Skip to main content

The need for Geriatrics


There is an excellent op-ed in the Boston Globe from Dr. Lewis Lipsitz that in clear yet eloquent language makes the case for training of more Geriatricians, and the survival of Geriatrics as a specialty. Dr. Lipsitz is a Professor at Harvard Medical School and chief of Gerontology at Beth Israel Deaconess Medical Center.

One of the nice things that were articulated in this op-ed is that one of the most of the important roles of the Geriatrician is to listen. While many older patients have a whole bunch of specialists, it is the role of the Geriatrician to put everything together, listening to the patient and caregiver at great length. There was one rather stunning statistic in the op-ed. In 2007 only 91 new Geriatricians were trainied in the US. As the need for Geriatrics is increasing, the number seeking training is falling.

Dr. Lipsitz notes a major problem recruiting Geriatricians is the poor compensation compared to other medical specialties. The key skills taught in Geriatrics are not lucrative procedural skills---and spending more time with patients is certainly not profitable.

An odd benefit of all these negative financial incentives for becoming a Geriatrician is that it ends up making it a lot of fun to play a role in training. This may seem like an odd statement, but our fellows are truly amazing, and I think one of the reasons is this anti-incentive. Our fellows certainly do not choose Geriatrics for the money--in fact, most of them have survived a gauntlet of attendings who have questioned their choice, noting that they are "good enough" to get a cardiology or GI fellowship. Our fellows join us because they are passionate about providing great care for the elderly, teaching others to provide this care, and doing research that will lead to care improvements. Working true believers who really believe in what they are doing is a lot of fun. However, training only a small number of true believers is not good for our health system, or our nation's elderly. It is really important the disincentives Dr. Lipsitz discusses be addressed.

Dr. Chris Langston, program director at the John A. Hartford Foundation, has an excellent discussion of this article on the health AGEnda blog. He calls on all of us to step up to the plate and make the case to the public for better care for older patients, and the workforce issues that are needed to make this happen.

Comments

Dan Matlock said…
Geriatricians are an interesting bunch. I hypothesize that we all have a bit of an axe to grind with the way elderly are treated in our system and it comes through. When talking to patients, we are caring, patient, and thoughtful; when talking to colleagues treating (or mistreating) our patients, we can be a little rough.

I do agree that this kind of passion is one of the biggest things I enjoy about a geri community.
Thank you very much for blogging about Dr. Lipsitz OpEd. He is devoted to geriatric research and improving the quality of life in older adults. Did you know he was recently highlighted in Boston Magazine as a Top Geriatrician?

Follow Hebrew SeniorLife's research and our leaders on twitter at http://Twitter.com/H_SeniorLife

Popular posts from this blog

Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

Delirium: A podcast with Sharon Inouye

In this week's GeriPal podcast we discuss delirium, with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.

Dr. Inouye's research focuses on delirium and functional decline in hospitalized older patients, resulting in more than 200 peer-reviewed original articles to date. She has developed and validated a widely used tool to identify delirium called the Confusion Assessment Method (CAM), and she founded the Hospital Elder Life Program (HELP) to prevent delirium in hospitalized patients.

We are also joined by guest host Lindsey Haddock, MD, a geriatrics fellow at UCSF who asks a great question about how to implement a HELP program, or aspects of the program, in a hospital with limited resources.  


You can also find us on Youtube!


Listen to GeriPal Podcasts on:
iTunes…

Are Palliative Care Providers Better Prognosticators? A Podcast with Bob Gramling

Estimating prognosis is hard and clinicians get very little training on how to do it.  Maybe that is one of the reasons that clinicians are more likely to be optimistic and tend to overestimate patient survival by a factor of between 3 and 5.  The question is, aren't we better as palliative care clinicians than others in estimating prognosis?  This is part of our training and we do it daily.   We got to be better, right? 

Well, on todays podcast we have Bob Gramling from the Holly and Bob Miller Chair of Palliative Medicine at the University of Vermont to talk about his paper in Journal of Pain and Symptom Management (JPSM) titled “Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association with End of Life Care”.

Big findings from this JPSM paper include that we, like all other clinicians, are an optimistic bunch and that it actually does impact outcomes.   In particular, the people whose survival was overestimated by a palliative care c…