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Money can't buy happiness -- just ask geriatrician

Few choose specialty, but those who do report high satisfaction

By Peggy Peck
MedPage Today Senior Editor has a business partnership with, which provides custom health content.

Freda Sandrich helped Dr. David Reuben teach his medical students until her death at age 103.
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ORLANDO, Florida -- Dr. David Reuben is the anti-Peter Pan.

Peter urged his followers to "never grow up." Reuben is in the business of helping people grow old.

He is a geriatrician, a physician who is specially trained to care for the elderly.

When the specialty was founded three decades ago, caring for elderly usually meant caring for patients who were over 65.

"But that has changed as aging has changed," says Reuben, who is president of the American Geriatrics Society, which just held its annual meeting in Orlando.

Today most people in their 60s are healthy, active and -- increasingly -- not yet retired individuals who receive their medical care from family physicians and other primary care doctors.

Typically Reuben's patients come to him when they are beginning to show signs of the diseases of aging --memory loss, dementia, and a mixed bag of chronic diseases that often worsen with age. These include heart disease, arthritis, chronic obstructive lung disease and diabetes.

In general, they are patients "on the other end of life," Reuben says.

As he talks about his work as chief of the division of geriatrics at the University of California at Los Angeles, Reuben often becomes caught up in the emotion of his patients' stories.

He laughs as he recalls stories from a woman who was involved in Hollywood glamour from the 1920s through the era of movie musicals in the 1940s and 1950s.

He is clearly torn up as he relates "awful" stories of patients who "died without dignity."

A compact, tanned 53, Reuben doesn't come across as a physician who spends much of his time in the company of 80- and 90-year-olds. But, as he says, "I love it. I've learned from every one of my patients."

One patient in particular, Freda Sandrich, taught him about a "polished death."

Now, he says, "my goal is to help every patient achieve a polished death -- a death that is dignified, where the patient is in control, a death that is orchestrated so as to be painless, dignified and respectful."

Freda Sandrich became Reuben's patient when she was 98. "She lived in an apartment in West Los Angeles," he says. "Since this is California -- where almost no one is a native -- I always ask new patients how long they have lived here.

"She told me she moved to Los Angeles from New Jersey -- in 1925. She came here to get married, and her husband was once a movie director, one of the very few who made the transition from silent films to talkies."

Teaching medical students

So, one of the joys of being Sandrich's doctor was "hearing all these wonderful stories about people like George and Ira Gershwin, Cole Porter, Irving Berlin Ginger Rogers, Fred Astaire," he says. "These were the people who were her friends."

When Sandrich came to him, she was still "sharp as a tack," with a "wonderful sense of humor and great dignity. She was beginning to have some disability, but she was very good at covering it up," Reuben says.

Every year, Reuben asked Sandrich to put in an appearance "when I was teaching medical students. I wanted them to find out what someone in their 90s was like," he says.

Sandrich faithfully made her medical school visits every year until she died at age 103.

start quoteMy goal is to help every patient achieve a polished death -- a death that is dignified, where the patient is in control, a death that is orchestrated so as to be painless, dignified and respectful.end quote
-- Dr. David Reuben

Now medical students and residents are still enjoying her annual visits because "I made a movie about Freda Sandrich. We videotaped all of her annual visits, and it is very interesting for me to watch that movie because I can see the differences -- the decline -- from year to year," Reuben says.

Reuben says his job satisfaction is fairly typical of geriatricians, a specialty that likes to promote itself as the one with the "highest job satisfaction."

That claim is backed up by a survey published in 2002 in the Archives of Internal Medicine in which "practicing geriatricians reported unusually high job satisfaction," even though they were, and remain still, the lowest paid of all specialties.

At the mention of income, Reuben shakes his head.

"We like the work we do, but for most geriatricians it is economically difficult," he says. "My situation is unique: I teach, I do research and I care for patients one day a week.

"If I had to make a living just by seeing patients, I don't think I could do it. I could do it mentally, but I don't think I could do it financially.

"It's a tragedy. These [geriatricians] are the people with the biggest hearts. They love their patients and they want to do the right thing -- but it costs them economically to do their jobs," he says.

That cost, Reuben says, is probably why so few doctors chose geriatrics as a specialty.

Last year fewer than 300 physicians entered geriatric training programs, which is especially disturbing, "because we only have about one geriatrician for every 5,000 elderly Americans."

When boomers grow old

That means a geriatrician gap of about 14,000 in 2005 and an anticipated gap of 36,000 by 2030 -- when the last of the baby boomers turns 65.

Those figures prompted the American Society of Geriatrics to issue a special report called "Caring for Older Americans: The Future of Geriatric Medicine."

As expected, the report makes a case for more money for geriatricians, but since, as Reuben says, "you can't just demand more money," the report also suggests ways to turn geriatricians into multi-tasking doctors who teach "geriatric approach" to all physicians that treat older patients.

The report also proposes that geriatricians enlist the aid of patients in a lobbying effort to change Medicare payment rules so that geriatricians will get a pay raise.

But Reuben doesn't expect immediate changes. Geriatrics, he says, has taught him patience.

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