TORONTO – It may not be the most glamorous of specialties in medicine, but it’s becoming the most needed: Canada is facing a shortage of geriatricians while the country’s population is aging.
Geriatrics is a diminishing field of study in Canada. Dr. Justin Lee is a rarity in medicine – as a medical resident focusing on geriatrics, he’s only one of 14 geriatricians currently training in Ontario.
“I do admit that it is a challenging field – there are patients who have multiple chronic conditions on a number of different medications, and many of them are often frail or socially vulnerable,” Lee told Global News.
He said that when people ask what he specializes in, awkward moments can come up.
“Sometimes there’s a little bit of a pause, or a little bit of an ‘oh,'” he explained.
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Large numbers of graduating medical students are selecting other specialties – a recent Canadian Resident Matching Service (CaRMS) report found that only 11 of 421 third-year internal medicine residents chose geriatrics as their first choice in 2012. That’s only 2.6 per cent.
CaRMS is a not-for-profit organization that works with medical schools to help residents apply for post-graduate medical training across Canada.
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If this trend continues, the implications could be grave. Those 64 and older make up Canada’s fastest-growing age group. By 2014, Statistics Canada estimates that there could be about 5.5 million seniors across Canada. By 2018, that demographic could swell to up to 6.4 million, according to projections the federal agency provided to Global News.
By 2051, about one in four Canadians is expected to be 65 or older. It’s geriatricians who would be looking after this ballooning demographic, after all.
They’re the ones who help patients with memory, cognitive problems, mobility, for example.
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Wong suggests the decline in geriatricians has improved but only slightly.
“The situation right now is better than it was even five, seven years ago but certainly it’s nowhere near the level that we need it at. I think two years ago … of all the spots that were available in Canada, only just a little over half were filled,” she said.
What could be at play is how geriatrics is introduced to medical residents going through their education.
“There isn’t enough exposure to aging in general so a lot of the times when medical students go on to the wards they’re only seeing the sickest of the sick, the frail elderly who are sick enough to end up in hospital,” Wong said.
“(Students) don’t have enough opportunity to see the well seniors who may have complexities of their own but are functioning in the community.”
Incentives could also be implemented: financial compensation, mentorships to foster interest or answer questions about the specialty, as examples.
Right now, geriatrics is a five-year training process, with the first three years spent on internal medicine and the final two years focused solely on geriatrics.
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Dr. Nathan Stall, a second-year resident in internal medicine at the University of Toronto, says that while medical school is supposed to open students’ eyes to various opportunities – family medicine, psychiatry, pediatrics, to name a few. Geriatrics is often overlooked.
He suggests there’s only about 250 geriatricians across Canada.
“It’s a ratio in Ontario of about 0.65 geriatricians per 10,000 population. The paediatric numbers are about 10 times that for 10,000. So at this point, we’re only training in Ontario, five to eight or even less depending on the year,” Stall said.
Stall plans to specialize in geriatrics. His mentors help him deal with any doubts he encounters.
“I get comments all the time, like, ‘why would you want to do that, you’re too smart to do that. Why are you choosing this field?’” he said.
A lot of this disapproval stems from society’s negative attitude towards older adults, Stall suggests.
“It’s hard to sustain an interest when you hear these things you have to be strong, you have to advocate for yourself,” he said.
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Wong said she believes that, ultimately, it’s interest in the unique field that will draw students in.
“Inherently that’s something that you have to love doing. You know geriatricians are among the most happy and satisfied physicians but really it’s because they really want to do it,” she said.
In the meantime, medical schools are trying to help usher in a new wave of geriatricians.
Dr. Mark Walton, assistant dean of post-graduate medical education at McMaster University, said that geriatrics is now part of every rotation.
“So when you’re on surgery, many of your patients are geriatric,” he explained.
“There’s certainly an awareness of the grey tide that is coming and is present. So I think there is a lot of exposure,” he said.
carmen.chai@globalnews.ca
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