As Population Grows Older, Geriatricians Grow Scarce

By Howard Kim
Special to The Washington Post
Tuesday, March 11, 2008

Mary Boland, 91, can consider herself fortunate. In 2006, the chronically ill former teacher from Cincinnati had a narrow brush with death when she came down with pneumonia. Within minutes, Boland's personal physician, Gregg Warshaw, was called.

"She was weak, confused and breathing abnormally," Warshaw recalls. "Her blood oxygen level was low, and she was suffering a low-grade fever."

In the elderly, pneumonia is often fatal. But instead of rushing Boland to the nearest hospital, as many family doctors might have done, Warshaw, a geriatrician, stabilized the condition and put his patient on antibiotics.

"Luckily, the pneumonia wasn't grave enough to warrant hospitalization," Warshaw says.

Geriatricians have provided specialized care to the elderly for decades, and until recently their numbers have been growing. But despite countless attempts to convince the medical profession and the public of their worth, the number of practicing geriatricians in the United States -- about 7,000 -- is falling seriously behind needed levels.

While the U.S. population age 55 and older is growing rapidly, according to a 2005 census report, the number of medical school grads going into geriatrics has been slow to keep up.

According to one estimate, the nation's teaching hospitals are producing one or two geriatricians for every nine cardiologists or orthopedic surgeons.

Low reimbursements and the allure of higher-paying specialties have been largely responsible. Then, too, the prospect of working long hours treating severely ill patients in their homes or at a hospital or nursing facility can be a turnoff, some physicians say.

"These are hard patients to treat because they're usually burdened with multiple complex disorders like Alzheimer's, dementia and congestive heart failure, and are often at the end of life," says Pittsburgh geriatrician Judith Black. Geriatrics isn't sexy, Black says, "but it can be extremely rewarding."

The rewards, geriatricians say, come from caring for a vulnerable, often misunderstood patient population and the strong relationships geriatricians develop with their families.

"Yes, they do die in the end; we all do," Black says. "But the effort is to bring dignity to those later stages of their lives."

That's not to say that primary care doctors aren't qualified to provide the same care. They are, says Kevin Grumbach, chief of the Department of Family and Community Medicine at San Francisco General Hospital. "What geriatricians are good at," Grumbach says, "is their coordinated team approach."

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