Medical society head sees gaps in elder care

Sonja Puzic, Windsor Star

Published: Wednesday, December 03, 2008

As a busy family physician, Dr. Nick Krayacich is all too familiar with the growing challenges facing our health care system.

His patient load of about 2,400 includes many elderly people battling chronic illnesses and adults whose health problems are compounded by job losses and the economic crisis.

Krayacich knows what the community needs -- more health care dollars from the government, better communication among local and provincial agencies and a collaborative, multidisciplinary approach to patient care. As the new president of the Essex County Medical Society, he's got several initiatives in mind.

"We are a very well-respected medical society in the province and one of the most active," said Krayacich, who will be formally installed as ECMS president tonight at the society's dinner gathering. "We need to be vocal and advocate for our membership."

One of the first items on Krayacich's agenda is putting together a medical advisory board to work with the Erie St. Clair Local Health Integration Network, which is responsible for allocating government funding for area health care facilities. The goal is to foster better communication with the LHIN, Krayacich said, "so that they can pick our brains before decisions are made and vice versa."

Krayacich said he will also focus his efforts on "connectedness and inclusion" within the medical community, making sure its members, especially those who were recruited from other parts of the country, feel welcome and get involved.

Krayacich said he is not worried about juggling his day-to-day schedule and new responsibilities as ECMS president. Having served on the medical society's executive, most recently as vice-president, Krayacich said he knows what to expect. He will replace outgoing president Dr. Anthony Glanz, chief of cardiology at Hotel-Dieu Grace Hospital.

Krayacich has been practising medicine in the Windsor area since the early 1990s. He treats many geriatric patients who struggle with various chronic conditions such as heart disease and diabetes. Caring for the aging and ailing population with stretched resources and a persistent shortage of family physicians is a complicated process across the province, Krayacich said.

"We definitely don't have enough nursing homes ... we don't have enough hospital beds," he said. "There are still 40 to 50 thousand people in the Windsor area who don't have a family doctor. We're definitely concerned about that."

Local Doctors' Actions Reflect Nationwide Trend

by T.M. Shultz at the Daily Courier
Saturday, April 26, 2008

What primary care doctors are doing in the Prescott area reflects what primary care doctors are doing across the country.

They are:

• Retiring.

• Changing careers.

• Not taking new patients.

• Converting to cash-only practices.

• Refusing to accept new Medicare patients or dumping them when they reach a certain age or, in at least one case, opting out of the Medicare payment system altogether.

• Limiting the insurance they'll take to one or two major companies. In Prescott, it's typically Blue Cross Blue Shield and the Arizona Foundation for Medical Care, which is a provider network for Yavapai Regional Medical Center's employees.

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As Population Grows Older, Geriatricians Grow Scarce

Officials, Schools Prod Doctors to Focus on Elderly Care

Mary Boland, 91, can consider herself fortunate. In 2006, the chronically ill former teacher from Cincinnati had a narrow brush with death when she came down with pneumonia. Within minutes, Boland's personal physician, Gregg Warshaw, was called.

"She was weak, confused and breathing abnormally," Warshaw recalls. "Her blood oxygen level was low, and she was suffering a low-grade fever."
In the elderly, pneumonia is often fatal. But instead of rushing Boland to the nearest hospital, as many family doctors might have done, Warshaw, a geriatrician, stabilized the condition and put his patient on antibiotics.

"Luckily, the pneumonia wasn't grave enough to warrant hospitalization," Warshaw says.
Geriatricians have provided specialized care to the elderly for decades, and until recently their numbers have been growing. But despite countless attempts to convince the medical profession and the public of their worth, the number of practicing geriatricians in the United States -- about 7,000 -- is falling seriously behind needed levels.

While the U.S. population age 55 and older is growing rapidly, according to a 2005 census report, the number of medical school grads going into geriatrics has been slow to keep up.

According to one estimate, the nation's teaching hospitals are producing one or two geriatricians for every nine cardiologists or orthopedic surgeons.

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