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Choosing Geriatrics as a Specialty

Want Job Satisfaction? Choose Geriatrics

Eric Widera, MD

 

 Editor's Note: This is the first article in a series examining different medical specialties, aimed at helping medical students choose their own specialty.

I am often asked by my patients, medical students, residents, and even my colleagues, "Why did you choose to go into geriatrics?" The answer is not simple. Much like the patients I care for, my reasons for practicing geriatrics are complex and nuanced. They have a great deal to do with my underlying values as a physician. That said, I will do my best to describe why I chose Geriatrics and why medical trainees should consider it as a career path.

The oldest of the US "baby boomers" generation turned 65 on January 1, 2010. Every day for the next 19 years thereafter, another 10,000 baby boomers will turn 65. To put this in perspective, this is the equivalent of a Boeing 747 airplane full of baby boomers turning 65 every hour. By 2030, the country's population of "senior boomers" will double to an estimated 71 million individuals.

Unfortunately, we are poorly prepared to meet the healthcare needs of this growing population. As they age, baby boomers will likely develop at least 1 chronic medical condition. These conditions will often present in atypical and subtle ways that may go unnoticed by many healthcare providers. These patients may also develop 1 or more common geriatric syndromes such as falls, delirium, dementia, incontinence, polypharmacy, and frailty. Over time, these individuals will become more dependent on a fragmented healthcare delivery model where services are often delivered by multiple providers without any meaningful care coordination.

This increased demand for healthcare services is being met by a dramatic shortage of physicians with expertise in the care of older adults. Currently, only about 7000 physicians in the United States are certified geriatricians[1]; by 2030, the nation will need an estimated 36,000 geriatricians.[2] However, only about 250 new geriatricians are graduating yearly from US fellowships programs. In other words, even as a planeload of baby boomers is landing at our healthcare system's doorstep every hour, the newly certified geriatricians would barely fill half that plan in an entire year.

Why aren't more new physicians choosing to specialize in geriatrics? Part of the reason may be the costs incurred with extra years of training, as well as the relatively low income compared with fields like cardiology or radiology. The complicated nature of caring for older patients, their families, and their caregivers may also turn away medical students and residents from careers in geriatrics, especially if they train in environments that are ill equipped to deal with this population.

But there are many reasons why a new physician should consider a career in geriatrics. Perhaps the most important reason is that geriatricians make a positive impact in the lives of others. This includes our elderly patients, as well as family caregivers who are increasingly relied upon by our healthcare system. The training provided by a geriatrics fellowship gives physicians the knowledge and skills to care for older adults with multiple complicated medical, psychological, and social problems. We are taught how to care for complex patients in a holistic, interdisciplinary, and systems-based manner; this involves learning strategies for successful aging, learning how to manage progressive functional disability, and learning how to care for those at the end of life.

The heart of geriatrics revolves around listening to the stories that our patients tell, and building meaningful and deep relationships. Not only are these stories and relationships integral to providing care for the elderly, they also are what keep me going as a physician by constantly inspiring me.

As a career path, geriatrics is also notable for its versatility. We practice in many different settings, ranging from academic medical centers to private practice clinics, to rural health centers. Some geriatricians also see patients at home or in long-term care facilities, either as a consultant or as a primary care physician. Geriatricians may spend additional time training to become expert educators or researchers. This is a field that carries with it many possibilities, and it has the resources and mentorship for future trainees to succeed.

These are just a few reasons why geriatricians, myself included, love their jobs.[3] In fact, there are good data to support this.[4-6] In a large, nationally representative sample of physicians from 33 different specialties, geriatrics was ranked first in job satisfaction.

So, why did I choose to go into geriatrics? I've given some general reasons, but it's not a simple answer. Then again, I probably wouldn't be a geriatrician if I liked simple answers.

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