Incentives needed

Five or six months. That seems to be the average wait if you’re a senior citizen in Roanoke, and you want to find a geriatrics-trained physician.

When Joanne Hicks and her husband moved from their Folsom, Calif., home to be near relatives in Roanoke, she called the Carilion Direct referral line in search of an internist who specialized in geriatrics.

There were fewer than 10 — a handful are certified geriatricians while others are family doctors or internists who have geriatric expertise. Only one was accepting new patients at the time, Hicks said, and the wait was five months.

In the meantime, Joanne Hicks had an abscessed tooth and had to wait three days before a dentist could work her in.

“I thought I was going to die,” she said, adding that she relied on some leftover painkillers from a hip replacement to get her through the wait.

Gary Cooper moved to Vinton from his home in Columbus, Ohio, to help take care of his mother, Phyllis, who was exhibiting signs of dementia but had never been screened for Alzheimer’s.

“It took me six months to get her any kind of help,” he said.

Cooper bulldogged his way through the situation, calling every resource and referral available and setting up a system with his brother wherein one of them is with their mother 24 hours a day.

“Her old doctor knew she had Alzheimer’s but he’d never diagnosed her or given her any medication other than tranquilizers,” he said.

Psychiatrist Dave Trinkle, who directs the Center for Healthy Aging, took Phyllis Cooper on as a patient. He makes house calls to see her — but that’s something he only has time to do once a month and usually accompanied by fellows in Carilion’s geriatrics fellowship program.

psychiatrist Dr. Dave Trinkle (center) makes a house call to check on Gary Cooper’s mother, Phyllis.

That’s one approach Carilion has taken to beef up the number of geriatrics-trained doctors in the region: Train them in Roanoke, and hopefully they’ll stay here after they graduate. So far, six have, Trinkle said.

A new section chief for geriatric medicine will begin work in July.

And a new electronic medical records system will make it easier for Carilion-affiliated doctors to communicate with one another — so that if in the future Phyllis Cooper has a physical problem that might affect the psychiatric medications she’s already taking, Trinkle and her primary care doctor will be in e-mail contact.

Too often, late-life depression is mistaken for dementia and vice versa, Trinkle said.

“It takes time to distinguish between the two,” he said. “That’s what geriatrics is all about.

“We know there needs to be a lot more coordination of care to prevent common mistakes like too many medicines, or too great a dosage, or missing the interplay between a urinary tract infection and confusion.”

Trinkle’s beeper went off continually during a recent hourlong interview. Several patients were calling because their primary-care doctor had just retired, and most of the doctors they were trying to see either weren’t accepting new Medicare patients or weren’t taking geriatric patients.

Trinkle doesn’t see the shortage easing until doctors-in-training see a financial incentive to go into geriatrics.

In 2005, South Carolina became the first state in the nation to offer student-loan forgiveness to doctors who complete fellowships in geriatrics. (A typical doctor leaves medical school $150,000 in debt.)

In March, Sen. Barbara Boxer, D-Calif., introduced a bill called the Caring for an Aging America Act. It would provide $130 million in federal funding over five years to attract and retain geriatric health professionals — from doctors to social workers — via loan forgiveness and career-advancement incentives.

Camardi, in fact, initially refused his first job out of residency because it required visiting nursing homes three days a week.

“At the time, I thought that was beneath my dignity,” he said. “It turned out to be the best thing that ever happened to me.”

To sweeten the deal, his boss offered to pay off his medical-school loans — $78,000 worth — an offer Camardi could not refuse.

“It’s not rocket science,” he said. “To increase the number of geriatricians, you increase the financial incentives.”