Focus on U.S. Geriatric Training in Medical School
EXPLOSIVE GROWTH IN America’s geriatric population is one reason medical school professors and practicing physicians advise all aspiring doctors to learn the basics of geriatric medicine. The number of U.S. residents at or over age 65 skyrocketed from 35 million to 49.2 million between 2000 and 2016, according to the U.S. Census Bureau data.
Dr. Alison Moore, a professor of medicine and psychiatry at University of California—San Diego and chief of its geriatrics division, says nearly all physicians besides pediatricians and obstetricians have frequent encounters with geriatric patients, so it’s ideal for medical schools to have mandatory, four-week clinical rotations in this discipline.
One key advantage of in-depth medical school courses in geriatric medicine, professors say, is that they provide exposure to complex patients with multiple prescriptions and numerous clinicians. Students learn how to manage prescriptions and lead a team of health care providers, which ensures coordinated care and prevents medical errors, professors say.
But experts caution that geriatric medicine is one of the least lucrative medical specialties.
“If you take care of mostly older patients, you wind up getting paid less; plus, they’re more complex,” says Dr. Paula Lester, a geriatrician and clinical associate professor of medicine at Stony Brook University—SUNY.
She says the pay gap between geriatricians and other types of physicians is causing a severe national shortage of geriatricians, but aspiring doctors who choose to pursue this medical specialty can do an enormous amount of good for underserved patients.
Experts say prospective medical students should ask the following six questions to determine whether a medical school excels in teaching geriatric medicine.
1. Is there a standalone course in geriatric medicine?
Lester, also the chair of the geriatrics task force at the New York Chapter of the American College of Physicians, says one sign that a medical school does not emphasize geriatric medicine enough is when this subject is only taught under the umbrella of a palliative or hospice medicine course.
She says equating palliative or hospice medicine with geriatric medicine is wrong, since geriatric patients aren’t necessarily terminal and their primary goal as patients isn’t always to avoid pain.
2. Do students encounter a variety of geriatric patients?
Experts say it is important for medical students to gain experience treating both geriatric patients with serious medical conditions and those who are healthy.
Scott Wallace, associate professor at the University of Texas—Austin‘s new Dell Medical School and managing director of its Value Institute for Health and Care, says a medical school education that only offers exposure to the sickest geriatric patients gives students a narrow view of what geriatric medicine involves. Many geriatric patients have long life expectancies, and they shouldn’t be treated the same as individuals with terminal diagnoses.
3. Do geriatric medicine clinical rotations include both in- and outpatient care?
Experts say geriatric patients often move back and forth between hospitals and outpatient clinics – aspiring geriatric physicians should be comfortable working with patients in both environments. Clinical rotations in each setting give students opportunities to hone necessary skills.
4. Does the school produce high-quality research in geriatric medicine?
Dr. Anna Chang, professor of medicine in the division of geriatrics at the University of California—San Francisco, says a school with multiple, generous research grants to investigate questions in geriatric medicine is more likely to offer students research opportunities in this field than a school without these grants.
Medical school applicants can also see whether a school’s students or faculty have received awards from the American Geriatrics Society for their research, she says. These awards recognize high-quality, original geriatrics research.
5. Are geriatric medicine faculty influential at the school?
Chang says it’s a positive sign when professors who specialize in geriatrics teach required core medical school classes and help shape an institution’s curriculum. She says that indicates the school emphasizes the importance of geriatrics.
6. Does the school offer lessons on how aging impacts the human body?
One sign that a medical school takes geriatric medicine seriously, experts say, is when it has at least one course about how aging influences health, which can help students distinguish between normal signs of aging and symptoms of serious disorders like Alzheimer’s disease.
Experts say another positive sign is when a school offers simulations that allow students to experience what it’s like to have hearing or sight impairments and mobility limitations. This helps them empathize and communicate well with geriatric patients.