up.”
Redmond said the growing senior population is straining the region’s health care system, which already struggles to keep up with demand for care.
“We don’t have enough (medical) services in the Valley to begin with, across the board, not just in geriatrics,” he said.
Pfizer’s Jones and Dolsten reported that as seniors age into the 85-and-older range, “these elderly adults often suffer from multiple and complex health conditions, including age-related diseases that affect their heart, brain, and immune system. However, the medical system lacks the experience and expertise to effectively treat these diseases and provide specialized, personalized care for this vulnerable group.”
“The increase in the share and size of the older population will have implications for the demand and supply of healthcare and social services, as well as for the economic and fiscal stability of the nation,” they added.
Geriatricians represent less than 2% of all primary care providers, University of Miami geriatrician Maria H. van Zuilen and Dr. Lisa J. Granville of the Florida State University College of Medicine wrote in a 2019 editorial in the Journal of the American Geriatrics Society. But aside from children under 1 year old, they wrote, “over half of all office-based physician visits are by persons 65 years and older.”
“Because older patients have longer hospital stays, almost half of all hospital bed days are accounted for by patients in this age group,” van Zuilen and Granville added.
In the Valley, fewer than 10% of residents under the age of 65 are classified with some form of disability, according to U.S. Census data. By contrast, about 40% of people over the age of 65 live with a disability. For people 75 or older, the percentage is even higher, almost 54%.
The supply of doctors for the elderly
The Medical Board of California’s 2023 annual report notes that of more than 148,000 physicians licensed to practice in the state, 841 were geriatric specialists. A board database provided to the Central Valley Journalism Collaborative reveals that only 37 physicians in the Valley have a geriatric subspecialty certification or fellowship from either the American Board of Family Medicine or the American Board of Internal Medicine:
- 10 in Stanislaus County
- Nine in San Joaquin County
- Eight in Fresno County
- Five in Kern County
- One in Kings County
- One in Madera County
- None in Tulare County
The bottom line is that there aren’t enough geriatricians to serve the senior population. Using the Medical Board’s figures as a basis, the Valley – from Stockton in the north through Bakersfield in the south – has fewer than seven geriatric doctors for every 100,000 senior citizens in the region, compared to a statewide rate of almost 18 such specialists per 100,000 people age 65 or older.
“We are trying to recruit geriatricians, and it's so difficult,” said Dr. Suseela Kumar, a geriatrician with Kaiser Permanente’s Modesto and Stockton medical centers. “Young people want to go into critical care programs, or pulmonary or cardiology, you know, all these fascinating programs, but nobody wants to go into geriatrics."
The need for specialized care for the aging is manifested in conditions that naturally tend to accumulate as people grow older: Alzheimer’s disease or dementia, heart disease, diabetes, hypertension, cancer, arthritis, chronic kidney disease and more, along with the danger of falls and broken bones.
“I think we all recognize that as we get older, we get really good at collecting things; take a look in anyone’s garage,” said Dr. Alex Sherriffs, a Fresno geriatrician and medical director of the UCSF Fresno Alzheimers and Memory Center. “Well, it's the same thing in terms of health conditions. For every decade over 50, you probably acquire a major diagnosis.”
While older people live throughout both the urban centers and rural enclaves of the Valley, almost all of the geriatricians and other medical resources for senior citizens are concentrated in the larger cities: Fresno, Bakersfield, Stockton, Modesto and Merced.
In the sprawling rural reaches of the Valley’s westside or its foothill or mountain communities, it’s up to general practitioners or family practice doctors – who may have neither the specialized training or experience in geriatrics, the same wide-angle view of seniors and their multiple medical problems, or even the time – to provide care.
“Geriatric patients need more time, more in-depth evaluation,” Kaiser Permanente’s Kumar said. “And to spend time, at least 30 to 40 minutes per visit, it’s quite hard for primary care doctors” because many may see two dozen or more patients per day.
But doctors aren’t the only aspect of care in which there is a shortage of resources for elderly patients – or their caregivers.
“I will say seeing patients at the UCSF Fresno Alzheimer and Memory Center, where they live gives me a clue as to how big an issue I have in front of me,” Sherriffs said. “People in rural areas have less access to resources. A theme of successful aging is more structure and support, and people in rural areas don't have a lot of support.”
Sherriffs mentioned support groups that offer practical resources and information as well as emotional support, activities and respite for the elderly and their caregivers as an example.
“We think of support groups as the emotional support, which is an important part of it,” he said. “But problem solving, that's what they're really great for. … You don't find them in the little rural communities, but they are hugely important for people navigating these chronic problems.”
And the need for those resources – in urban and rural areas – will only increase as the Baby Boomer generation adds to the population of senior citizens.
“We are not currently set up to handle this (population) bulge,” said Steve Seita, vice president of business development for IIH PACE. “We see a huge shortage in geriatricians and…in mental health.”
“Either one of those could really sink a senior community,” he added. “If you don’t have adequate mental health or adequate geriatricians in a community, it can make it really tough.”
Economic implications of the aging population
Nationwide, as the population of senior citizens – most of whom are eligible for the federal Medicare health insurance program – grows, so does the amount of money and resources needed to provide health care for them. Most seniors live on fixed incomes and rely on public insurance programs to help cover medical expenses that can add up quickly when multiple conditions, doctors and medications are involved.
Valleywide, about 95% of the senior population is covered by Medicare, which kicks in for most at age 65. But the Valley’s relatively high rate of poverty compared with most of California means that about one out of four seniors in the region also relies on Medi-Cal, California’s version of the federal Medicaid program for low-income individuals.
KFF, a nonprofit health policy research and polling organization, estimated that in 2020, about $40.3 billion was spent in Medicare Part A and B benefits for recipients in California – part of almost $379 billion in benefits nationwide. Medicare Part A includes coverage for inpatient care at hospitals, skilled nursing centers and hospice as well as home health care. Part B helps cover doctor visits, outpatient care, home health care, medical equipment and preventive care.
The federal Centers for Medicare & Medicaid Services estimated that nationwide, Medicare spending was about $832 billion in 2020. The agency projects that will more than double by 2030, reaching nearly $1.7 trillion.
Medicare also reported that it spent an average of about $6,200 per enrollee aged 65 to 84 in 2002 and about $10,300 per enrollee aged 85 and older. By 2020, those figures had increased substantially: about $11,300 per enrolled person in the 65-84 age range, and almost $19,000 per enrollee in the 85-and-older age group.
At those averages, taxpayer spending on Medicare for the Valley’s overall senior population in 2020 amounted to about $6.7 billion.
Indeed, while many seniors are covered by Medicare, older Americans nationwide spent an estimated $164.6 billion on out-of-pocket costs in 2020 for health care needs, including hospital care, doctor and dental services, in-home health care, nursing or retirement communities, prescription drugs, medical equipment and other expenses. According to the Centers for Medicare & Medicaid Services, that doesn’t count expenses picked up by private insurance, Medicaid or other programs and payers.
“As the number of Americans over the age of 65 grows, the prevalence of diseases disproportionately affecting older people and economic burden associated with these diseases will increase,” the American Geriatrics Society stated in written testimony submitted in April to a subcommittee of the House Appropriations Committee.
In its statement, the American Geriatrics Society laid out a case for increased federal spending for training and education for geriatric specialists as well as research into the health needs of senior citizens.
The grim prognosis for the shortage of geriatricians and the ability of seniors to afford medical care comes as Congress and the Trump administration pledge to cut federal spending by trillions of dollars over the coming years.
Earlier this year, the Republican-controlled House of Representatives adopted a budget blueprint that directs the House Energy and Commerce Committee – which oversees a wide range of programs including Medicaid, Medicare and other public health and research fields – to slice at least $880 billion from its spending docket over the next 10 years. Such cuts are widely seen by analysts as requiring significant cuts to Medicaid – which in turn could have a large impact on seniors who rely on Medi-Cal in California.
Those potential cuts worry IIH PACE’s Seita, as well as other PACE programs throughout the state and across the U.S.
PACE, or Program of All-Inclusive Care for the Elderly, is a national program that relies on federal Medicare and Medicaid funding to provide an alternative to nursing home placement for seniors who are able to safely remain in their homes.
The PACE program operated by Innovative Integrated Health in Fresno, Bakersfield and Anaheim serves about 2,300 seniors, including roughly 1,300 members in the Fresno Area. It is one of three PACE programs in Fresno County, six in the Valley and 35 in California. Nationwide, there are 185 PACE programs with a total of about 84,000 seniors.
“It's a huge concern,” Seita said. “And I think with this administration, you're not certain what's bluster and what is actually going to stick. So we try to not get our hair on fire and run around screaming that the sky is falling, but there can certainly be some huge ramifications for programs like PACE if that $880 billion cut does go through.”
Seita said the uncertainty around looming federal cuts makes it difficult to plan a way forward.
“You're kind of at the will of the administration, at the mercy of the administration, whatever they elect to do,” he said. “Our funding goes from year to year. So if they decide to make an $880 billion cut, we could be impacted as soon as January of 2026.”
Beyond the prospect of cuts to Medicaid, there are also looming questions about President Trump’s executive order to bar undocumented immigrants from receiving any sort of federal benefits. In California, Medi-Cal – and, in turn, PACE – is available to all qualifying low-income seniors, regardless of citizenship status.
“There’s a real concern that if the administration decides, ‘we’re going to cut funding to any plan that serves non-citizens,’ then do we get completely cut out or are they going to be surgical about this and just remove non-citizens?” Seita said. “They haven’t shown much of an interest in being surgical in their cuts thus far.”
Seita expressed dread as he considered the potential impact of possible federal cuts and executive orders on seniors.
“The last thing you want to do is tell somebody that's 80 years old that is on some regular treatment that you no longer have care as of tomorrow,” he said. “I just can't even stomach that thought.”
Tim Sheehan is the Health Reporting Fellow and a senior reporter with the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. CVJC student research assistant Lauren Aiello contributed to this report.