I was in the midst of a 3-week geriatrics elective when I curiously read Is Geriatric Medicine Terminally Ill?, an article in the American College of Physicians (ACP) publication, Annals of Internal Medicine. In short, the article stated that since its creation in 1988, the field originally created to care for the complex medical needs of aging patients has struggled to attract and retain physicians, owing to issues such as “futility of care,” and “lack of remuneration.”
I was absolutely blown away. My knowledge of and interest in the field of geriatrics had only grown during my rotation, and I was both impressed and inspired by the genuine love and dedication my attending physicians and geriatric fellows demonstrated on a daily basis. I was both floored and amazed by the tact, sensitivity, and candor the physicians displayed when discussing particularly difficult subjects. I learned early on that end-of-life conversations, and malignancy treatment planning were something commonplace in the geriatrics clinic. I even became comfortable discussing subjects like advanced directives and living wills on my own.
Not only was the rotation educational from a patient-interaction perspective, but it was also incredibly eye-opening from a health-systems perspective. In addition to the geriatric clinic, I was required to spend part of my rotation in an acute rehab facility, as well as in a long-term living which featured all levels of care- from independent living to hospice. I took part in a number of interdisciplinary team appointments, including falls assessments, comprehensive geriatric assessments, and geriatric oncology planning. First-hand exposure to the coordination of care between inpatient and outpatient settings, as well as interdisciplinary team participation is something that few medical students are able to experience, and I believe I walked away from the rotation with both a wealth of practical and academic knowledge that will one day improve my ability to care for and communicate with my patients.
It turns out that I am not the only one who was alarmed by the ACP piece. When reading more into the subject, I not only read a number of snarky responses, but also quickly learned that Geriatrics will be officially entering the 2014 National Residency Match Program (NRMP) as a fellowship, rather than as a Certificate of Added Qualifications. Given the increasing health care costs and strain created by the aging population, it is clear that there is a concrete need for physicians trained in this field… in fact, perhaps ALL physicians should be familiar with the particular concerns of elderly patients, at least to some degree. In either case, I found most of the assertions of the ACP piece to be far from applicable to my wonderful attending physicians and fellows, and would highly recommend a rotation or elective in geriatrics to any medical student.