Wanted: More doctors to focus on elderly care

The nation and Clark County are experiencing a shortage of doctors who specialize in older patients at a time when more geriatric patients need their extra care.

The American Geriatrics Society estimates that there should be about 20,000 geriatric doctors nationally treating the elderly instead of the actual 9,000.

About half a dozen geriatric doctors practice in Las Vegas, compared with 86,258 residents between the ages of 65 and 74 in 1997. Estimates say that population group will increase to 97,000 by 2000.

The American Geriatrics Society has expressed concern that the shortage will only get worse as current geriatricians retire and fewer graduate from medical schools to take their place.

Geriatricians are a special breed of doctors who must be willing to go an extra mile for their fragile senior patients.

Dr. Susan Bannick-Mohrland schedules an hour of her time for every new patient she sees. And each follow-up visit takes a minimum of 30 minutes, she said. This may include going to a patient's home when mobility is a problem.

"To me, it takes three to four visits before I know a person and what his history is," Bannick-Mohrland said. "A lot of it is reviewing the medical records. It takes a half-hour to an hour just to understand the medical chart."

It's that extra care and time that tends to deter young medical students from the specialty, despite the rapidly growing population that would indicate good potential for business.

"If you have to spend more time with your patient, that means less money," said Patty Swager, who develops continuing geriatric education programs for physicians for the Nevada Geriatric Education Center. "An older person takes more time, takes more medications and has more disease problems. Your average middle-age adult doesn't take that much medication or need that much time."

Sen. Harry Reid, D-Nev., plans to introduce two bills in Congress to try to address the problem on a national level. One is designed to encourage medical students to specialize in geriatrics. The other calls for medical schools to beef up their geriatrics programs.

The senator's bills are:

"We have a real problem in this country," Reid said. "We need tens of thousands of newly trained geriatricians. Medical schools train 100,000 students a year, and only 250 go into geriatrics. We have over 35,000 people who are over 85 years of age in Nevada. We are becoming a senior-based state."

According to the Nevada State Demographer's office and state Department of Taxation, there were 127,826 people between the ages of 65 and 74 living in Nevada in 1997. That's projected to grow to 140,709 by 2000.

Medicare currently pumps $6 billion a year into university programs to train doctors. The Balanced Budget Act of 1997 revised this provision so that schools could divert some of their funding to develop graduate fellowship programs in geriatrics.

The University of Nevada School of Medicine is addressing the problem by creating an office of geriatrics to develop a curriculum.

The office was formed in December and a curriculum is expected to be in place by July 1. According to Dr. Steven Phillips, associate director of the office, it hasn't been decided whether geriatric courses would be required of all students or offered as a fellowship, which would be elective for those who wish to pursue the field.

Dr. David Reuben, chief of the Division of Geriatrics at the University of California at Los Angeles, said Reid's two bills are important in advancing geriatric medicine throughout the nation. He praised the University of Nevada School of Medicine for starting a geriatrics department, but said setting up the curriculum will be a challenge. UCLA has had a geriatrics program since 1979.

To have a good program, Reuben said, the School of Medicine will have to first increase its faculty of geriatrics specialists. You can't inspire medical students to go into geriatrics, he said, unless they have mentors.

Geriatricians are the lowest-paid specialists in the medical profession, he added. But because there are so few doctors going into the field, he said, there will be more job security.

A geriatrics specialist can make a world of difference to the patient.

Bannick-Mohrland has been seeing Irving Brandes, 88, for several weeks. Confined to his home, he suffers from congestive heart disease and urinary infections and was recently diagnosed with anemia. Once a strapping 225-pound amateur football player from New Jersey, he has seen his weight dwindle to around 160 pounds.

His wife, Hannah, was disgusted with the medical care her husband received in Las Vegas until she met Bannick-Mohrland.

"We started with three doctors and they shipped him off for tests and never told me what the tests were for," an angry Hannah said."They'd just say hello, say a few words and they were gone. This is the first time I've had a doctor read the reports and explain things to me."

As a result, Hannah is skeptical of the medical profession in Southern Nevada. She doesn't have confidence in any doctors because they never spent much time with her husband or seemed -- in her words -- never to treat him like a human being.

"You need to be able to address all the nonmedical issues of the patient," said Dr. Charles Bernick, associate professor of medicine with the School of Medicine and a geriatrics specialist. "It becomes more of a holistic approach with an elderly patient. You need to know how he functions daily and how the family is involved."

A geriatrician, Bernick said, must be patient and spend a lot more time with an elderly patient. Bernick said a geriatrician gets less back financially, but professionally helping an ill senior citizen recover is much more rewarding.

"If you go into internal medicine, 55 to 60 percent of your patients will be geriatrics," Phillips said he plans to tell the School of Medicine's medical students. "If our residents are educated in geriatrics, they will benefit in the long run."

archive