Geriatric Medicine
A Career In Geriatric (Old Age) Medicine
Introduction
In a survey several years ago elderly patients were asked what their specialty should be called. Care of the Older Person, Care of the Elderly, Medicine for the Elderly were all suggested and considered. The sagacity of this group shone through when it was concluded that they didn't really mind as long as it wasn't Geriatrics. Thus I have chosen to call the doctors who work in this specialty, Physicians for the Elderly.
How do you become a Physician for the Elderly?
Many years ago the old adage 'Those who can do, those that can't become geriatricians' was often levelled at doctors within the specialty. Today this is far from the truth and often comes as a shock to those who think that becoming a Physician for the Elderly is an easy option. In these days of 'super sub-specialisation' ('I am sorry you want the hepatitis C registrar'), Medicine for the Elderly may be considered the last bastion of true general medicine; indeed some would say the last home of good old fashioned 'proper medicine'. Students looking for good firm grades will often point out that 'this is the first time we have witnessed holistic medicine and multidisciplinary team working'. What they really mean is the true art of the physician.
Qualities which are important when considering a career working in Medicine for the Elderly include:
- A liking of older people and their carers
- Excellent General medical and therapeutic skills
- The ability to apply appropriate care from Intensive care to providing death with dignity
- The ability to deal with uncertainty and a relatively poor evidence base
- The ability to use the art and science of medicine in appropriate proportions
- Respect and appreciation of the skills and value of the multidisciplinary team
Models of Care
For a specialty dedicated to the care of older people ours is a relatively pubescent upstart compared to the 'glamour subjects' of the other adult medical specialties. Over the last 50 years three main models of Care of Older people has arisen within hospitals. Your final choice as to the model you wish to join will depend heavily on the flexibility of the department you join and your own career preferences.
(a) Age related - this is perhaps the commonest model in use in most hospitals in the UK. Patients become officially old at a given, arbitrary chronological cut off, often 75yo. However depending on the demographics of the local population and the resources of the hospital, this may vary from 60 up to 85yo.
(b) Needs related - patients are selected by the department on the basis of health care needs and not chronological age. These services require a 'gate-keeper' approach and are now becoming increasingly team, as opposed to medically led.
(c) Integrated Service - The Physicians for older people are fully integrated into large medical teams and take a more active role in patients within these teams who they feel would benefit from their input.
Training requirements
Post foundation year 2, juniors will need to complete a 'run through' grade in General medicine, ideally exposing them to a broad general medical experience, including some Medicine for the Elderly. Having gained the MRCP (or equivalent) they will need to apply to one of the many SpR rotations within the UK. SpR rotations are run by local deaneries but care should be taken selecting rotations. Despite being nominally within the same 'local' deanery, juniors may find Trust hospitals within these deaneries are often geographically dispersed. This is particularly important when partners, family, accommodation and financial obligations need to be considered.
Accreditation in Medicine for Older people as a single specialty is a three year commitment. However most SpRs chose to be dually accredited in Medicine for Older People and General Internal Medicine G(I)M, which takes a further two years. During training, a period of accredited research can count for up to one full year of training. During a five year rotation, at least one year is spent in an academic / teaching hospital placement.
As well as general medicine and day to day care of hospital in-patients, SpRs are required to undergo periods of training in Orthopaedic and Surgical liaison, Mental health services for older people, Palliative care, Continence services, Stroke medicine, Day Hospital and Community liaison and Intermediate care and inpatient rehabilitation.
There are plans to introduce an exit examination at some point in the near future.
Things to recommend our Speciality
- The last place to observe and practice true general medicine
- The case mix of patients is often interesting and challenging
- Diverse subspecialty potential within the profession
- Physicians for Older People now form an increasingly powerful lobby in general medicine and the politics of most district and general hospitals.
Areas to consider when applying
- Still a general lack of appreciation of what we do; Often asked to take over patients with 'social problems'; Remember like everyone else our MRCP did not have a section for social work!
- Not regarded as a very 'glamorous subject'; this is a matter which my own department is successfully trying to redress!
- Despite a huge scientific and qualitative potential the specialty still lacks a real academic and research cutting edge; massive potential for dynamic, enthusiastic researchers.
How to find out more
For further information and details take a look at the following website:
> The British Geriatric Society
Adam Feather
Last updated 25/12/06
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