Medical resident Braca Cantor is on her lunch break during one of her rotation shifts at St Vincent's in Indianapolis. She’s carrying a cardboard clam of cafeteria food and has her long white doctor’s coat on…which is significant. As a med student, she used to wear a short white coat—“One is like a cocktail dress and the other is like….you’re going to a gala.”
The long coat means she’s 70 percent through a very long 15 -year journey. Cantor is spending even more time in medical training than usual because she wants to be a geriatrician: a specialty that means, to be board-certified, she needs to train for yet another year after she completes her residency.
Cantor says she was really close with her grandparents while she was growing up. “It just made me really interested and passionate in helping them age with grace and get them the best care they could.”
But that’s not the only reason she chose to be a geriatrician. “It’s a growing need, there’s a tsunami of aging folks entering the healthcare system,” she explains.
That tsunami means the field needs more people like Cantor. But data shows there aren’t enough. For example, in Indiana, there are only 91 geriatricians for an over-65 population of 900 thousand. The American Geriatrics Society estimates 300 doctors are immediately needed to make up for the shortage.
Steven Counsell is President of the American Geriatrics Society. He says many schools are working to recruit students to the field, but students gravitate toward specialties that will help them pay back their massive medical school debts more quickly. “Geriatricians are at the lowest pay level for physicians now,” he explains.
Additionally, geriatrics is very rarely about quick solutions and more about managing lots of chronic conditions—like diabetes—that never truly get cured. “If you compare that to specialties that have procedures or can do a quick treatment and actually cure someone’s problem, that can be much more gratifying to a young person,” he says.
These barriers mean Indiana University School of Medicine’s Glenda Westmoreland, the Director of Geriatrics Education, not only needs to develop curricula for med students, but also act as a PR director.
“Sometimes they don’t necessarily realize they want to go into geriatrics until they get into medicine and they see oh this is a really cool field,” says Westmoreland.
Westmoreland says so much of the problem is about exposure. If students didn’t know older people growing up, they often just don’t consider geriatrics at all. (Instead, she says, med students gravitate toward lucrative fields such as oncology or cardiology.)
The solution? Getting to students early. IU med school used to save the required geriatrics rotation until the third year of residency, but recently moved it to the first year, hoping to catch people before they decide to pursue a different specialty.
And once a student shows just a kernel of interest, Westmoreland says they nurture it …hard.
“Once a resident thinks about geriatrics as a career not to let them drop that and not get persuaded by their peers,” she says.
She says students then get hooked up with a geriatrician as a mentor, who checks in with them periodically and—yes—becomes a sort of cheerleader.
Finally, the school recruits a bench of of octo- and nonagenerians—“a council of elders”—to travel the state and meet with medical students in order to dispel certain stereotypes about what older people are like. Westmoreland says those stereotypes—that older people are grumpy, frail, and intractable—are another barrier keeping students from the field.
Braca Cantor says that kind of exposure will do one of two things:
“You get exposed to an aging person,” she says, “and you’re either disgusted or annoyed you lose patience or it opens up something inside you and it makes you want to help.”
It’s worth noting even though they’re paid less, geriatricians are among doctors who report the highest quality of life and amount of job satisfaction—they have generally more flexible hours and, because of the many chronic conditions they treat, usually cultivate long-term, close relationships with their patients.
IU is hoping that will sway students’ minds. They’re hoping for dozens more Bracas. Because right now, the mere handful of students isn’t enough to fill the state’s need.