Now, Brown and other U.S. medical schools are plugging geriatric courses into their curricula and adding specially trained faculty members as they respond to an imminent boom in the number of older Americans and the need to better understand how to properly care for the elderly.
The U.S. Census Bureau projects the number of elderly Americans will nearly double to 71 million by 2030, leaving one physician trained in geriatric care for every 7,665 seniors.
The first members of the Baby Boomer generation, so named for the explosion in births in the years after World War Two, turn 65 in three years. In addition, people are living longer than ever.
"The first ripples of the silver tsunami are lapping at the shores of our country, but there is not a coordinated or strategic response taking place in America," said Richard Besdine, who is director of the geriatrics division at Brown University medical school in Providence, Rhode Island, and past president of the American Geriatrics Society.
Geriatrics has never been a field of choice for young doctors. Elderly care doctors are paid less than most other physicians and surgeons and the aged can be hard to treat.
They have complicated medical histories and their ailments, even such routine illnesses as pneumonia, can be more difficult to diagnose because they may be masked by other conditions. Also, drugs can affect them differently than middle-aged adults.
HARD WORK, LOW STATUS
"It's a hard job; it's not paid very well; it's complicated; and there's very little status within the hierarchy of medical specialties to being a geriatric physician," said Gavin Hougham, senior program officer and manager of medicine programs at the John A. Hartford Foundation, which focuses on aging and health.
Out of 800,000 doctors in the United States, roughly 7,000 are geriatricians, Hougham said. The country needs another 13,000 to adequately care for today's older population, according to the American Geriatrics Society. The shortfall could reach 36,000 by 2030.
To help counter that, private groups are bankrolling medical schools' emphasis on aging.
The Hartford Foundation has given more than $40 million to 27 schools to train faculty in elderly care, and the Donald W. Reynolds Foundation has given more than $100 million to 30 schools to include more geriatrics content and establish geriatric departments at two colleges, said Steve Anderson, the foundation's president.
Since arriving at Brown in 2000, Besdine has increased the geriatrics faculty to a dozen from two and is weaving aging content into every course at the medical school.
The University of Oklahoma College of Medicine requires all third-year medical students to complete a rotation in geriatrics, said Marie Bernard, a geriatrician and chair of the school's Reynolds Department of Geriatric Medicine.
The University of California at Los Angeles has integrated geriatrics training into all four years of its medical program, said David Reuben, chief of geriatrics at the school.
"If they don't learn it, they still have to deal with it," Reuben said. "It's not that not learning geriatrics will cause these older people to go away. They're coming whether we're ready or not."