Susan Valot
July 03, 2008
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In the next couple of decades, California's population of those 65 and older is expected to double to nearly 8 million. But the state may not have the enough doctors skilled at care for an aging population. KPCC's Susan Valot reports on the shortage.
Nursing home intercom: At 9:30, we will be having our coffee social for all of our residents...
Susan Valot: Country Villa Westwood's nursing stations are a flurry of activity. In a common room, elderly patients wait for the start of their wheelchair yoga class. But some residents stay in their rooms, too old or too confused to leave their beds. Dr. Michelle Lee makes her rounds in the nursing home.
Michelle Lee (ordering EKG for a woman who complained of chest pains): It happened at rest, so I'm sort of alarmed. Can we get an EKG? Do we
have that ability here?
Valot: Dr. Lee recently finished her geriatric fellowship at UCLA. She's now one of about 700 geriatricians in California. That's about one for every 6,000 Californians age 65 and older; fewer doctors than a decade ago, even though we'll need more geriatric specialists as the Baby Boomers hit their golden years. Most of Lee's patients are in their 80s.
Lee: I really enjoy taking care of older people and I enjoy just what a geriatrician does, which is, you know, how you imagine a doctor to be: you get to know a person. You focus on the
person, rather than, you know, this lab value, that lab value. You get to know their families.
Valot: Lee says being a geriatrician isn't just about being a physician. You're part doctor, part social worker, part troubleshooter...
Lee: Does he have his hearing aid?
Nurse: I don't know, sweetie.
Lee: To don four hats in a certain amount of time isn't always easy when you have a patient on 20 medications with family issues, and financial issues.
Lee (rolling patient in wheelchair): OK, let's get you back, OK?
Valot: At UCLA, where Dr. Lee received her training, Dr. David Reuben is in charge of the geriatrics program.
Dr. David Reuben: Well, I've always liked to call the geriatricians the Labrador Retrievers of medicine. A lot of heart, a lot of love, you know, just kind of glad to be in there in the fray with patients. And sometimes, for geriatricians, the more complicated it is, the more we like it.
Valot: Right now, about one in every 10 Californians is 65 or older. It'll be one in five in a couple of decades. But Dr. Reuben says less than one percent of U.S. med school grads go into geriatrics. You don't make enough.
Reuben: For example, if you spend an extra year training in geriatrics, so that you're really good and become certified in geriatrics, you'll earn on average about $7,000
less than if you
hadn't had that training.
Valot: Not that geriatricians are starving. They earn upwards of $160,000 a year. But Reuben says other specialties can make twice that much. He says most geriatric patients are on Medicare, which doesn't pay as much for non-procedure office visits, the mainstay of geriatricians.
Reuben: It's a lot of, kind of, what we call "high touch" work. So, for example, it's coordinating care. It's calling families. It's coordinating with other doctors. It's stuff that takes a lot of time, that is frequently off hours, at nights and on weekends, and also care that you're not compensated for.
Dr. Solomon Liao (showing the UCI Senior Health Center): ... like our exam rooms, where the exam table is designed for people with disabilities.
Valot: So it's a little bit, it's shorter.
Liao: It comes all the way down to the floor...
Valot: Dr. Solomon Liao is at home at UCI's Senior Health Center in Orange. He runs the hospital's geriatric fellowship program, which trains two fellows a year,
if they can find two. Liao says UCI used to
require all med students be teamed up with an older person as a mentor.
Liao: When they learn to listen to the heart, or take a blood pressure, they go out to their senior's house and do that. When they learn how to take a sexual history, they go out to their seniors and talk to them about sex. When they learn about medications, they go out and talk to their senior partners about what medications they take.
Valot: Liao says the program boosted the number of med students interested in geriatrics and made students more comfortable with older patients. But UCI cut the program. Now, only a few students take part, on a voluntary basis. UCLA's Dr. David Reuben says
something needs to be done to boost the number of geriatricians before the Baby Boomers need them.
Reuben: If we wait until 2020 or 2025, when they start becoming frail and quite old, it'll be too late. We won't be able to ramp up. We won't be able to turn the Titanic around.
Valot: California lawmakers are considering a bill to forgive student loans for those who go into geriatrics. But Dr. Reuben says that's only a first step... a "baby" step toward better elder care.
