"That's the number of people turning 65 in our country," says Cheng, founder of the Palo Alto Medical Foundation's new geriatrics department.
"We say we're a Silicon Valley startup," he said of the geriatrics department. "We have big dreams and ideas."
The 42-year-old physician, who joined the Palo Alto Medical Foundation six years ago as an internist, said he was first inspired to consider a career in geriatrics by his grandmother, who lived with his family in his native Taiwan. Later, he studied under "giants" in the field at Johns Hopkins University School of Medicine, where he completed a fellowship after medical school.
A major goal of geriatrics at PAMF, Cheng says, is to help people age well through prevention, screening and pro-active planning. That means, for example, reducing the risk of falls by evaluating and addressing hazards in the home ahead of time, or planning ahead about social needs as one ages.
"We have star surgeons who can treat a broken hip, but of course the best way is not to fall in the first place," he said.
Cheng answers "no" to the question — frequently asked — of whether people should switch to a geriatrician when they turn 65. Geriatrics should be considered a medical subspecialty, not primary care, he says.
"We actively discourage people from breaking off their long-term primary care relationships," he said. "That doctor knows you, and you know and trust that doctor. If people have the type of primary care relationship we all want to have, we definitely think they should continue to work together."
In any case, the 7,000 board-certified and fellowship-trained geriatricians in the United States would never be enough to cover the 40 million Americans now over 65.
Rather, the value added by a geriatrician is as a specialist in dealing with complex and interacting medical illnesses, medications, home-care, available social systems to support patients and palliative and end-of-life care, he said.
"These are things that geriatricians deal with on a day-to-day basis — that's what we're trained to do," says Cheng, who, in addition to seeing patients at PAMF, visits them in local skilled-nursing facilities including Lytton Gardens, Vi, Channing House, the Sequoias and the Palo Alto Sub-Acute and Rehabilitation Center.
Skilled-nursing facilities play the role that hospitals played as recently as 10 years ago, he said. "People are leaving the hospital sooner and many are not ready to be home right away. They still have a lot of complex medical needs, there are social needs that bubble to the top and also rehabilitation needs that exist.
"So the skilled-nursing facilities have evolved a lot from your nursing homes of the last century," he said.
"They're set up more like little hospitals where a lot of great care and great stories can be found of victory, courage and compassion. It's a great arena for geriatricians to make a difference, so part of our operation is focused on doing that part well."
Cheng also has been known to make home visits.
"Our goal is to create the right systems and teams in order to pass on this knowledge and to have the older patients get what they need," he said.
Among the initiatives of PAMF geriatrics is Mind, Body & Soul, a three-part series on pro-active aging — offered monthly — that is presented as a "shared medical appointment." A class of six to eight patients meets weekly for three weeks to address core themes, including the aging brain, assessing risk factors and emotions and attitudes about aging.
"We're proud of this idea and looking for ways to refine and improve it," said Cheng of the two-year-old initiative. "Traditional appointments are short, and usually there's a whole list of other topics to cover. This is about planning for the future and thinking proactively. A lot of nice friendships form as well."
PAMF also partnered with the nonprofit senior-services agency Avenidas to twice present a "Successful Aging Celebration" — a full day of seminars, vendor booths, food, music and artists — that Cheng hopes will become an annual event.
"In this country there's a concept called ageism — our society just hasn't paid much attention to aging, the positive aspects of it," he said. "In the Far East, you're supposed to do things to celebrate aging. The older people get the prime opportunities to speak and to make a difference, in terms of making decisions."
Thinking of his grandmother, who stayed in Taiwan when his family moved to the United States when Cheng was 10, he remembers "just hanging out with her, listening to her talk, getting some of her values and being comfortable around her and her friends, who were older.
"That was really my first and biggest influence," he said.