At Edgewood Summit retirement community in Charleston, W.Va., 93-year-old Mary Mullens is waxing eloquent about her geriatrician, Dr. Todd Goldberg.
"He's sure got a lot to do," she says, "and does it so well."
West Virginia has the third oldest population in the nation, right behind Maine and Florida. But Goldberg is one of only 36 geriatricians in the state.
"With the growing elderly population across America and West Virginia, obviously we need healthcare providers," says Goldberg.
That includes geriatricians — physicians who specialize in the treatment of adults age 65 and older — as well as nurses, physical therapists, and psychologists who know how to care for this population.
"The current workforce is inadequately trained and inadequately prepared to deal with what's been called the silver tsunami — a tidal wave of elderly people — increasing in the population in West Virginia, across America, and across the world really," Goldberg says.
Goldberg also teaches at the Charleston division of West Virginia University, and runs one of the state's four geriatric fellowship programs for medical residents. Geriatric fellowships are required for any physician wanting to enter the field.
For the past three years, no physicians have entered the fellowship program at WVU-Charleston. In fact, no students have enrolled in any of the four geriatric fellowship programs in West Virginia in the past three years.
"This is not just our local program, or in West Virginia," says Goldberg. "This is a national problem."
The United States has 130 geriatric fellowship programs, with 383 positions. In 2016, only 192 of them were filled. With that kind of competition, Goldberg laments, why would a resident apply to a West Virginia School, when they could get into a program like Yale or Harvard?
Adding to the problem, the average medical student graduates with $183,000 in debt, and every year of added education pushes that debt higher.
Dr. Shirley Neitch, head of the geriatrics department at Marshall University Medical School in Huntington, W.Va., says students express interest in geriatrics almost every year. But, "they fear their debt," she says, "and they think that they need to get into something without the fellowship year where they can start getting paid for their work."
This trend troubles many people, including Todd Plumley, whose mother Gladys has dementia, and lives in West Virginia.
"It's kind of scary that [older patients] don't have the care that they really need to help them through these times, and help them prolong their life and give them a better life," Plumley says.
There are no geriatricians in the family's hometown of Hamlin, so Plumley drives his mother almost 45 minutes to another town, Huntington, to see one. He says seeing this specialist has helped stabilize his mother's symptoms.
"Right now, if we didn't have the knowledge and resource," he says, "I believe my mother would have progressed a lot further along, quicker."
Plumley is in his 50s. He worries that if he needs the care of a geriatrician as he gets older, driving even 45 minutes may not be an option.
This story is part of NPR's reporting partnership with West Virginia Public Broadcasting and Kaiser Health News.