THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Monday, April 3, 1995 TAG: 9504030035
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: By DEBRA GORDON, STAFF WRITER
LENGTH: Long : 117 lines
First it was schools. Then jobs. Then housing. Now it's doctors.
Just another shortage in the wake of the baby boomers' sail through the decades.
As the boomers move into their senior years, doubling the number of Americans 65 and older within the next 35 years, those who treat the elderly warn of a severe shortage of physicians who understand the complex medical problems peculiar to older people.
The result, say geriatric and health care experts, is more expensive and possibly inappropriate care given to an age group already consuming the majority of health care services.
``I'm afraid the first wave of boomers is going to have a tough time getting the care they should get,'' said Dr. Robert N. Butler, chairman of geriatrics and adult development at New York's Mt. Sinai Medical Center, the only medical school in the country with a separate department of geriatrics.
Currently, the United States has only one-fifth the number of specially trained doctors needed to care for its 30 million residents age 65 and older. That shortage will worsen in the next three decades,when the country will need more than 36,000 geriatricians.
Compare that to Great Britain, Butler said, where geriatrics is the third largest specialty and every medical school has a department of geriatrics.
And, Butler notes, with few exceptions, the nation's 126 medical schools are not providing the necessary training for future doctors.
Eastern Virginia Medical School is one of only 14 medical schools that requires its students to take separate, clinical training in geriatrics. Most schools, including the University of Virginia and the Medical College of Virginia, incorporate information in the general curriculum or offer training as an elective.
That's not enough, says Dr. John Franklin, director of geriatrics at EVMS. He began the school's geriatric clerkship three years ago in response to a ``demographic imperative.''
``This population is not only doubling in size, but getting older, and it presents very special problems because these people have very unique biological problems,'' he said.
For instance, an elderly person may suffer a heart attack without feeling any chest pain. Also, the very old are particularly vulnerable to injuries and illnesses caused by medications, diagnostic tests and medical treatments - things that are supposed to make them feel better.
And they often have four or five chronic illnesses at the same time.
Butler has seen patients whose primary doctors diagnosed them with Alzheimer's disease, when what they really had was a treatable thyroid problem.
The medical history of an 85-year-old needs to be taken differently than that of a 40-year-old. It has to include not only physical complaints, but a social history as well, Butler said. An 80-year-old woman who lives alone may be suffering from certain illnesses because she can't afford decent food or heat for her house.
Geriatricians are trained to evaluate an older person's entire physical and mental being. Too often, Franklin says, doctors fall into the trap of ageism: ``It says that if you're old, you're going to be sick. Some older people feel that way, too; that they're supposed to be this way because they're old. And oftentimes their symptoms and findings are neglected based on the fact that they are told `this is a normal aging process.' ''
It's not appropriate, Butler said, that doctors ``learn on the job'' to treat elderly patients.
``Then you're experimenting on the category you've left out of your training,'' he said. ``Older people need to be part of the training.''
About 45 medical schools offer an elective geriatric internship, but only about 4 percent of their students take advantage of it, Butler said.
``It seems like a downer. But the truth is, once they expose their students to it and they jump over that precipice, they find it very interesting to work with older people because they are more complex and challenging. When you're 35, you may have one disease straight and simple. At 80, you may have four or five diseases and some of them may conceal the effects of the other, so it's more intellectually challenging.''
Eastern Virginia used to offer its two-week clerkship on a voluntary basis, Franklin said. But no one took it.
Fourth-year medical student Kevin Baiko said he wouldn't have taken the clerkship he completed in March if it weren't required. ``I would have wanted to take something fun, as opposed to something challenging.''
But he discovered that he enjoyed learning about the issues of aging.
``Otherwise, I wouldn't have explored them, and they're important issues to explore,'' Baiko said.
Franklin agrees. As EVMS trains more physicians as generalists, geriatrics will receive more attention, he said.
Eventually, the school's proposed Center on Aging and Human Development may offer a geriatric fellowship program, training physicians to sit for their Certificate of Added Qualifications in Geriatric Medicine, which requires two years of geriatric training, and which grants them the title of geriatrician.
That type of academic training is very important, notes a study released in 1992 by the Alliance for Aging Research in Washington. One major obstacle to widespread incorporation of geriatrics training in medical schools, the study said, is the severe shortage of academic geriatricians available to teach undergraduate students and residents.
``Every medical student,'' Butler said, ``regardless of the specialty they'll be going in, should have some knowledge about the issues that affect older people.'' MEMO: WHY A SHORTAGE?
Why aren't there enough doctors trained in geriatrics?
Country's preoccupation with youth.
Lack of role models in geriatric medicine.
Geriatrics is not a high-paying field.
It's difficult for a new discipline to break into the establishment
of a medical school.
Mt. Sinai Medical Center in New York is the only medical school in
the country with a separate geriatrics department.
ILLUSTRATION: Color photo by Beth Bergman, Staff
LEFT: Medical student Kevin Baiko, in sensitivity training, shops
with his feet tied together, wearing a neck brace and scratched
plastic glasses, to simulate cataracts.
KEYWORDS: DOCTOR MEDICAL SCHOOL GERIATRICS by CNB