En español | It is the middle of March in Baton Rouge, Louisiana, and Donnie Batie, M.D., has lost one of his closest relatives — his wife's sister Gertie. There will be no funeral, however, no embraces, no flowers. Grieving will take place over the phone. And the memorial service itself — a ceremony in which a religious family like the Baties would gather and pray and sing and cry over the deceased — won't happen for many months. The coronavirus has come to the South.
The death toll from the pandemic is piling up around the world, and now Batie's hometown of Baton Rouge is in the crosshairs. Perhaps no one is more central to the crisis here than this trim, handsome, lightly bearded, utterly unflappable 66-year-old physician, one of just a few dozen geriatricians in the entire state. In the coronavirus crisis, it is his patients who are most likely to die from the disease itself, or from myriad other ills that can't be attended to as an overtaxed health care system struggles to cope with the pandemic. There have been more than 2,000 cases in Louisiana and 153 deaths, yet Batie has not lost a single patient to COVID-19. “Most [of my] patients have mild symptoms, and the vast majority do fine,” he says. But that doesn't mean he hasn't been impacted. His oldest patient, who is 103, has the coronavirus, but thus far is in stable condition at a skilled nursing facility. “I have been checking on her once every few days. So far she is doing fine,” Batie says. A woman in her 60s whom Batie has been treating for many years lost her father to the virus, and it was Batie who helped her and her family process the death.
"Unfortunately, I have done it a lot,” he says. “One thing that a geriatrician deals with is death.” Batie typically loses about one patient every month, often from heart disease. I ask how he handles speaking to someone who has just lost a loved one in regular times, let alone these times, when the sick cannot even be visited in their final moments.
Batie pauses for a long moment.
"I am a physician of faith,” he says, “and I guess over time I have developed a skill set where I am able to work through that separation. I talk beyond just the medical. I express the belief that we are just passing through this world, that this is just a temporary setting for us."
A Critical Shortage
Even before most of the world had ever heard the word “coronavirus,” Batie was already in the epicenter of a growing health crisis. Nationwide, the shortage of geriatricians is striking: Only about 7,000 physicians in total have the specific training needed to attend to the unique combination of ills that can haunt the approximately 49.2 million Americans who are 65 and older.
In few states is the crisis of geriatricians as bad as it is in Louisiana. According to a 2018–19 American Board of Medical Specialties report, Louisiana has just 55 geriatricians. That's roughly one for every 13,016 potential patients.
"The system,” Batie says, “is broken down."
Batie himself juggles about 2,000 patients, 1,200 of whom are older adults. In a medical crisis, Batie is exactly the type of doctor you want managing your care: Like a fighter pilot, he is laconic and hyper-organized, a workaholic by nature and necessity. If you are a geriatrician in America, it is the only way to survive. Batie works every day of the week, often from 7 a.m. until midnight, seeing patients not only in his office but in five area nursing homes. His phone is “his umbilical cord,” says his wife, Veris. He gives his patients his number and will take calls in the middle of the night. Batie has helped his patients get jobs, delivered their children's babies and counseled them through difficult life scenarios. He approaches every crisis, including the COVID-19 pandemic, with a dogged Southern optimism.
"The situation has brought into focus elderly care,” he says, looking me in the eyes, “and hopefully can be turned into something good."
"I have wondered about how he keeps strong through it all,” Veris tells me, but even she does not know the secret. “What I know,” she says, “is he is a very caring man, and he is very concerned about his patients."
Batie grew up and went to med school in Gainesville, Florida, before moving to Baton Rouge, at age 24, to complete his residency in family medicine. Although he spent his childhood in Florida, “I grew up in Baton Rouge,” he says. The culture was different, the food was different, the politics were different, and the storms were different — Louisiana is more prone to severe flooding from hurricanes than Gainesville, in the inland portion of northern Florida. The needs in terms of health care were different, too.
Right after finishing his residency, in 1983, Batie worked in a pair of community centers, both located in poor sections of Baton Rouge. “People in their 30s and 40s were bringing in their parents who were in their 60s, 70s and 80s, and that got me more interested in taking care of senior citizens,” he says. In 1990, Batie sat for the board certification exam in geriatrics and passed. He later served as the associate director of community affairs for the family medicine residency program at Baton Rouge General Medical Center, and on a series of committees with the state's governor.
His work has informed his efforts to build a healthy lifestyle for himself and his family. Batie practices “square-foot gardening,” a method conceived in the 1970s by civil engineer Mel Bartholomew that suits Batie's well-ordered mindset. It involves a rigid routine of soil tending and weed care, planting in squares rather than rows. He grows okra, tomatoes, mustard greens, spinach, Swiss chard, watermelon, squash and, in large flowerpots, pineapples.
In his practice every day, Batie sees chronic disease connected to poor eating habits, specifically uncontrolled hypertension, kidney disease and diabetes. “Unfortunately, I am in a state where eating is celebrated,” he says. “There is a segment of the population that says, ‘I would rather die eating something I enjoy than taking care of my health.’ And that makes it very hard to diet and exercise.” Income level and economic status play a role, too. “You can eat healthy while poor,” Batie says, “but it's a little bit harder."
Service to others is a Batie family value: Their son, Theron, a former board member for Habitat for Humanity, now lives in Chicago and is training to be a pilot; daughter Krystal, a pediatric registered nurse, still lives in Baton Rouge and continues to join Donnie and Veris for services at South Baton Rouge Church of Christ. That is, until the age of coronavirus. Now worship for everybody is via Zoom. The pastor and some members of the choir are the only ones in the actual church. Prayers are sent out over the phone to a nervous congregation. Batie will not tell me that he is frightened, but Veris is more forthcoming. “I have prayed and I have asked God to remove the virus from not just the United States but from the world,” she says. “This is the time for prayer,” she adds. “We can never have too much prayer.”
By mid-April, the COVID-19 crisis in the United States had grown even more dangerous for older Americans. That reality is bringing America's geriatrician shortage into a new and harsher focus, as Batie suggested. The virus presents a challenge not only to older people but to untrained doctors unfamiliar with older patients’ response to the infection itself and to various health interventions. For example, the Global Council on Brain Health recently reported that half of people 65 and older will experience postsurgery delirium. “We were at a place where there was still a shortage of ventilators,” says Michèle J. Saunders, a national expert in geriatric health professions education and former president of the Gerontological Society of America. “A non-geriatrician might assume the older person is permanently confused and triage him or her to a lower priority for a ventilator. That would be disastrous for a temporarily confused older adult."
The Need for Care as a Nation Grows Older
The shortage of geriatricians in the United States has many causes, but a primary one is demographics. “Within just a couple decades, older people are projected to outnumber children for the first time in U.S. history,” reaching 77 million by 2034, the Census Bureau recently reported. And the number of doctors in training going into geriatric medicine isn't keeping up. “Over the last 10 years the number of certified geriatricians in America has stayed pretty flat,” says Elizabeth Bragg, an assistant professor in the School of Nursing at Xavier University in Cincinnati and author of numerous papers on the topic.
One reason for that is money. A 2017 survey by the Association of American Medical Colleges reported that medical students are typically graduating from four-year programs with debts of around $190,000. That motivates new doctors to avoid choosing to become geriatricians, whose pay is significantly lower than that of other specialists.
According to the “MedScape Physician Compensation Report 2020,” the average orthopedist makes half a million dollars annually, the average cardiologist makes $438,000, and the average anesthesiologist makes $398,000. Meanwhile, the median salary for a geriatrician is about $240,000. Geriatricians must invest time in additional education, yet there is little financial upside.
To become a subspecialist in geriatric medicine, first a student must go through the typical arc of medical schooling. That is, four years in an undergraduate degree program, four years of medical school and then at least three years of residency in either family medicine, internal medicine or psychiatry. Then there's an additional one to two years in a geriatrics fellowship, in which physicians spend time with older patients in a clinic or nursing home setting and learn the specific knowledge and skills for how to provide a continuum of care for them. “Essentially, you have to know just how the body wears and tears as it ages,” says Louisiana geriatrician Teresa Garrison, M.D.
While the fellowships are often sponsored by big hospitals or agencies like the U.S. Department of Veterans Affairs, “These folks are coming out with phenomenally huge medical student debt,” Saunders says. “Physicians who go into geriatrics need to be able to make a living.”
But Saunders says the issue runs deeper, to something more systemic in our society and the place it makes for older people. “There is no doubt about it: We are a throwaway society,” she says. “Youth is better. And medical students are ending up with negative stereotypes, which further ingrains a stereotype against older people.” Additionally, she says, medical school teaching is oriented toward curing people, whereas doctors who treat older adults more often need to be focused on managing disease and slowing decline — a very different mindset.
By the end of April, more than 3,000 coronavirus cases had been reported at assisted living facilities in Louisiana, and state officials reported 637 deaths of residents at nursing homes and other assisted living facilities across the state. The five nursing homes Batie visits are all in a full-scale war on the virus, but none has had the sort of tragic breakout of the virus that has developed at many facilities across the country.
Batie's practice is in the eastern part of Baton Rouge, where 1 out of every 4 residents live in poverty. “It's the inner city,” he says. Many patients use a local hospital as their primary care provider, believing that, “I only go to the emergency room for my health care,” he says. “And if you are sick enough to go to the ER as a senior citizen, chances are, when we do intervene, it is going to take a lot of work."
The reliance of many older Americans on emergency rooms worries Batie. Too many ER visits and too many different doctors often leads to a situation called polypharmacy, in which older patients wind up with numerous, sometimes contraindicated, prescriptions. Which is why he encourages his younger patients to bring their parents and grandparents in to see him, too.
One of Batie's patients is 64-year-old Cynthia White Criss, whose family he has been treating for nearly four decades. Batie treated her grandfather, Gilbert, a housepainter who lived to be 96. He took care of Cynthia's mother, Burdette, who passed away at 90. He helped find quality care for her mentally disabled sister. He helped talk her daughter Sarah through the difficulties of a teenage pregnancy, and even delivered Sarah's baby, Keah. (Yes, he delivers babies, too.) And Batie has been treating Criss since she was a young adult; he helped walk her through a difficult diagnosis of Crohn's disease and colitis when she was in her 20s. The conditions had her on a colostomy bag, a disability that made finding work difficult, but Batie wrote a letter of recommendation to help Criss get a prime job at American Airlines, where she worked until she retired.
Patients as Family
Batie treats his patients like he does his family — and himself. “Some doctors you go to, they bury you in prescriptions, but not Dr. Batie,” Criss says. “He talks to you; he cares about his patients.” Criss gives an example: When she complained to Batie that her stress level was too high and she was wondering about antianxiety medication, “He told me, ‘You don't need pills. You need a bicycle.' " And he helped her lay out a regimen to get more exercise. “He is not just a doctor, he is a counselor, and he is like a part of my family.”
Criss’ story is typical of Batie's patients. Sixty-eight-year-old Vernon Hills first saw Batie in 1974. Hills liked him so much that eventually both his parents and grandparents — and also his wife, Dianne, and both of her parents — were soon seeing Batie.
"He has been really good to me and the family,” says Hills, who also trumpeted the doctor's focus on healthy diet. When Hills and his wife both came down with the coronavirus, “Dr. Batie was real cool, calm and collected,” Hills says. Batie never overdramatized the situation and walked them through a self-quarantine, with phone calls every few days and his constant reminder of fluids, bed rest and Tylenol. “He is more like a family member,” Dianne Hills says, “and he treats us like we are his family.”
Now it is June, and the situation in Louisiana appears to be turning a corner. Despite nearly 2,845 deaths in the state — and 252 deaths in East Baton Rouge alone — Batie still has yet to lose a patient. And fatalities in the state have dropped from more than 100 a day in mid-April to as little as a few dozen. But reminders are everywhere that things have not returned to normal. Services at South Baton Rouge Church of Christ continue to be held via Zoom. And the doctor's cherished breakfasts with friends at Frank's, a popular family-run spot that claims “the best homemade biscuits in the world,” have not yet resumed.
I check in one more time with some of Batie's patients, who are all doing well and bursting with gratitude for his care and attention. This brings up a natural avenue of inquiry. Batie is 66 himself, working seven days a week in a stress-laden environment during the nation's worst medical crisis in 100 years. What would happen to these families if Batie ever retired?
"I really don't think he wants to retire,” Hills says. “But I tell you another thing: As long as he is not dead, his patients are not going to want to see anyone else.”