TORONTO - When Dr. Jo-Anne Clarke tells fellow med school grads what field she has chosen as her speciality, she typically gets one of two responses: "Oh good for you. I couldn't do that" or "What a waste, you're too smart for that."
"That" is geriatrics, an area of medicine desperate for more practitioners to meet the needs of a rapidly greying population, but one that those committed to caring for the elderly say gets far too little respect.
Yet the need for geriatricians has never been greater. According to 2006 census figures released this week, the number of Canadians aged 80 and older jumped 25 per cent to 1.2 million since 2001, while those 100 or more rose 22 per cent to 4,635.
By 2016, Statistics Canada projects, seniors will number 5.8 million. And by 2031, the ranks of centenarians alone could triple to more than 14,000.
Currently, there are fewer than 200 geriatricians across Canada, and Clarke is one of only a handful of newly minted doctors who has chosen to join the ranks of a specialty that even its most fervent advocates concede is far more challenging than most.
"You really have to love the elderly," says Clarke, acknowledging that the multiplicity of older patients' medical and psychosocial problems can seem overwhelming, especially to doctors just learning their art.
"Because it's absolutely true that they're incredibly complex."
For Clarke, who is part way through a two-year geriatrics residency at St. Joseph's Health Centre in London, Ont., it is a complexity that she thrives on, as well as working with elderly patients and hearing the stories of their lives.
"It's such an amazing population. It's such a rewarding field," says the native of Lively, Ont., near Sudbury. "How could you not want to do this?"
Dr. Laura Diachun, who's in charge of undergrad geriatric education for the University of Western Ontario, says there are several reasons why medical school grads are not clamouring to care for Canada's oldest citizens.
"What our surveys have shown is that students like to work in areas they feel confident in," says Diachun. "And what they tell you is they like to work with individuals who are cognitively intact, who have single, well-defined problems."
"And one of the populations they least like to work with is people with chronic disease."
"Now this is a problem because that is the future of health care in Canada. And so there is a bit of dichotomy between what students want to do and what the needs of our society are."
Another critical factor, she says, is money.
Compared with high-end specialties like surgery and cardiology, geriatricians are paid relatively poorly because the standard fee-for-service remuneration system favours doctors who see a large number of patients and perform procedures.
The practice takes more time
A geriatrician can easily spend an hour or two with one patient, says Dr. William Molloy, head of the Centre for Studies on Aging at McMaster University in Hamilton, whose love of working with the elderly has kept him in the field for more than 20 years.
"The trouble is that geriatricians tend to be holistic, they tend not to deal with single issues like a single disease," says Molloy.
Take, for example, a patient suffering from falls. The cause could be one or a combination of many factors -- from poor vision and arthritis to medication side-effects and even improper footwear.
The geriatrician -- usually with a team of physical and psychosocial therapists -- looks at every possible angle "and tries to come up with a solution that takes all of those into account."
"And everything takes twice as long with the elderly," says Molloy. "But geriatricians, besides seeing patients, they advocate for the elderly. We do a ton of education of the professionals and young students. We do a ton of research and we do a ton of administration in the system to try to get people organized."
"The truth is, the billing system kills us," says Molloy, who believes governments that fund the health system don't value the specialty of geriatrics -- or the aging patients that are the single biggest users of health-care resources.
"The powers that be have not supported the specialty and as a result, the specialty is dying on the vine."
And when it comes to picking a niche to practise in, future earnings are not a trivial concern, says Diachun. Most medical school grads are carrying huge debt loads from their years of education -- typically more than $100,000 before they even hang up their framed degree.
Clarke still has 14 months to go in her geriatrics residency and she is already up to $120,000 in loans, a burden the 31-year-old mother of a young child admits "weighs on my mind."
Still, she has not let that deter her from her path -- nor has she let naysayers dissuade her from her passion to care for the elderly.
"A lot of the reasons people go into medicine is they think they can help people, and oftentimes helping people means keeping them alive," she says. "I've had friends say: 'You don't help these people. You don't honestly think you help these people?"'
Her answer is unequivocal.
"I would absolutely say I do help these people. I don't always make them live 10 years longer, but I certainly improve their quality of life and their function."
That may mean an older person is still able to walk and care for themselves or to live without as much pain. It may mean keeping the person living independently in their own home, instead of bound to a wheelchair or bedridden in a nursing home.
"In my population, even though you might not live to see 85, my job is to make sure you want to live to see 85."
