A lack of interest among medical students has helped create a shortage of geriatricians – doctors who specialize in treating older people – at a time when Canada's senior population is about to explode.

One expert in geriatrics says there are only about 200 of these specialists in the entire country. 

That shortage is causing problems for people with Alzheimer's and other forms of dementia, says Dr. Laura Diachun, who directs the geriatrics residency program at the University of Western Ontario.

"What this means is that individuals aren't getting their diagnosis made, they aren't getting the support for their family members, the education their family needs to cope and deal with and plan for the future," she says. 

Case in point: an 89-year-old Hamilton man with both Alzheimer's and heart disease.

The man used to get up five or six times a night to urinate. Because of his Alzheimer's, he often became confused and wandered out of the house. This exhausted his wife who was ready to put him into long-term care.

The man finally visited Hamilton geriatrician George Heckman, who was able to alter the timing and dose of the man's diuretic heart medication so he wouldn't have to urinate so often at night. He also stopped a dementia drug, which was contributing to the need to urinate (a common side effect), and got him involved in daycare programs for seniors so his wife could get a break during the day.

"This was 18 months ago," Heckman says. "I saw him in clinic recently. He is still at home. His heart failure is fine. His memory remains stable without the dementia pills (because he sleeps better), he is still active and relatively fit (because he goes to daycare programs), and his wife is relaxed and happy."

Geriatricians are probably the best prepared to deal with people who are frail and have complex medical conditions, says Diachun, who co-wrote a study in 2006 on the lack of interest in geriatrics among medical students.

"If there are only 200 in Canada, there's approximately one-third of a geriatrician per 10,000 people over the age of 65," she says. "It was anticipated that it would best serve our population if we had 1.25 geriatricians per 10,000 over 65." 

The wait lists to see a geriatrician will increase as baby boomers age. Diachun knows of some Ontario communities where it already takes 18 months to get an appointment. 

For Alzhiemer's patients, that could delay access to treatments and support programs that may slow the progression of the disease. 

There are now only three geriatricians in Ontario between the ages of 30 and 34, according to the Ontario Physicians Human Resources Data Centre. 

Dr. Jo-anne Clarke, 31, will become the fourth when she graduates next year from the geriatrics program at the University of Western Ontario. But her career choice is both unusual and unpopular among her peers. The most common refrain she hears is that she's wasting her time.

"The comments are from friends, too," she says. "They're from people who truly think they're helping me by asking, `You don't really do anything.' 

"It's so frustrating because I do so much, if I could just show them," she says, suggesting the misconception may come from the fact medical students spend so much time in hospitals, where elderly patients are often frail, confused and agitated. "It's not place where you think you can make a big difference."

But Clarke knows that she can make a huge difference in the quality of life for seniors who are still living in the community.

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