04/10/2014 04:25 pm ET Updated Jun 10, 2014

Dare to Be 100: I Am a Geriatrician

For 50 years, I have been the caring steward of the medical needs of my older patients. It has been an incredibly wonderful career. Not only did the opportunities for doing good for very needy persons gratify, but so too did the inherent benefits in geriatrics provide daily lessons about the very essence of life.

By definition, every geriatrician is also a gerontologist, a student of the aging process. This is a critical additional advantage of being a geriatrician. Importantly, it recasts my medical profession in a totally different profile. Almost all current medicine has been consecrated to treating illness, Panacea's ancient task. Medicine is preoccupied by disease as the dominant theme.

But aging is not a disease, so it requires a different conceptual paradigm. And that different paradigm that aging represents is health. I have described this conceptual shift in detail in my book Next Medicine, which I'm confident should be the dominant resetting of the medical profession.

But beyond the mandate for a reformulated medicine is the recognition that geriatrics is an endangered species. Every summary report indicates that there is an inadequate supply of geriatric doctors. They are woefully underrepresented and their numbers worsening. The number of young doctors who are entering geriatric training programs is pitiful, a few dozen each year.

There are multiple reasons for this disaffection, but most of them involve money. Most medical students accrue a substantial financial debt due to the high tuition costs of medical school. So when the just graduated M.D. faces a career choice, geriatrics which is notably underpaying or a surgical specialty which immediately offers a substantial salary with the promise of further bonanzas in the immediate future the young doctor faces a simple choice.

I was personally spared this burden as my dad paid my tuition, and subsequently by joining a large multi-specialty medical group that cross subsidized my clinical efforts since they recognized the need to provide geriatric coverage for their increasingly elderly patient load.

As geriatric medicine gradually becomes a scientifically-grounded enterprise it achieves a noble state that emphasizes prevention and function over repair and structure, and system over components. Within geriatrics is to be found the very essence of the medical profession that has sadly been overwhelmed by our capitalistic adoption of treatment and cure, because they pay. Pharmacy and tech generate big charges.

We geriatricians are eager to find ways to make health pay. It surely is better to be healthy than ill. This is a choice that our society must make. We geriatricians are here to help in that choice.