LEBANON — Dartmouth Hitchcock Medical Center is creating a new section for geriatric medicine that focuses on providing holistic medical care for older patients.

The exact form of the new section of medicine she will lead is still coming together, but Dr. Serena Chao said she hopes to increase the number of practicing providers in her field at DHMC when she assumes the role of the hospital’s chief of geriatric medicine in late June. She will take on a group of patients and oversee several other providers and services.

Chao said plans include establishing an outpatient treatment clinic specifically for geriatric patients and expanding an existing home-visitation program.

In a recent interview, Chao, who is coming to DHMC from Cambridge Health Alliance in Cambridge, Mass., described the field of geriatric medicine as “family-medicine plus.”

Geriatricians do many of the same things that family practice doctors do, but many older adults have “multiple complex conditions,” creating something of a “puzzle” that providers need to solve, Chao said.

“You can never use cookie-cutter with older folks, because each person is different, and each combination of medical conditions is different, each set of values is different,” Chao said.

The move is a bit of a homecoming for Chao, who spent her childhood and early teenage years in Derry, N.H.

“For me, moving back to New Hampshire for this role at Dartmouth Health is in some ways coming full circle,” she said. “I’m really looking forward to it because of the opportunity to give back to the state that treated me so well when I was a little kid.”

The geriatric section will focus on clinical care, which is “one pillar” of Dartmouth’s existing Geriatric Center of Excellence, Ellen Flaherty, vice president of the center, said via email. The other pillars are education, research and policy.

The new section will be “key to attracting and recruiting geriatric professionals that are critical to build capacity to provide care to the most vulnerable older adults throughout Vermont and New Hampshire.”

Almost 20% of New Hampshire’s population was over 65 years old in 2023, a percentage that’s growing, according to a report from the New Hampshire Fiscal Policy Institute.

In Vermont, adults over 65 made up 22% of Vermont’s population in 2023. The population was growing faster than any other age group, according to the state’s Legislative Joint Fiscal Office.

Having a geriatric section at DHMC will allow the creation of a geriatric fellowship that can be a “‘pipeline to attract and recruit,” Flaherty said.

Currently, there are about 25 “team members dedicated to geriatrics” at the hospital, Flaherty said.

One potential challenge to staffing is the overall shortage of geriatricians. By 2030, the American Geriatrics Society, or AGS, estimates that the demand for geriatricians will significantly outpace the supply, with a larger gap in rural areas.

In 2021, there were 44 board-certified geriatricians in New Hampshire and 20 in Vermont, according to the AGS.

In comparison, there were about 250 board-certified pediatricians in New Hampshire and about 150 in Vermont in the same year, according to the American Board of Pediatrics. That is despite both states having more senior citizens than children.

Chao attributes the national shortage to several things. For many people, geriatrics is a less attractive field of medicine because it is not well paid relative to other specializations even as the cost of medical school rises, Chao said. It is also a field with which many medical students are not familiar.

One way hospitals are getting around the shortage is by pursuing different certifications that help them to “implement geriatric principles of care, even if you don’t have geriatricians,” Chao said.

Elsewhere in the Upper Valley, Gifford Health Care, which is not affiliated with DH, has no geriatricians on staff but has an accredited “geriatric emergency department” in Randolph, Chief Medical Officer Josh White said in an email statement.

“Our staff is very experienced (at) managing a geriatric population. This is true of our primary care providers, inpatient unit, and ED,” White said.

While she said there is a shortage of primary care providers for seniors in the Upper Valley, Christi Mooney, director of the Aging and Disability Resource Center of Grafton County, said there are other often more significant barriers to care because of how rural the area is.

Mooney said she regularly receives calls from people seeking rides to medical appointments or other locations and the center only has about a 50% success rate in helping them because of the difficulty and expense of arranging transportation.

Older adults also regularly call Mooney seeking referrals or help finding a doctor and she has noticed an uptick since about October in older adults in the Lebanon area who say they have lost their primary care provider.

“We certainly don’t get them every week, but there’s a significant enough amount for it to have established a pattern already,” Mooney said.

While she said adding more geriatricians will help to meet the “significant need” for primary care doctors in the area, there are also issues with Medicare and Medicaid coverage that need to be addressed.

At DHMC, Chao said she hopes to work with area agencies such as visiting nurse associations, long-term-care facilities and other aging service providers to determine how to best serve the region.

Chao, who has mostly practiced in urban centers such as Boston, said she still has a lot to learn about the Upper Valley’s health care ecosystem.

“I will be the first to admit that one of the things I have to get up to speed on and really learn is about the experiences of older adults who are aging in rural communities,” Chao said.

Clare Shanahan can be reached at cshanahan@vnews.com or 603-727-3216.