Two years ago the Institute of Medicine, part of the National Academy of Sciences, issued a major report on the state of U.S. health care as the country faced an aging society. The picture wasn't pretty.

Between 2005 and 2030, the number of Americans over 65 will double. To treat these aging patients, the U.S. needs about 36,000 geriatricians — that is, medical doctors trained to meet the unique health care needs of older adults.

But if you want to consult one, you may have a hard time.

Throughout the U.S., 7,590 certified geriatricians currently are registered — one geriatrician for every 2,500 Americans 75 or older. The ratio is expected to drop to one geriatrician for every 4,254 older Americans in 2030. In California, only about 700 physicians identify themselves as geriatricians, said Dr. Cheryl Phillips, president of the American Geriatrics Society.

Of course, such numbers are meaningless — until it's you who needs less such a specialist.

The lack of geriatricians may reflect an American attitude toward aging. Geriatricians earn less, compared with the training they receive, than most other specialties, and they work long, often unpaid hours.

"Nobody wants to go into it," said Dr. Steven Snyder, an internist, endocrinologist and geriatrician in San Francisco who recently has cut back his work in geriatrics. "Because of lifestyle — long, unpredictable hours and money — lower salaries than other specialties."

Another difficulty for aging patients is that medical students receive minimal, if any, training in basic geriatric concepts.

"Most medical schools in the U.S.A. have no requirements at all for geriatric training," said Phillips. "In California, a minimum of six hours is required during four years of medical school."

Medical providers often assure patients who request a consult from a geriatrician that internists and family physicians, trained in all diseases and who usually serve as primary physicians, can treat a variety of patients. Phillips said that geriatric training makes a difference.

"Medical students learn about disease, but they often don't understand how the older person is different from the younger adult and how to integrate functioning," Phillips said.

Geriatricians complete four years of medical school, a three-year residency in internal medicine or family medicine and an additional one- or two-year program in geriatrics.

"The question with older patients is not just what disease do I have but how do I manage my life around that disease," she said. "Are the patients having problems with memory, incontinence, managing medicine — those kinds of questions. That is where geriatricians differ from internists without such training."

Although internists often work with aging people who remain independent and active, geriatricians are sometimes preferred by such patients. They understand that their body is changing and want a specialist's perspective. Such patients are especially uncomfortable when medical providers use "age" as a catchall.

I was told at age 40 that my problem with contact lenses — redness, pain, swollen eyelids — was due to "aging eyes." A second ophthalmologist referred me to a contact lens expert who identified the culprit as a chemical in lens solution. Age had nothing to do with it.

A few years later, another specialist attributed digestive problems to age. But when the complex dental work I had been undergoing was completed, the problems, along with the need for medications I had been prescribed, disappeared.

"When a doctor says, 'It's just your age,' " said geriatrician Dr. Elizabeth Landsverk, "it's time to look for a different doctor."

Expressing the frus-

tration of many geriatric specialists, Landsverk, who has a private practice in San Carlos, doesn't take Medicare.

"With Medicare, doctors are not paid to talk to their patients and understand what's going on with them," she said. "They are paid for procedures. The time of doctors who do procedures is more lucrative than talking to a frail older person who needs to talk. We aren't paid for our time."

So why does anybody go into geriatrics?

Phillips reported results of a study released recently from the UC Davis School of Medicine. Of all the specialties, she said, geriatricians rated themselves the happiest with their professional choices, "although there are few of us and we are the least well-paid."

"Geriatricians love their work," she said.

Next week: recommendations to reduce the shortage of geriatricians, what doctors advise for families who can't find a geriatrician and where in the Bay Area can you find a geriatrician for outpatient care.

Contact Joan Aragone at 650-348-4332.