Clinical Reflection

The Importance of Geriatric Medicine

When the infamous question “what kind of doctor do you want to be?” has been thrown my way, I have typically responded by throwing out three fields of medicine that I currently find interesting: pediatrics, endocrinology, and geriatrics. However, while the usual response includes much satisfaction about 2 of my potential career choices—with lots of oohs and ahhs about the joys of treating children, and the approving nod for endocrinology because, hey, diabetes—the standard, usually skeptical, follow up question I receive is: why would you want to take care of old people if they are just going to die soon anyway? Isn’t that…depressing?

Despite these ageist misconceptions, the importance of the growing need for trained geriatricians in the U.S. cannot be denied. According to the Association of American Medical Colleges, the latest studies are suggesting that by 2025 the number of American baby boomers over the age of 65 will double, and become the fastest-growing age group in the country. This demographic will soon account for 20% of the nation’s population! We can see the practical results of this trend today, as Americans are clearly living longer, requiring assistance in managing chronic health conditions like hypertension, heart disease, diabetes, dementia, etc.

The most alarming fact? The American Geriatrics Society has estimated that 25,000 certified geriatricians are needed in order to provide quality care to this growing population, but currently there are fewer than 7,500 geriatricians in the U.S. In fact, only 44% of the nation’s 353 geriatric fellowship positions are even filled. Geriatrics is considered to be one of the most underrepresented specialties, even though geriatricians have been found to have high career satisfaction.

So, why the disinterest from budding physicians? Financially, geriatrics is often not considered attractive, particularly with nascent residents facing a looming amount of debt right after medical school. Most elderly patients have either Medicare or Medicaid, which have traditionally lower rates of reimbursement for physicians than that of private health insurance. Indeed, geriatricians, despite the extra years of training, have traditionally received less compensation than other subspecialists.

What can be done to help entice young physicians to this challenging field of medicine? While a restructuring of the current reimbursement difficulties would be an ideal fix to this situation, and would help entice young physicians to geriatrics, perhaps more immediately realizable goals should be considered in the meantime. For example, emphasizing the importance of geriatric medicine within medical school curricula is one alternative and realistic way in which to effect change. Students could learn of the intricacies and complexities involved in providing care to this population. This would be particularly relevant for students, as they are the generation of doctors which will be faced with treating a larger population of older individuals, given the statistics mentioned above.

Here is an even simpler idea: help people realize their passion for the field. Dr. Mitchell Heflin, MD, an associate professor of medicine at Duke University School of Medicine, said it best, “People in geriatrics are called to it.” A commonly cited influence for this career choice is meaningful interactions, particularly in childhood, with older populations. I personally can see why I am drawn to this field of medicine, as much of my happiness as a child (and up to the present day), has revolved around my experiences with the elderly. I remember every Sunday I would cross the street and have a spaghetti dinner with our elderly neighbor, affectionately known as Auntie Eva. She was a chain smoking, fiercely opinionated and loving German lady from Buffalo, who could make a killer homemade marinara sauce and meatballs. Even more influential, however, is the relationship I have with my now 83 year old maternal grandmother who has lived with my family since my birth. She not only always babysat me, but also taught me how to fish, ride a bike, tie my shoes, and crochet. Watching her gracefully age with a high quality of life through her 60s and 70s, and then seeing her current struggle with the beginning stages of dementia, has really made me reflect upon the importance of geriatric care in our society and my potential role in it.

So, while I’m not yet sure if geriatrics is in the cards for me, it is obviously a complex field of medicine, critical for the health of the older population and for the health and dignity of our society at large.



Featured image supplied by the author

Lifestyle Narrative Reflection

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The in-class assignment was simple: write a short paragraph of your thoughts about narrative medicine. But after ten minutes, my paper was a mess; pen lines angrily crossed out sentences that had been started but not finished, my usually neat penmanship was messy, my vocab unsure. My writing screamed hesitation. After begrudgingly turning in my assignment, I realized just how long it had been since I had written in my journal, which I had left tucked away in a nightstand in my childhood bedroom. I thought it was an appropriate place to leave the book—covered in cheesy flowers with a creased binding—that had chronicled my high school and college years. As I was packing for medical school, it seemed almost off-putting at the time to continue to chronicle the next chapter of my life—what I naively perceived to be the real challenges of medical school—on the same page as my previous entry, in which I complained about the trials and tribulations of learning how to drive stick shift and tackling organic chemistry. Instead, tucked away in my new bedroom, is a leather-bound journal, a gift I received for medical school, emblazoned with the words “FOLLOW YOUR DREAMS.” Every inch of it is covered in cartoon birds. It has been sitting in a drawer since I moved in, untouched.

As I juggle this new chapter as a busy first year med student, that seemingly simple assignment reminds me how much I miss, and clearly need, a nightly journaling routine as my outlet to find peace with my hurried thoughts at the end of a hectic day. It is all too easy to fall into the daily hustle and bustle of med school life such that every day seems almost like the one before. Study, extracurriculars, preceptorship, sleep. Lather, rinse, repeat. All too often, before I fall asleep, I find myself falling into the trap of using my phone to mindlessly relax; catching up on my Facebook newsfeed, scrolling through photos on Instagram—or, if we’re being totally honest here—catching up on celebrity gossip (let’s just say, I’ve definitely been keeping up with the Kardashians). But by the time I “unplug,” my brain is often wired. So much for unwinding.

Yet, even as I write this entry (yes, write, not type!), I understand how relaxing it is to unwind and take the time to process the day’s events with the written word. To really chronicle how every day is not like the one before, but how each day actually brings a new perspective as a result of what I had done that day: conversing with a new classmate, grasping the latest material in class, practicing the hands-on skills I’ve obtained in my preceptorship, etc. I see how important writing about these experiences is for me; to have something tangible to look back upon, years after medical school. To read through each chapter—to remember how I had stumbled when learning to measure blood pressure and take a patient history—just as I reflect now when I read back on my teenage struggles.

It’s important that we, as future physicians, find whatever it is that provides us with this sense of mindfulness, whether it be exercise, meditation, spirituality, etc., and hold on to it. It is through this self-awareness that we can see not only how we have changed, but even more importantly, to find a moment’s peace in the midst of the commotion that each day brings as we pursue careers in medicine.

So, when I go back to my childhood home to visit my family, I’ll be sure to pack up my journal.

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12.2.2010 <homework> 321/365 by Phil Roeder