Paul Cary used to examine up to 30 patients a day at his senior-focused internal medicine practice in Dallas – until he began charging them $1,500 a year to secure a spot in his schedule. The fee cut his workload significantly, but Cary isn't complaining. From his perspective, he traded quantity for quality. Now he can give the lengthier exams his aging patients often need or call pharmacists or specialists on their behalf. Cary's unconventional decision is an example of the rapidly changing nature of geriatric care – and new approaches doctors are taking to meet the bottom line. As the nation's 78 million baby boomers begin to flood the healthcare system, doctors focused on caring for the elderly find themselves in greater demand, shorter supply and searching for ways to balance costs with quality care. There are fewer than 8,000 trained geriatricians out of more than 900,000 physicians in the United States, according to the American Medical Association. In Texas, less than 1 percent of its 48,712 licensed medical doctors are geriatricians. Experts predict four times as many geriatricians will be needed by 2020 to serve the nation's aging population.