Speculating on what motivates doctors to specialize in their chosen branch of medicine can be intriguing. For some physicians, the priority is glamour and recognition, while others prefer a less stressful existence with sociable hours and a manageable workload. Much seems to depend on the individual's personality and experiences during training. Senior colleagues, tutors, and family members can also influence these critical career choices.
Recently, I was speaking with a French friend, Jean-Pierre, whose daughter has just received her medical degree. Whereas her father specialized in clinical pharmacology, she is opting for geriatrics. The decisive factor for her was the death of about 15,000 elderly French people during the heat wave in the summer of 2003. She is convinced that older people deserve better care and that society in general does not treat them with the respect they deserve.
Jean-Pierre's daughter is likely never to be short of work. Across Europe, the proportion of older people compared with the rest of the population is growing dramatically. German experts project that by 2030 their country will have about seven million fewer people of working age than it has now, but there will be 8.5 million more people of retirement age. Four German workers currently support each retired person, but within a generation that number may fall to two.
Furthermore, European Commission economists estimate that Europe's aging societies will impose extra costs of 4% to 8% on each country's gross domestic product over the next five decades. Unless major reforms are implemented, taxes will have to rise by as much as 20% to cover the growing pension costs and healthcare expenses.
These demographic changes will have a huge impact on the practice of medical imaging. Musculoskeletal radiology is likely to be an area of particularly dramatic growth. In a visionary speech in August at the Paris meeting of the International Society of Strategic Studies in Radiology, Dr. Elias Zerhouni, executive director of the U.S. National Institutes of Health, listed in order of priority the six major healthcare issues that will trouble future generations of older people: arthritis/musculoskeletal disease, heart disease, loss of hearing/vision, joint injuries/bone fractures, diabetes, and mental illness.
In the coming months, more articles in DI Europe will focus on these core areas. The cover story in this issue addresses spondyloarthropathies, a fairly common group of musculoskeletal disorders. The news section has items about the diagnosis of dementias and pneumonia.
As new healthcare challenges arise for our aging population, it will be important to invest more resources in conditions that affect the elderly. As long as bright doctors continue to choose geriatric medicine, there is every reason for hope.