As one of only two geriatric physicians in western South Dakota, Dr. David Sandvik is a critical cog in the local geriatric health care machine.

But Sandvik is also only nine months away from his 65th birthday. When that landmark day arrives, he plans to cut back on his work. His semiretirement will add stress to an existing situation - a growing elderly population and severe shortage of doctors working in geriatrics.

Sandvik and others in health care are fearful of that future.

"In South Dakota, we've lost a lot of geriatricians. That really has to change if we are going to take care of the baby boomers," he said. "I think it's coming close to a crisis. … Our system is in real trouble."

In the next 17 years, the number of people in South Dakota older than 65 will double. There are only 17 physicians licensed in South Dakota as geriatricians, with several living out of state and several others not practicing in the specialty, Sandvik said.

There also are no clinical sites in the state to refer a complicated case of an older medical patient. For instance, Sandvik and his geriatrician partner, Priscilla Bade, practice only in nursing homes, assisted living facilities and at the hospital.

In hopes of addressing the shortage of geriatric physicians, the University of South Dakota Sanford School of Medicine and the Department of Family Medicine and Internal Medicine created the South Dakota Institute of Geriatrics in Rapid City.

Sandvik, who directs the institute, said its plans are simple.

"Our big goal is trying to get more geriatricians into the state," he said.

The institute hopes to do that that by educating more "home-grown" geriatric physicians and helping to make their specialty more economically appealing.

Sandvik said less than 1 percent of medical students opt for a geriatrics specialty despite studies that show geriatricians are the most professionally satisfied medical specialists.

Sandvik said the main reason for the low numbers is income. A geriatrician in a clinical setting must work 60 hours a week or more to earn less than a family physician or general internist.

Geriatrics specialists also have lower incomes because they are largely dependent upon reimbursement from Medicare, rather than higher paying private insurance. By comparison, Sandvik said, geriatrics is the fourth top specialty in Great Britain, partly because that country reimburses doctors based on the complexity of cases.

In the United States, geriatricians are required to have a one- to two-year medical fellowship. South Dakota currently doesn't have a fellowship director. The institute has been advertising the position since February 2006. Once filled, the fellowship director can work to draw more physicians into a geriatric specialty, Sandvik said. "Our goal is to grow our own," he said.

Sandvik said the institute also hopes to connect physicians considering geriatrics with endowment funding that will allow them to work part-time and use the remainder of their time for research.

The institute plans to educate rural health care providers about the most cost-effective geriatric care, using webcasts and the state's video-conferencing system.

But the overall goal remains the same: Get more geriatric physicians to South Dakota before the state finds itself facing a medical nightmare.

"We are one of the most aged states. We have to be able to provide good care for our elderly," Sandvik said. "We need to somehow muddle through. …"

Contact Taylor Rick at 394-8414 or lynn.taylorrick@rapidcityjournal.com