Monday, January 08, 2007

Why be a Geriatrician?


Kevin MD links to this article discussing the shortage of geriatricians:
Today, there is about one geriatrician for every 5,000 adults ages 65 and older. By 2030, the American Geriatrics Society estimates that while the population of older adults will have doubled to 70 million, the proportion of geriatricians will have dropped to one doctor per 7,665 people.
Geriatric care is a lot of fun, but it's never been glamorous and no one perceives it as fun. It's very challenging. There are a lot of issues to be dealt with. I think the real key is to find young physicians who share that interest and are willing to make that the focus of their careers. : makes going into geriatric care less appealing for medical students? : think it would be fair to say (that salary for a starting geriatrics specialist is) roughly a third of what a starting cardiologist would make. The typical medical school graduate is finishing med school with $100,000 to $200,000 in debt.
Other than those wanting to enhance an academic career, I can't understand why anyone would want to do a geriatrics fellowship (which is an additional 1 year beyond the standard 3 year internal medicine residency). Internal medicine residency training is sufficient for developing the necessary knowledge and skills to take care of geriatric patients.
For non-academic physicians, a geriatrics fellowship is an additional year of training (and receiving a low resident/fellow's salary) with no payoff at the end. In fact, because of low Medicare reimbursement, a geriatrician in private practice will make less money than a general internist who sees both young adults and geriatric patients.
Being a medical director of a nursing home can be profitable, but this can also be done by a general internist.
I'm all in favor of education and enjoy learning about about the wide field of medicine, but at some point a person needs to begin earning a living, and a geriatrics fellowship is an unnecessary delay in this process.

5 comments:

Vicoprofen said...
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Anonymous said...

Why be an endocrinologist? Why be a non-invasive cardiologist? Why be a sportsmedicine specialist? Why train in internal medicine and not just 1 year of internship? Why be a radiologist? Anyone can treat diabetes, read ekgs, do a treadmill, etc... passing a board exam - does that help with anything? Prior to entering a geriatrics fellowship, I felt overwhelmed in an internal medicine practice of 15 minute appointments when a frail elderly came in a wheelchair from a care home. I was prescribing medications that likely caused iatrogenic problems and polypharmacy. Now, I handle those same patients without a rise in my pulse rate. Likewise, my spouse treated diabetics prior to his endocrinology training. Now after endocrinology training, he just does it better. Doing a fellowship like geriatrics, or any other additional fellowship training is a personal choice. Often it is about professionalism and the perfectionist goals. I want to not only care for my elderly patients, I want to do it to the best of my abilities. Geriatrics fellowship training enhances my skills in the care of the elderly. Cardiology fellowships enhances the cardiovascular skills of those interested in being experts in that area. Endocrinologists, infectious disease, rheumatologist, geriatricians - are specialsist in their respective areas. Added training helps us do our jobs better ... it's that simple.

Michael Rack, MD said...

to anonymous: that was very idealistic of you to do an extra year of training that did not increase your income potential any. I admire your dedication. I once felt the same way, and that is one of the reasons why I spent an extra year in training (beyond the standard 4 year psych residency) completing a 5 year med/psych residency. I have become a lot more cynical since then.

Anonymous said...

I have done a one year fellowship to better prepare me for a community based primary care practice that will likely be dominated by geriatric patients. I had no desire to go into academics after the fellowship. I was offered $15,000 more than the regular new internal med docs. Another geriatrics fellow was offered $25,000 more. I don't know if this is a trend, but it would be interesting to know more.

muddywaters12strg said...

I got to agree that there is a need for more geriatricians. Although a nurse practitioner is capable of taking care of the elderly, they cannot do as much as an actually MD or DO. In the time being some of the elderly are capable of either living at home or in an assisted living but if something goes wrong they will need to see a geriatrician.