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Mastering the Art of Healing the Most Complicated Patients: Spotlight on the Geriatrician

Recently, the New York Times published what feels like the millionth sobering article which called out the shortage of geriatricians in light of the great aging wave that is quickly barreling toward. We are consistently reminded that it is probably way easier to get tickets to a one-night only show featuring the Rolling Stones, than it probably is to see a geriatrician. With all this brouhaha, how much do we really know about this relatively rare specialty?

According to the American Geriatrics Society, a geriatrician is “a medical doctor who is specially trained to meet the unique healthcare needs of older adults. Illnesses, diseases and medications may affect older people differently than younger adults and older patients often have multiple health problems and take multiple medications.”  Truly, this definition does not do this specialty justice. In fact, geriatrics is probably one of the most complex areas in which to practice.

As we age, common conditions tend to present “atypically”, therefore practitioners must have incredibly astute assessment skills and instincts. For example, a patient with a urinary tract infection may not necessarily have burning, but might have a dehydration and confusion. Similarly, an MI might present mild discomfort in the upper abdomen rather than crushing chest pain. Therapy options are also limited to some extent; there are certain drugs that have a high risk to benefit ratio in the elderly. So too, they must play detective when a drug reaction or interaction is suspected.

Due to the nature of their patient population, geriatricians often veer well beyond the realms of what is considered “medicine”. They must take a holistic approach to disease management and prevention. It is not unusual that a potential crisis is averted by maintaining or improving function through the incorporation of nutrition, hydration, psychiatric modalities, physical therapy, and referrals to social work. We think of geriatricians playing a critical role in the identification and management of dementia. What is often neglected is that their training readies them to take on the challenge of treating other chronic conditions in the presence of dementia.

Talking about training, there is no shortage of fellowship programs with 104 in the U.S. alone. In the U.S., geriatrics is a subspecialty of internal medicine. A residency in internal medicine with a one to two year fellowship for geriatrics is required for certification.  In the EU, the training path differs by country with the norm being two to three years of geriatric concentration. Unlike in the U.S, 16 countries within the EU recognize geriatrics as a specialty.

To echo the Times article, there is a global shortage of geriatricians. Reasons range from funding and reimbursement to its perceived lack of “sexiness” by medical students and trainees. That said gaps are slowly being filled by non-physician clinicians such as nurse practitioners and physician assistants. Another trend is the geriatric focus of certain specialists. Behold the geriatric psychiatrist, geriatric cardiologist, geriatric nephrologist, geriatric oncologist and even the geriatric emergency physician. This is driven on the realization that many of the patients seen in these specialty practices are older or elderly and the appropriate knowledge base is critical to ensure optimal management. Other innovative solutions such as continuing education for non-geriatric clinicians are also well established.

With a solid grasp on the role and qualifications of geriatricians, industry professionals can develop innovative ways to engage and provide value to them. Additionally, there are endless opportunities to assist non-certified clinicians to practice geriatric medicine through effective therapy development and education along with linking clinicians up with valuable resources.

Melissa Hammond, MSN, GNP is Managing Director at Snowfish and a well-recognized industry expert in geriatrics. She can be contacted at Melissa.hammond@snowfish.net

Snowfish integrates, clinical, analytic, and business insights for life sciences companies. We have long experience of working on geriatric issues and have helped companies to realize the opportunities of therapies, products and programs targeted to the older population.  

Snowfish can be reached at (703) 759-6100 or via e-mail at info@snowfish.net.  We are also on the web at www.snowfish.net.

Posted by Melissa Hammond  |  0 Comment  |  in Management Consulting

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