Although the population of aging America is going to skyrocket in the next two decades, the practice of geriatric medicine is actually decreasing. The number of certified geriatricians fell by a third between 1998 and 2004. The reasons for this are very similar to the reasons for the decline in the practice of adolescent medicine in the U.S.,: income for geriatric medicine is among the lowest of any of the medical specialties and aging people are difficult to deal with (they complain a lot, their memories are bad, you have to be extra patient with them etc.). A lot of work for little money. But what’s going to happen when there are millions of us needing medical care that recognizes our special needs as older people, and there are no doctors specialized in geriatric medicine around to fill the bill?
A geriatric doctor often pays more attention to small details than to big medical issues. One case was of an eighty-five year old woman who had glaucoma, arthritis, lower back pain, both knees replaced, high blood pressure, surgery for colon cancer, and a lung nodule that needed a biopsy. What was important to the geriatric physician who examined her that day, however, was not these major medical problems, but instead what she’d been eating, what her feet looked like, how she got up out of her chair, and other relatively insignificant issues. As Harvard Medical School professor Atul Gawande, pointed out, “The single most serious threat she faced was not the lung nodule or the back pain. It was falling” The geriatric specialist was concerned with the quality of her daily life. Without good feet, or the ability to get out of a chair easily, she could be only a short step away from a nursing home. Without proper daily nutrition, social support, or nightly rest, she might lack the energy, interaction, or repose necessary to a functional life.