University of South Carolina medical school resident James Lee stood behind Lt. Gov. Andre Bauer's desk Tuesday and posed for a picture.

Now, state officials are hoping the Conway resident - and a few others like him - will take advantage of a law Bauer signed off on to specialize in geriatrics, the treatment of medical issues associated with old age.

The bill establishes the State Loan Repayment Program in the Office of Aging, part of the lieutenant governor's office. If signed into law by Gov. Mark Sanford and funded by legislators, the program will reimburse educational loans - up to $140,000 - for four physicians a year for accredited, graduate training fellowships in geriatrics or geriatric psychiatry.

The doctors would have to agree to practice geriatrics in South Carolina for at least five consecutive years. They also would have to agree to accept Medicare and Medicaid patients, a problem within the state and nationally, experts say, because of low government payments.

"This is so important," Bauer said, "because South Carolina is the fifth-biggest state in terms of in-migration of seniors, and we have got to have more doctors."

The numbers are stark: There are 30 geriatricians in South Carolina, which has 500,000 residents 65 or older, a number that will grow by 10,000 this year alone, according to the Office of Aging. That means the state has 17,000 patients per geriatrician.

Experts say the ratio should be closer to 1,000 patients per doctor, meaning South Carolina needs at least 500 geriatricians.

Most older patients now go to general practitioners or internists. Experts say many could benefit from a doctor with specialized training because symptoms of illness can appear differently in older patients. Elderly patients, for example, often have complex, overlapping, chronic health problems.

In an attempt to address the shortage of geriatricians, seniors, including the Silver-Haired Legislature, made the geriatrics bill one of their centerpiece issues for the 2005 legislative session.

Physicians now face disincentives to get into geriatrics and stay in the practice, experts say.

The disincentives start with another year of study - beyond eight years of medical school and residency - required to be a geriatrician. Becoming a geriatric psychiatrist requires two extra years of study. That means doctors-to-be must give up at least a year or two of income to be geriatric specialists.

Medicare also doesn't reimburse geriatricians well enough to entice medical students to pursue the career, said Dr. James Bouknight, director of geriatric psychiatry at the USC School of Medicine.

But the demand for geriatricians is only growing, Bouknight said. "Look at the demographics of the number of seniors in South Carolina and those who will suffer Alzheimer's and other diseases with that."

Advocates hope the loan repayment program will start addressing the demand for geriatricians.

"When you survey fellows in the field, loan forgiveness is high on the list" of possible incentives, said Victor A. Hirth, medical director of geriatric services at Palmetto Health and associate professor of geriatrics at USC's School of Medicine.

For instance, the 29-year-old Lee, a third-year medical resident, told Bauer on Tuesday he has $180,000 of educational debt facing him.

Lee said loan repayment is appealing, but he has not decided what area he wants to specialize in.

If funded by the legislature, the program would allow four physicians loan repayments of up to $35,000 a year while in the graduate geriatric programs. Because budget negotiations were concluded before the bill passed, money for the program was not included in the 2005-06 spending plan.

But freshman Rep. Nathan Ballentine, R-Irmo, lead sponsor of the House bill, predicts legislators will find money to pay for the program next year.

The bill now goes to Sanford, who is expected to sign it into law. "The governor's staff ... is inclined to recommend to the governor that it be signed into law," Sanford spokesman Will Folks said.

USC's Hirth said the S.C. bill is a national model. Other states are searching for ways to lure medical students into geriatrics too, he said, adding the S.C. program will be presented at a Washington conference.

Bauer, who was appointed head of the Office on Aging this year by Sanford, said the bill is one step toward greater empowerment for S.C. seniors.

"It shows us if we pick out some topics that are key to seniors," he said, "we can make some changes."