LAURA KAUFMAN no longer treats her patients in a suburban dental office. These days, she cleans teeth, does simple extractions and provides other basic care in the homes of inner-city elderly who are too frail to travel.
After a decade of private practice in the Boston area, Ms. Kaufman found that a growing number of her dental patients were older people and that she often had little idea of their complete medical picture. So she decided to become "geriatricized" — educated on how to recognize and handle aging patients, who typically have several chronic conditions, as well as multiple prescription medications.
"I saw these patients at my practice," she said. "And then my father-in-law was homebound, and I saw first-hand there were no at-home dental services available."
Eighteen months ago, she was accepted into a federally financed fellowship program in geriatric dentistry at Boston Medical Center that she will soon complete. The program for geriatric medicine, dentistry and mental health is one way that health care professionals can gain more specific knowledge and training to recognize and provide comprehensive care for the growing number of people 65 years old and up.
The federal government underwrites some fellowships and is asking for $54 million, up $11 million from last year, in the next budget for such training, especially for Geriatric Education Centers at dozens of medical schools and major medical centers. Private groups, notably the John A. Hartford Foundation, have also been financial pillars for elderly care training.
Even so, given the enormous number of retiring baby boomers, the problems are worrisome. Prestigious organizations like the Institute of Medicine have warned of a looming scarcity of medical professionals equipped to deliver coordinated treatment of elderly health problems.
There could be a shortage of as many as 90,000 doctors, about half in primary care, by the end of the decade, the Association of American Medical Colleges has warned. Doctors do not flock to practice geriatrics because Medicare reimbursement is comparatively low. The average geriatric specialist made $183,523 in 2010 — less than half that year's $392,885 median for dermatologists, according to the Physician Compensation and Production Survey. And, like all fledgling doctors, the geriatric specialist struggles with medical school debt.
Geriatrics is also seen as a plodding area of medicine, set apart from the glamour of life-saving heroics. That may be why the specialty has made little headway among nurses as well.
The Hartford Foundation and the Atlantic Philanthropies have supported a wide-ranging effort, at more than 300 hospitals, to provide nurses with geriatric training, in a program called Niche (Nurses Improving Care for Healthsystem Elders).
Medical schools and others have been exploring shorter and more specific ways to expose health care professionals to the complexities of aging care, especially because midcareer professionals have limited ability to leave their practices for a year or two of training.
The American Geriatric Society and other groups sponsor minifellowships, weekend workshops, Web seminars and online courses, and add material to the physician relicensing process that occurs every decade.
And the geriatric residency that must be completed before becoming a board-certified doctor has been reduced to one year from two, to make it less punishing financially for doctors.
After decades of practice in Maine where his caseload of aging patients was rising steadily, Dr. William Bogan Brooks, a psychiatrist, decided he needed to know more. He entered a one-year fellowship program in geriatric psychiatry at Brown University in Providence, R.I.
"Older people have more health problems, but they are also dealing with losses of loved ones and cognitive disorders," he said. Along with another doctor, he made home visits in the Boston area as part of a team to give patients health assessments. But it was not an easy year, Dr. Brooks recalled. Now in Alabama after completing the program last summer, he said: "I had to do some moonlighting at a local hospital. Taking the year was a financial hit, but I learned so much."
That is music to the ears of Sharon Levine, a geriatric physician who helps direct a Boston Medical Center program of weekend geriatric immersion workshops for doctors. "There will be at least 70 million Americans over age 65 by 2030, and we only have 7,100 board-certified geriatricians," she noted, adding that "there will never be enough."
Sharon A. Brangman, chief of geriatrics at SUNY Upstate Medical University in Syracuse, and a board member of the American Geriatrics Society, commented: "We have a huge disconnect in this country. Primary-care physicians — who were our feeder pipeline for geriatricians — are now seen as workhorses who are not doing dramatic medicine."
Joan Weiss, who heads the federal Health and Human Services program that finances Geriatric Education Centers and other health work force education efforts, predicted, "By 2030, we will need 36,000 geriatricians."