Recruiting medical students into geriatrics is an important way to work toward improving older Americans' health care, but doing so requires helping these future professionals embrace a fundamentally different perspective on "healing" and patient care.
Unlike most medical specialties, which narrow their focus to diseases of discrete systems in the body, geriatrics defines itself by the age of its patients. Only one other branch of medicine, pediatrics, does something similar, but in one profound way, pediatrics is much closer to the other specialties. It tends to follow a medical model of acute care, which works through the same three step process: diagnose, treat, and cure. In fact, more than 75 percent of all medical student/resident training is organized around acute, in-patient medicine.
Geriatricians, on the other hand, must take a different perspective. Most of their patients cope with one or more chronic diseases that cannot be made to disappear with a pill or a scalpel. This can be a frustrating situation for young physicians, many of whom end up dismissing chronic illness -- and by extension, the people who suffer with them -- as unworthy of serious medical care. Helping students see the value of reducing pain, improving function, and supporting the dignity of older patients is a vital consideration when giving them their first exposures to geriatrics.
Despite increased integration of geriatrics into medical school curricula over the past ten years, while the population of older adults explodes, the number of graduates who go into geriatrics remains flat. If the current trend continues, 2010 will see only four geriatricians available per 10,000 adults over age 75. By 2050, that ratio will shrink to 1.6 per 10,000. One implication of these disappointing numbers is that we have not yet succeeded in awakening students' awareness of the importance of the work geriatricians do.
Helping future professionals see the high value in palliative and quality-of-life care represents one important way to make a career choice toward this field a far more desirable option. One good source of information for policymakers and educators who would like to learn about ways to approach this issue is The John A. Hartford Centers of Excellence in Geriatric Medicine and Training publication, Approaches to Recruiting Premedical and Medical Students and Residents to Careers in Geriatric Medicine. You can find this online at: http://www.geriatricsrecruitment.org/ManualOne.