Just as the Baby Boomers gave rise to an army of pediatricians during the second half of the 20th Century, so too will they drive up the demand for specialists in geriatrics. It's a whole different type of medicine, focused on managing multiple conditions and propping up aging bodies.
Ultimately, geriatricians are the kind of doctors who must accept aging issues that can't be fixed and focus on helping families navigate excruciating decisions.
"The way I teach it to the medical students and the residents (is, especially for the extremely old), 'You focus on keeping the older individual as independent as possible and making them comfortable and functional. But you're not focusing on curing, because you're not going to cure a whole heck of lot at that point,' " said Dr. Alan Dengiz, who teaches geriatric medicine at the University of Michigan.
Dengiz has spent 30 years as a geriatrician. He finds fulfillment in sorting through the issues facing his elderly patients, listening to their stories and helping them deal with an often complex and bitter aging process.
The problem is that there may be too few like Dengiz.
This spring, there were 7,029 certified geriatricians in the U.S. for more than 39 million Americans older than 65. And fewer than 1% of registered nurses, pharmacists and physician assistants are certified in geriatrics, according to the American Geriatrics Society.
Here in Michigan, fewer than 1% of active doctors list geriatrics as their specialty, though 9% listed it as a secondary specialty, a slight increase over the year before, in a 2007 survey by the Michigan Department of Community Health.
Part of the problem is that geriatrics, unlike some specialties, is hardly a moneymaker and therefore not attractive to medical school graduates facing a mountain of debt. The quickest way to pay off that debt is by seeing lots of patients and doing lots of procedures.
In a family practice, doctors might see a patient for five or 10 minutes, Dengiz said.
"If I have a 95-year-old in my office, even for a follow-up visit, I can't get out of there for less than 30 minutes," he said. "They're walking with walkers or a family member is pushing them in a wheelchair. They're getting out of the wheelchair and onto an examination table and from the exam table back to the wheelchair. The whole process is very, very long. ... We're looking at prescriptions and managing multiple conditions and helping them cope with end-of-life and palliative care."
But it isn't just extremely old people in need of care. Even those in their 50s and 60s are seeing the first signs of chronic diseases, daily medications and strings of doctors' visits.