• There's a growing problem for older Americans: doctors who specialize in geriatric care are dwindling.
• More than 80 million Americans are expected to be older than 65 by 2050, according to the US Census Bureau.
• However, geriatricians are in short supply, which could complicate access to care.

Jerry Gurwitz, a 68-year-old geriatrician based in Massachusetts, is at a tricky point in his career.

He's spent decades taking care of older Americans, but now, as Gurwitz approaches the age of some of his own patients, he sees a brewing problem with his profession: there aren't many people willing to take his job, and he has serious doubts over whether there will be enough doctors to properly take care of people as they get older, he told Business Insider.

Gurwitz, who graduated medical school in 1983, said he saw this problem brewing decades ago as he was completing his medical education. Part of the reason he chose to specialize in geriatric medicine was because practically comparatively few people were interested in the field, he said, a trend that hasn't improved more than forty years later.

"These people are going to be retiring. There's not substantial interest on the part of trainees to go into the field," he said of the supply of geriatricians today. "I can't see how the healthcare system isn't going to be overwhelmed over the next decade. It'll be too much, and too many people to take care of."

Medical professionals say the problem has been in the making for years, with the supply of doctors trained specifically to treat older adults nowhere near keeping pace with a quickly aging US population.

There's no clear path to addressing the shortage, Gurwitz said. He and other medical professionals told BI the influx of older patients could lead to a quality-of-care crisis.

The problem is visible in the numbers.

According to an estimate from the American Geriatrics Society, the US will need some 30,000 geriatricians by the end of the decade. Yet, the total number of board-certified geriatricians declined to around 7,400 in 2022, according to the American Board of Medical Specialities, down from around 10,000 at the start of the century —and the US population is quickly getting older.

According to the latest projections, the number of Americans aged 65 and older is expected to soar to 82 million by 2050, up 47% from 2022 levels.

Timothy Farrell, a geriatrician and a professor of medicine at the University of Utah, says the signs of strain on the profession have been increasing for years, but have become more severe recently.

Across the board, wait times have gotten longer, with the average wait for a physician appointment rising to 26 days, according to one 2022 survey, up 8% in five years.

"We could probably double our space, and we would very quickly fill," Farrell said, adding that he believed stress in the geriatric unit could be higher than in other areas of the hospital.

R. Sean Morrison, a geriatrician at Mount Sinai, says he knows others in the industry who say they have waiting lists that stretch for six months.

The strain of caring for older adults is particularly evident in nursing homes. A survey of over 400 nursing homes conducted by the American Health Care Association found that 72% had fewer employees in 2024 than they did prior to the pandemic.

The survey also showed that 57% of nursing homes said they had a waiting list, 46% said they began to limit their intake of residents, and 7% said they were turning away patients on a daily basis.

"We don't have right now, nor will we unfortunately ever have enough people who are trained," Morrison said. "That's evidenced by the amount of time it takes for an appointment within our geriatric practices. It's evidenced by the number of older adults that need to be taken into the hospital that the inpatient services don't have the capacity to see. And it's just the tip of the iceberg."

A dwindling medical profession

Gurwitz says he had always wanted to be a geriatrician, but the sentiment is rare among medical professionals. Data from the National Resident Matching Program showed that only 174 out of 419 available positions in geriatric specialty programs were filled in 2023, making it one of the most unfilled programs the organization tracks.

Convincing people to specialize in the field isn't easy.

For one, the profession doesn't pay as much as some specializations. According to data from Salary.com, the median salary for a geriatric physician in New York hovered around $264,163. That's less than half the median salary of a cardiologist in New York, which stood at $573,498 a year as of March 1.

There is also a perception that geriatrics medicine is a less distinguishing field than other areas, Gurwitz said.

"I think there are certain fields of medicine that are more prestigious in which they are more respected than others. Geriatrics, for one reason or another, is not among those," he added.

Farrell said he thinks that the complexity of treating older patients could be another factor turning professionals away from the trade. Geriatricians treat older adults who typically have overlapping health conditions, with some patients taking as many as 20 medications, he said.

"How do you prevent falls? How do you manage multiple chronic conditions for the same person?" he said. "I think there's people in primary care who have more or less comfort with the complexity taking care of complicated, older adults, and that's what geriatrician is trained to do."

Stop me if you've heard this before: Millennials have gotten screwed by the housing market.

The lack of affordable homes is one of the biggest reasons for the generation's economic shortcomings — why they can't catch up to their parents financially, live in cities near their friends, or even have as many kids as they want to. Several suspects have been blamed for this, including house-hoarding baby boomers and greedy corporate landlords. But the main issue was timing: A huge number of millennials reached their prime homebuying years after the 2008 financial crisis, right as the housing-market bust was pushing builders to cut back on construction. When it came time for millennials to claim their share of the American dream, the homes simply weren't there.

While the country's housing shortage, now measured in the millions of units, seems intractable, there are growing signs that it may not be a permanent state of affairs. Sure, lots of people have struggled to become homeowners over the past few years, sending prices to record highs and deepening the housing crunch. But population forecasts for the coming decade suggest a monumental shift is on the horizon. And millennials, after finally lifting themselves onto the homeownership ladder, may wind up with the short end of the stick yet again.

There's no denying that Americans are getting older. Slower population growth over the next decade and beyond, with more deaths and fewer births, will mean weaker demand for housing. This slowdown could come to a head in the 2030s, when members of Gen Z — a slightly smaller cohort than millennials — take over as the primary contingent of first-time homebuyers. Baby boomers will simultaneously be aging out of the market (economist-speak for dying), freeing up millions of homes nationwide. Unless immigration picks up dramatically to compensate, the combination of more supply and less demand could cause home prices to flatline or even drop.

Don't get me wrong: Cheaper housing is a good thing. But while a dip in home prices probably sounds like a godsend to the millions of renters hoping to become owners, it could be devastating for those who bought a place in the past few years. These homeowners, mostly millennials, are counting on their properties to grow in value and deliver a hefty financial return — the gilded path enjoyed by baby boomers. Like generations before them, millennials have tied up most of their wealth in their homes, which they'll rely upon to fuel their retirements or fund the purchases of bigger places down the line. Instead, when it finally comes time for them to sell, they may find that their nest eggs have turned out a lot smaller than they'd hoped.

Population trends, unlike the constant ups and downs of the economy, follow a steady drumbeat: People grow up, settle down, and eventually die. Demographics can't tell us exactly how many homes we'll need in a decade or two, but they can offer a pretty good idea. Builders and policymakers, however, haven't been great at reading the tea leaves. A recent paper from a team of researchers led by Dowell Myers, a demographer at the University of Southern California, argues that the lever pullers who control the housing supply have been out of touch for decades, relying on old data or focusing too much on the short term at the expense of the more distant future.

Take the current housing crunch. For years, demographic forecasts made it clear that a huge chunk of millennials would be looking to settle down in the late 2010s, signaling a need for a lot more houses. But homebuilding activity in 2011 dropped to its lowest level in 60 years, and credit availability tightened, making it harder to get a mortgage and creating more pent-up homebuying demand. Cue tough times for millennials.

But some real estate experts are starting to pay more attention to the underlying realities. I recently had lunch with Nik Shah, the CEO of Home.LLC, a housing analytics, consulting, and AI conglomerate. Shah and his team have gained prominence over the past few years for accurately predicting changes in home prices despite a tumultuous market. I was surprised, then, when instead of talking about the coming months, he mostly wanted to discuss the long term. Shah told me he's bullish on home prices for the next handful of years, forecasting mild year-over-year increases. But based on the demographic data, Shah expects home prices to stall out in the 2030s.

"Demographics play a critical role in home prices," Shah says. "And right now, the future projections on demographics are not rosy."

The biggest factor is deaths. In the coming decade, baby boomers will begin "aging out of the market" in droves. The size of the generation's adult population is second only to millennials, with roughly 66 million members who range in age from 61 to 79. But their numbers are projected to shrink by about 23%, or 15.6 million people, in the next decade, and by another 23.4 million people from 2035 to 2045. Boomers own about 41% of real estate nationwide, worth roughly $20 trillion, per the Federal Reserve. Their exodus will represent a sea change in the housing market.

All those boomer deaths, combined with a slight decline in birth rates over the next two decades, will work out to slower population growth. The result will be a lot less demand for homes. Data from the Harvard Joint Center for Housing Studies indicates that the total number of households in the US is expected to increase by 8.6 million over the next 10 years. In the past three decades, that figure ranged from 10.1 million households, in the 2010s, to 13.5 million, in the 1990s. From 2035 to 2045, household growth is expected to retreat even more, to a net increase of just 5.1 million, which would be the lowest growth rate in a century.

With more deaths and fewer births, the total number of US-born people in the country will shrink. The trajectory of the country's population, Daniel McCue, a senior research associate at the center, wrote in a report, will therefore be "entirely dependent on future immigration." Those household-growth projections from the Census Bureau assume that net immigration holds steady at 873,000 people a year for the next decade, roughly in line with the past 30 years. But even if you assume significantly higher immigration, McCue tells me, household growth is expected to decline over time.

The next generation of new homeowners won't represent a steep dropoff in demand. Harvard JCHS estimates there are now roughly 68 million Gen Zers, aged 16 to 30, compared to 68.8 million millennials. McCue says the real problem comes from the other end of the population equation, since a steady handoff to Gen Z homebuyers won't offset the wave of boomers exiting the housing market.

"It's not going to be enough to keep up with the pickup in losses, because the baby boomer generation is just so much bigger than previous generations," McCue tells me. "The pickup in mortality is going to outpace that."

Given the shifting demographics, the center says America probably needs to build about 11.3 million homes over the next decade and just 8 million new units between 2035 and 2045 to keep up with demand from new households (not factoring in the current shortage). These are fairly modest goals — in the 2010s, which included the weakest years for new construction in more than half a century, builders still finished almost 10 million units. In the 2000s, they built 17 million. As demand for homes slows down, McCue says, construction should have a chance to catch up.

That possibility should sound tantalizing to anyone hoping for an end to our housing shortage. But the imbalance between supply and demand has fueled an extraordinary run-up in home values — if that lopsidedness goes away, millennial homeowners may not see the same financial windfalls as their predecessors.

Millennials aren't young upstarts anymore. In 2030, they'll range in age from 34 to 49, according to Pew Research's cutoffs, which means many will be looking to move up the rungs of the housing ladder as they buy their first places or upgrade to bigger homes. They've already made up considerable ground in this department, with more than half the generation now owning their homes. For these fortunate millennials, the past few years of home-price gains have padded their net worths and contributed to a sunnier financial outlook.

While things are looking up, that may not last. A slowdown in home-price growth, or even outright declines, could leave a large chunk of millennials in a weird spot. Sure, for those who don't yet own a home, a breather in home-price appreciation could offer a chance to play catch-up. But among the millennials who are actually doing pretty well financially, most wealth is tied up in real estate and retirement accounts. An analysis by the Federal Reserve Bank of St. Louis suggests that from 2019 to 2022, the typical person born in the 1980s, otherwise known as an elder millennial, saw the value of their assets balloon by a whopping 57.3%, even after adjusting for inflation. Most of that increase — 41 percentage points — came from real estate.

So let's say household formation slows down as expected, relieving some of the pressure on home prices to keep going up, up, up. The team at Home.LLC projects that in this scenario, even if immigration holds steady, home prices will stay flat, maybe increasing by about 1% in some years and dipping slightly in others. That's a long way from the kind of market crash we saw in 2008, but it would mean far less wealth gains for today's millennial homeowners.

To illustrate this tension, compare a hypothetical baby boomer with a hypothetical millennial. Each buys a $300,000 home during their heyday. The boomer bought the house in 1994. Thirty years later, it's fully paid off and sells for about $1.21 million — a stunning gain of 305%, based on the typical home-price appreciation in the US over those decades. The millennial buys the house in 2010 and also holds on to it for 30 years. Its value grows by 2.5% each year from 2025 to 2030 and by just 0.5% a year from 2031 to 2040. The home ends up being worth about $813,000, a 171% increase. That's nothing to sneeze at, but you'd take the boomer's gains any day of the week.

"Obviously, the difference is pretty huge," Sid Samant, Home.LLC's lead economist, tells me.

But even the elder millennial in this example is lucky, because they got to ride out the historic home-value increases from the the pandemic. In Home.LLC's model, someone who bought a house in 2022 — say, a millennial who finally found their foothold in the housing market — would see their home's value increase by just 31% through 2040.

Forecasting home prices a decade from now is a fraught endeavor. Nobody expected baby boomers to stay in their homes as long as they have, throwing the housing market out of whack for everyone else. For policymakers, immigration is the easiest lever to pull in counteracting demographic realities, which also makes it the biggest question mark. And there's no way of knowing how future changes in the economy will alter construction activity or the homebuying calculus.

But demographic change is inevitable. And even McCue, the Harvard researcher who lives and breathes this stuff, is still wrestling with the downstream effects of our aging population.

"The extent to which we're going to start losing households was very eye-opening," McCue tells me. "I think we still need to get our heads around the implications of that."

If the housing shortage does indeed go away, it will hardly be mourned. But any big shift usually comes with some collateral damage. In this case, it could be homeowning millennials who get burned.

James Rodriguez is a senior reporter on Business Insider's Discourse team.

• David Martin and Harry Shen are chefs from St Vincent's Care, a nursing home in Melbourne.
• The chefs understand that not all nursing homes have the budget, but they hope to raise standards.
• Their efforts come as nations worldwide are facing aging populations.

David Martin can still recall the conversation that changed his career path.

He was 25 and had spent the past decade working in the restaurant and fine dining scene. The hours were brutal — up to 16 hours a day — and he was on the verge of burnout.

His parents brought up the idea of working in a nursing home. They had a cousin who worked in that industry and suggested he try it.

"I told them, 'Why would I want to go to aged care? That's where people retire. My skills will go to waste,'" Martin recalled. Still, with an open mind, he decided to give it a shot.

He hasn't looked back since. Martin, now 35, is an executive chef manager at St Vincent's Care, a nursing home facility in Australia.

By his side is Harry Shen, 39, a senior head chef who also left the restaurant scene to try something different. They share the same vision: to raise the standard of food in aged healthcare.

Apart from working under top chefs, including Donovan Cooke, Shen had also picked up shifts at Australian nursing homes in the past. It was during that time that he noticed frozen food was often the norm.

So when he saw a job posting from St Vincent's for a chef to elevate nursing home food, it stood out.

"This is something I also wanted to do. To change things," he told Business Insider.

A premium offering

With Shen on board, Martin and his team worked during the pandemic to reinvent meal plans at one of St Vincent's healthcare centers in Kew, a suburb of Melbourne. The facility doubles as an aged care home and a hospital.

It's a more premium nursing home option. According to St Vincent's Care's website, a stay at a standard room in the facility costs 171 Australian dollars a night, or around $111 — almost double the basic daily fee for nursing homes in Australia, which is AU$63.57. The room has an ensuite toilet, and residents can access a café, cinema, and hairdressing salon within the facility.

A typical meal plan at St Vincent's is as follows: In the morning, residents are offered a continental breakfast and a tea cake of the day. For lunch, they have a main with a selected sauce, a starch, and two vegetables.

They end the meal with a sweet — warmed apple coconut strudels on some days and a green tea cheesecake on others — then round the day up with an afternoon tea snack and a generous dinner selection.

"We want to break the stereotype that aged care food is just a lump of food on a plate," Shen said.

Cooking for older residents does come with certain considerations. In particular, the chefs have to look out for residents who have dysphagia, a geriatric syndrome that affects swallowing. According to the Mayo Clinic, 10% to 33% of older adults have dysphagia and can face malnutrition as a result.

As such, the chefs provide a range of options for residents with different needs so that everyone — even those who struggle to swallow — can enjoy a hearty meal.

Nursing home food on the world stage

Martin and Shen wanted to show the world that nursing home food can — and should — be just as good as restaurant food.

In 2023, they decided to compete in culinary competitions together. After placing in several local competitions, they were approached to apply for the International Salon Culinaire, one of the world's top competitions for chefs. Previous winners of the competition include Gordon Ramsey and Michael Deane, a Michelin-star chef.

In March this year, the duo competed alongside top chefs worldwide over the three-day competition in London. Their dishes included coconut rice pudding with crème brûlée and seafood paella — food they can serve at a nursing home.

They emerged with two silver medals. But more than the accolades, they hoped that people would focus on the message they were trying to send.

The chefs are well aware that not all nursing homes have the same luxuries of staffing and budgets to prepare premium meals. Still, it's about setting a standard, they said.

"We want to make this industry better for now and into the future for our parents and grandparents to be respected in," Martin said.

"The main thing is the frame of mind. The chef can be creative, whether it's adding a bit more garnish for presentation or baking things in-house rather than buying," he continued.

A graying world

Shen and Martin's efforts come as nations worldwide are graying rapidly. In October, the World Health Organization called for an urgent transformation of care and support systems for older people. They projected that 1 in 6 people will be 60 or older by 2030. By 2050, this number will double to 2.1 billion.

In the US, the aging of the baby boomer generation means that the number of Americans ages 65 and older requiring nursing home care could increase by 75% by 2030, a recent report by the Population Reference Bureau found.

That's where the importance of food comes in.

Dr. Andrea Maier, a professor of medicine at the National University of Singapore's Centre of Healthy Longevity, told BI that raising food quality is especially important in nursing homes, where people are often at the final stages of their lives and need nutrition.

"If they don't have an appetite, they're losing muscle mass, and their health is deteriorating. So food needs to be fun." When food is fresh and well-plated, it gives residents motivation to eat, she added. "It's a double positive."

Then there are the emotional impacts of having a good meal.

"When you're in a care home, life is relatively unrushed. Dining is one thing that I think people look forward to other than engagement activities," said Wee Shiou Liang, an associate professor of Gerontology at the Singapore University of Social Sciences.

"So, that experience is even more important."

Martin and Shen now collaborate as co-creative directors on menus in St Vincent's homes across New South Wales and Victoria. They also manage and mentor chefs in the region.

Neither chef intends to return to the restaurant scene. Seeing their impact on their residents has moved them to stay.

Working in end-of-life care, Martin said each meal, pastry, or salad could be the last dish their residents eat.

"And that's big to me because if you can give comfort to someone when they're in serious pain, that is a present to them," he said.

"They don't need to remember your name. They don't need to remember the dish. But if at that moment they realize they were at ease and were comforted by you — that's the heart of it."