Geriatrics: A "heart-warming" job

For many older Americans, finding a doctor who specializes in caring for their myriad of chronic later-life aches is as much a pain as the ailments themselves.

And from the looks of it, there's no cure in sight for the anemic number of physicians who specialize in geriatrics.

But that means good career opportunities for such doctors, making it another area of demand in the field of health care, which has been best-known to job seekers in recent years as a place to find work as a nurse.

"In this culture, most people believe [working with] old people wouldn't be fun or interesting," says Dr. Laura Myre of Seattle. "But taking care of older people is gratifying and heart-warming."

Locally and nationally, the number of geriatricians — doctors with extra years of training and certification to help prevent, diagnose and treat diseases and disorders afflicting older patients — is flat at a time when the population of Americans over age 65 is soaring.

Statewide, just 51 physicians list geriatrics as their primary specialty — up only three doctors from four years ago, according to the Washington State Medical Association. That compares with 949 pediatricians in this state.

"Creating enough geriatricians for our aging population is a statistical impossibility," says Dr. Wayne McCormick, professor of medicine in the University of Washington's Division of Gerontology and Geriatric Medicine.

That's because the number of seniors 65 or older is projected to nearly double — from nearly 35 million today to almost 72 million in 2030, according to the Census Bureau.

By that year, one in five Americans will be seniors — and they're not always a healthy bunch.

Patients 65 or older see a doctor an average of 11.4 times per year — and those 85 or older average 15 physician visits, according to a report by the U.S. Department of Health and Human Services. Younger adults, meanwhile, average 7.2 doctor appointments annually.

Keeping seniors independent

Geriatricians work in places such as Seattle's Providence ElderPlace, an arm of Providence Health System, which offers weekday lunch and adult day-care activities along with primary and specialty medical care.

One of 40 PACE (Program of All Inclusive Care for the Elderly) facilities in the country, Providence ElderPlace serves 235 patients who are 55 or older from throughout King County, according to marketing director Jenny Kennta.

Patients participate in health-promotion activities ranging from crafts and music to fitness and current events.

They also receive medical care from Drs. Myre and Assad Kasemi.

Many of their patients are among "the very sickest, most frail in this population," according to Kasemi. Their shared goal, he says, is to keep seniors living as independently as possible.

Kasemi and Myre start their days around 7 a.m. with hospital and nursing-home visits.

By 8 a.m., they're in meetings with staff members for updates on other patients.

Between 9:30 a.m. and 3 p.m., both see patients, then follow up with paperwork and telephone calls to family or associated health-care providers.

By seeing 10 to 12 seniors a day — and counting on observations from ElderPlace staff — they work to identify any ailment before it completely debilitates their patient.

"An alternate choice"

While seniors' health issues often are challenging, geriatricians are not the only health-care provider equipped to handle their needs.

"We're an alternate choice,"McCormick says. "We consider ourselves primary-care physicians who are somewhat specialized. We'll often see people when the family doctor or general internist feels frustrated by a set of multiple, chronic diseases that require an inordinate amount of time to care for.

"Most primary-care physicians do a very good job taking care of their older patients," McCormick says, but adds that it is "harder for general internists to connect with a variety of specialists for a single patient."

On the other hand, managing and treating the often complicated overlapping needs of older patients is what geriatricians do best.

For the most part, these specialists work in primary-care settings, frequently consulting with other doctors, nurses, social workers, rehabilitation therapists, pharmacists, psychologists and other health-care professionals treating older patients.

They also coordinate care among patients' adult children, and other volunteer caregivers.

As the educational hub for a five-state area, the University of Washington Medical School's geriatrics team — a 33-member division within the Internal Medicine Department — serves the UW and Harborview medical centers, and the local Veterans Affairs Medical Center.

"A great reward"

Increasingly, McCormick says, medical schools must work to provide coursework that covers chronic-care training that "spans all years of schooling ... so all students know a little more about geriatrics."

What's keeping more medical students from specializing in this field?

McCormick thinks potential geriatricians are often discouraged by recent drops in insurance and other health-care payment reimbursements.

"What attracts people to this specialty is the aspect of commitment," McCormick says.

"A lot of people are attracted to primary care because they can stick with a patient through whatever happens, from good health to serious chronic illnesses. There's a great reward for accepting this entire journey."