The elder-care crunch

Nation's growing ranks of seniors face rising scarcity of doctors in a field that pays less than others

"Who? Me?" Finucane said, smiling and helping her to lift her up gently.

Before long, Kropkowski was laughing, aches and pains all but forgotten.

Seeing the whole patient

In addition to their bedside manner, the geriatricians' specialized training is helpful to patients who might be prescribed several different remedies by several different specialists, Finucane said.

As an example, Finucane describes a patient who came to him with chest pains, heart disease, an irregular heartbeat and a spot on her lungs that looked like it could have been cancer. The patient, in her 90s, had been to see a thoracic surgeon, an oncologist, a radiation therapist, a cardiac surgeon and an electrophysiologist. Each recommended a different treatment. And each treatment would have been costly.

"If you tried to fix everything that was wrong with her, she would be sick as heck, she'd be quite delirious, she'd suffer a good bit," Finucane said. "And in the aggregate, it probably would not increase her [life span]. In fact, it might decrease it."

That's where a good geriatrician comes in, Colburn said, to assess the best health care program for an aging body. "Instead of only being focused on treatment or cure, I'm interested in what is the quality of life for that patient and their own priorities and goals for their own health care and how we can make that possible."

But many medical schools have trouble finding students interested in geriatrics. In 2007, slightly more than half of 468 geriatric medicine first-year training slots across the country were filled.

The biggest reason is financial. Saddled with huge loans after medical school, new physicians are presented with many lucrative options for careers. Geriatrics requires additional training, and ultimately it offers a lower salary than many other fields.

"Geriatricians are making, on average, $12,000 less than other internal medicine doctors," said Elizabeth Bragg of the Association of Directors of Geriatric Academic Programs. "And they have to go through at the very least another year of training. It's like you're going to school for another year to make less money."

Finucane again offers a real patient as an example. If an older man fell at home and broke a wrist but couldn't explain why the fall happened, he would see two doctors afterward - someone to set the bones in his wrist and possibly a geriatrician, trained to understand falls among the elderly.