Is Geriatric Medicine Terminally Ill?

Abstract

In the Balance1 May 2012Is Geriatric Medicine Terminally Ill?Adam G. Golden, MD, MBA, Michael A. Silverman, MD, MPH, CMD, and Michael J. Mintzer, MDAdam G. Golden, MD, MBAFrom the University of Central Florida College of Medicine and Orlando Veterans Affairs Medical Center, Orlando; West Palm Beach Veterans Affairs Medical Center, West Palm Beach; and University of Miami Miller School of Medicine and the Miami Geriatric Research Education and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida., Michael A. Silverman, MD, MPH, CMDFrom the University of Central Florida College of Medicine and Orlando Veterans Affairs Medical Center, Orlando; West Palm Beach Veterans Affairs Medical Center, West Palm Beach; and University of Miami Miller School of Medicine and the Miami Geriatric Research Education and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida., and Michael J. Mintzer, MDFrom the University of Central Florida College of Medicine and Orlando Veterans Affairs Medical Center, Orlando; West Palm Beach Veterans Affairs Medical Center, West Palm Beach; and University of Miami Miller School of Medicine and the Miami Geriatric Research Education and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-9-201205010-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Geriatric medicine was established as a discipline to care for the complex needs of elderly patients (1). After much pioneering work, the American Board of Internal Medicine and American Board of Family Medicine granted geriatric medicine a Certificate of Added Qualifications in 1988. Board eligibility required completion of an accredited 2-year fellowship or qualification under the "practice pathway" based on practice experience.Even with this recognition, geriatric medicine in the United States has struggled to clearly identify its clinical niche and to attract interest among physicians (2). After closure of the practice pathway in 1994, the number of physicians seeking ...References1. Libow LS. Geriatrics in the United States—baby boomers' boon? N Engl J Med. 2005;352:750-2. [PMID: 15728805] CrossrefMedlineGoogle Scholar2. Kane RL. The future history of geriatrics: geriatrics at the crossroads. J Gerontol A Biol Sci Med Sci. 2002;57:M803-5. [PMID: 12456740] CrossrefMedlineGoogle Scholar3. Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: National Academies Pr; 2008. Google Scholar4. Warshaw GA, Bragg E. ADGAP National Survey of Geriatric Medicine Fellowship Program Directors. Cincinnati: Association of Directors of Geriatrics Academic Programs; 2011. Accessed at: www.adgapstudy.uc.edu/slides.cfm on 20 March 2012. Google Scholar5. Farber J, Siu A, Bloom P. How much time do physicians spend providing care outside of office visits? Ann Intern Med. 2007;147:693-8. [PMID: 18025445] LinkGoogle Scholar6. Warshaw GA, Bragg EJ, Fried LP, Hall WJ. Which patients benefit the most from a geriatrician's care? Consensus among directors of geriatrics academic programs. J Am Geriatr Soc. 2008;56:1796-801. [PMID: 19054198] CrossrefMedlineGoogle Scholar7. Caprio TV, Karuza J, Katz PR. Profile of physicians in the nursing home: time perception and barriers to optimal medical practice. J Am Med Dir Assoc. 2009;10:93-7. [PMID: 19187876] CrossrefMedlineGoogle Scholar8. Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med. 2009;169:1712-7. [PMID: 19822829] CrossrefMedlineGoogle Scholar9. Phelan EA, Genshaft S, Williams B, LoGerfo JP, Wagner EH. A comparison of how generalists and fellowship-trained geriatricians provide "geriatric" care. J Am Geriatr Soc. 2008;56:1807-11. [PMID: 19054199] CrossrefMedlineGoogle Scholar10. Torres C, Ciocon JO, Galindo D, Ciocon DG. Clinical approach to urinary incontinence: a comparison between internists and geriatricians. Int Urol Nephrol. 2001;33:549-52. [PMID: 12230293] CrossrefMedlineGoogle Scholar11. Chin MH, Wang JC, Zhang JX, Sachs GA, Lang RM. Differences among geriatricians, general internists, and cardiologists in the care of patients with heart failure: a cautionary tale of quality assessment. J Am Geriatr Soc. 1998;46:1349-54. [PMID: 9809755] CrossrefMedlineGoogle Scholar12. Phillips SL, Phillips JV, Branaman-Phillips J, Miller DJ. Geriatric versus non-geriatric approach of care to moderate Pra risk senior population. J Am Med Dir Assoc. 2005;6:396-9. [PMID: 16286061] CrossrefMedlineGoogle Scholar13. Vladeck BC. The continuing paradoxes of nursing home policy. JAMA. 2011;306:1802-3. [PMID: 21972271] CrossrefMedlineGoogle Scholar14. Leipzig RM, Granville L, Simpson D, Anderson MB, Sauvigné K, Soriano RP. Keeping granny safe on July 1: a consensus on minimum geriatrics competencies for graduating medical students. Acad Med. 2009;84:604-10. [PMID: 19704193] CrossrefMedlineGoogle Scholar15. Williams BC, Warshaw G, Fabiny AR, Lundebjerg N, Medina-Walpole A, Sauvigne K, et al. Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents. J Grad Med Educ. 2010;2:373-83. [PMID: 21976086] CrossrefMedlineGoogle Scholar16. Hazzard WR. General internal medicine and geriatrics: collaboration to address the aging imperative can't wait [Editorial]. Ann Intern Med. 2003;139:597-8. [PMID: 14530233] LinkGoogle Scholar17. Christmas C, Park E, Schmaltz H, Gozu A, Durso SC. A model intensive course in geriatric teaching for non-geriatrician educators. J Gen Intern Med. 2008;23:1048-52. [PMID: 18612742] CrossrefMedlineGoogle Scholar18. Eckstrom E, Desai SS, Hunter AJ, Allen E, Tanner CE, Lucas LM, et al. Aiming to improve care of older adults: an innovative faculty development workshop. J Gen Intern Med. 2008;23:1053-6. [PMID: 18612743] CrossrefMedlineGoogle Scholar19. Mazotti L, Moylan A, Murphy E, Harper GM, Johnston CB, Hauer KE. Advancing geriatrics education: an efficient faculty development program for academic hospitalists increases geriatric teaching. J Hosp Med. 2010;5:541-6. [PMID: 20717891] CrossrefMedlineGoogle Scholar20. Podrazik PM, Levine S, Smith S, Scott D, Dubeau CE, Baron A, et al. The Curriculum for the Hospitalized Aging Medical Patient program: a collaborative faculty development program for hospitalists, general internists, and geriatricians. J Hosp Med. 2008;3:384-93. [PMID: 18836989] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the University of Central Florida College of Medicine and Orlando Veterans Affairs Medical Center, Orlando; West Palm Beach Veterans Affairs Medical Center, West Palm Beach; and University of Miami Miller School of Medicine and the Miami Geriatric Research Education and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida.Acknowledgment: The authors thank S. Barry Issenberg for his editorial feedback of the manuscript and insights on medical education.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-3079.Corresponding Author: Adam G. Golden, MD, MBA, 5201 Raymond Street, CLC-136, Orlando, FL 32803; e-mail, adam.[email protected]edu.Current Author Addresses: Dr. Golden: 5201 Raymond Street, CLC-136, Orlando, FL 32803.Dr. Silverman: 7305 North Military Trail, Code 114; West Palm Beach, FL 33410.Dr. Mintzer: 1201 Northwest 16 Street, 11GRC, Miami, FL 33125.Author Contributions: Conception and design: A.G. Golden, M.A. Silverman, M.J. Mintzer.Analysis and interpretation of the data: A.G. Golden.Drafting of the article: A.G. Golden, M.A. Silverman, M.J. Mintzer.Critical revision of the article for important intellectual content: A.G. Golden, M.A. Silverman, M.J. Mintzer.Final approval of the article: A.G. Golden, M.A. Silverman.Provision of study materials or patients: A.G. Golden.Administrative, technical, or logistic support: A.G. Golden.Collection and assembly of data: A.G. Golden, M.J. Mintzer. 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Durso, MD, MBADialogue on Geriatrics: How Should We Fix the Problem?David Hamerman, MDDialogue on Geriatrics: How Should We Fix the Problem?Leslie S. Libow, MDDialogue on Geriatrics: How Should We Fix the Problem?Kenneth M. Madden, MD, MSc and Kenneth Rockwood, MDDialogue on Geriatrics: How Should We Fix the Problem?T.S. Dharmarajan, MD and Abishek Kumar, MDDialogue on Geriatrics: How Should We Fix the Problem?Hajime Ichiseki, MD, PhDDialogue on Geriatrics: How Should We Fix the Problem?Adam G. Golden, MD, MBA, Michael A. Silverman, MD, MPH, CMD, and Michael J. Mintzer, MD 1 May 2012Volume 156, Issue 9Page: 654-656KeywordsAcademic medicineElderlyFellowshipsGeriatricsHealth careMedical educationMedicareMotivationNursesSub-specialty care ePublished: 1 May 2012 Issue Published: 1 May 2012 PDF downloadLoading ...