Shortage implosion

It’s not the sexiest of specialties. There’s no cracking open of chests. No rushing down the hallways to perform an emergency intubation.

“Every now and then you get a ‘House’ moment,” Camardi said, a reference to the television show where the cranky doctor detects diseases that no one else can figure out.

With an average salary of $160,000, a geriatrician earns less than half of what a gastroenterologist makes in a year.

That’s because much of what geriatricians do — including coordinating care with other doctors, managing multiple diseases and medications, talking to patients about preventive care — isn’t covered by Medicare.

Camardi tends to a resident of the Springtree Healthcare Center nursing home who slipped out of her wheelchair.

Right now, 0.5 percent of all medical-school graduates are going into geriatrics, according to Colleen Christmas, assistant professor of medicine at Johns Hopkins University. With 78 million baby boomers about to turn 65, the shortage “will get worse very, very soon,” she said. “It’s already on the edge of imploding.”

How will that implosion play out in hospitals, nursing homes and doctors’ offices?

Not well, experts say. Area seniors and their family members already report a lack of care coordination that gives rise to missed diagnoses and over-medicated seniors.

It’s a condition that Christmas calls “too many patients suffering from too much care, too little care and wrong care — all at the same time.”

Anita Robarge, a Salem insurance executive, knows the syndrome well.

She and her sister alternate taking off work to accompany their 72-year-old mother to the doctor — becoming her de facto care coordinators.

Joyce May was diagnosed with mild dementia three years ago. A second diagnosis of depression was made when May told her family doctor that she’d never fully grieved the death of her 21-year-old son.

A former banker, May had baked cakes to order in her retirement, but Robarge was concerned when she noticed her mother suddenly couldn’t follow her old recipes. A dementia drug called Aricept helped slow down the memory decline, and an antidepressant worked so well that her family doctor eventually took her off it.

But before long, Robarge noticed that her mom was crying almost every time she talked to her, and “getting mad at McDonald’s because they didn’t put enough chicken in her wrap.”

Was it the return of the depression, or dementia-related agitation?

Different doctors had different opinions. “And they didn’t seem be talking to one another,” Robarge said.
A third doctor suggested that May might have a Parkinson’s-like syndrome on top of it all — speculation that turned out, after a fretful day of testing, to be false.

“There just isn’t a single resource that’s able to take you from point A to point B,” Robarge complained. “In my perfect world, that person would be the family doctor, and you’d see that person every time, and when you left the office you’d have everything written down for you so you’d remember it when you got home.”