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

Practical Advice for the End of Life: A Podcast with BJ Miller

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End."

As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care.  His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times.  As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement.

The book he and Berger wrote is filled to the brim with practical advice.  I mean, nuts and bolts practical advice.  Things like:
How to clean out not only your emotional house but your physical house (turns out there are services for that!)Posting about your illness on social media (should you post to Facebook)What is the difference between a funeral home and mortuaryCan I afford to die?  …

Caring, and the Family Caregivers We Don’t See

Over lunch at a restaurant in Manhattan, my father and I talked about long-term care insurance and the emergence of senior centers and nursing homes across the U.S. that offer a variety of ethnic cuisines and cultural events, catering not only to a growing population of adults over 65, but also, to an increasingly diverse population of adults who call the U.S. their home. This conversation was different from many similar ones before it – we weren’t talking about my research; we were talking about our own lives.
My parents immigrated to the U.S. in the late ‘70s and early ‘80s, following their parents’ advice on professional opportunities that seemed unimaginable in India at the time. Although they considered moving back soon after to care for their aging parents and to raise children, they ultimately decided to stay in the U.S. As I chronicled earlier, my paternal grandparents lived with us until I completed middle school, at which point they returned to India and lived with my mater…

Top 25 Studies in Hospice and Palliative Care (#HPMtop25)

by: Kara Bishoff (@kara_bischoff )

Back in 2015 we wrote a post asking for input on what articles should belong on a list of the top 25 articles in hospice and palliative care.   We decided to focus on hospice palliative care studies and trials - as opposed to review articles, consensus statements and opinion pieces.

Here’s what we came up with. It was hard to pick just 25! We highly prioritized clinical utility and tried to achieve diversity & balance. Many others are worthy of inclusion. Take a look and let us know if you have suggested changes for next year.

Module 1: Symptom Management
Randomized, Double-Blind, Placebo-Controlled Trial of Oral Docusate in the Management of Constipation in Hospice Patients. Tarumi Y et al. JPSM, 2013.Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study. Currow DC et al. JPSM, 2011.Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomise…