Geriatric Medical Skills: Essential to Care

 Karl Steinberg, MD, CMD

Along with the well-publicized nursing workforce shortage affecting nursing centers nationally, there is a tremendous shortage of qualified medical specialists in geriatric medicine, and the gap is growing every year.

The geriatric population (usually defined as 65 and up, although some might rankle at being called “geriatric” at that age) is increasing rapidly as the baby boomers hit Medicare territory, while the number of geriatrics fellows being turned out annually is diminishing.

Those who choose to practice this specialty are well aware of its intangible rewards—the opportunity to help people who are vulnerable and ill, the privilege of walking with their patients on the path of their last months and years of life, providing care that helps optimize function, and the satisfaction of helping them explore their priorities and goals—then guiding them and their families to make informed decisions about medical treatments. Having the luxury of longer visit times helps relieve the tyranny of the packed waiting room. 

But those intangibles don’t resonate with every medical student or resident, and geriatrics will sadly never be as sexy or desirable a specialty as the much more highly compensated surgical specialties like orthopedics and neurosurgery. Indeed, as Provider’s readers know, it takes a special kind of person to choose to work with frail elders, especially in skilled nursing centers.

Need for Expertise Escalates

While not every person over 65 needs the specialized knowledge of a geriatrician, the benefits of such training and knowledge clearly are important for many nursing center residents, who have become much more complex and seriously ill in the past decade—especially in the post-acute population. Geriatricians are focused on function and treat the whole patient, not just one body system or illness.

Geriatricians think first about stopping medications (deprescribing) rather than adding additional drugs to already huge medication lists—since often the symptom that’s bothering the patient is in fact being caused by one of their other meds, or by interactions among meds.