If I had to compile a list of “frequently asked questions” when discussing my future medical career with others, “what type of doctor do you want to become?” nears the top of the list (right after “But don’t you want a family?”). This question is deeper than an academic interest in one specialty over the other; it is a question of personality, lifestyle, income, and as an incoming U.S. medical student, a tower of student debt. Thousands of medical students, junior doctors, and residents in the U.S. and UK face this question every year, and as of 2016, the top three specialties to which graduating medical school seniors matched were internal medicine, paediatrics, and emergency medicine. These specialties, and the year-to-year increase in number of applicants for residency positions, provide an indication of the future medical workforce available for the growing U.S. population, but the question remains: is the supply growing in a way to meet the type of future demand? Specifically, with older adults expected to comprise around 20% of both the U.S. and UK population by 2030, will the future medical workforce in these countries have enough expertise for geriatric-specific medical issues?
Currently, there are 7,500 geriatricians in the U.S. The estimated number of geriatricians needed to care for the future American older adult population? 17,000. In 2010, however, only 75 residents in the U.S. pursued a geriatric fellowship that year after their residency in internal or family medicine. This trend could be due to a variety of factors, including a lower median income than other specialties given the length and expense of medical training in the U.S., or a lack of exposure for medical students during clinical rounds. The median income for a geriatrician in the U.S. is $184,000/year, which sounds like a lot and it is. But considering U.S. medical schools cost close to a quarter of a million dollars, spending less time in medical training and raking in a median income of $473,000/year as a radiologist is ironically the more practical choice for those looking at specialties upon graduation from medical school. In the UK, the story is perhaps less dire, but more complex. Consultant applications and positions in geriatrics are actually up, but the proportion of positions filled is still well below 100% .
Round 1 recruitment data for ST3 geriatric medicine (2010-2013).
"Geriatric medicine workforce planning: a giant geriatric problem or has the tide turned?” Clinical Medicine, 14(2), pg. 104
In addition, the ageing population has resulted in a greater workload per consultant geriatrician, with ‘finished consultant episodes’ increasing by 29% between 1998 and 2009 . Beyond the quantitative considerations, from my experience, those entering medicine tend to be competitive and ambitious. These attributes are useful in getting into medical school, but also may surface when considering prestige and competitiveness of specialty. For many, the thought of working with the elderly may be unpleasant rather than inspiring. Besides, to treat dementia, there’s neurology; to treat kidney failure, there’s nephrology; and to treat heart failure, there’s cardiology. Unfortunately, this can leave people with the misconception that geriatrics is a kind of residual specialty that spends a lot of time dealing with problems of incontinence. This attitude speaks to the lack of exposure through geriatric rounds in most medical schools rather than the nature of the specialty itself.
So what is being done? For starters, the U.S. has implemented programs such as “Medical Student Training in Aging Research” (MSTAR) program to expose medical students to geriatric medicine before residency. Many, including the prominent physician/author Dr. Atul Gawande predict a system of training for all primary care providers in some geriatric medicine, and leaving truly complicated cases to specialist geriatricians due to the sheer rate of change of number of older adults in the U.S. and UK.
What am I going to do? I’ve been lucky in that my first exposure to clinical research as an undergraduate was through a research group dedicated to improving the health and lives of older adults who presented to emergency departments in the U.S. My research mentor was an emergency physician whose research interests primarily concerned older adults, and he invested a lot of time in allowing undergraduates like myself to shadow, to interview older adults for our research papers, to get involved in the research process, and even to graduate university with publications in geriatric emergency medicine. As any pre-medical student in the U.S. will tell you, having face-to-face experience with patients is critical for admission to medical school, but also ridiculously difficult to obtain. While shadowing is an excellent opportunity, it can be rather passive compared to what medical schools (somehow) expect you to have done by the time you apply. Therefore, having a physician/research mentor who took a chance on a young, inexperienced undergrad like me was transformative, and as a result, I’m genuinely considering a career in geriatric medicine; but it is too early to make an informed decision without exposure to other specialties. Having attentive, inspiring mentors in geriatric medicine or research is perhaps one way to invigorate a future generation to take on the responsibilities of caring for the older adult population. Perhaps, in fact, the future of geriatric medicine is not an army of geriatricians, but a team of consultants or specialists working together to provide integrated, specialized care for older adults. Regardless of the format, however, the medical field will undoubtedly have to get creative to improve the health and lives of older adults.
 Fisher, J. M., Garside, M., Hunt, K., & Lo, N. (2014). Geriatric medicine workforce planning: a giant geriatric problem or has the tide turned?. Clinical Medicine, 14(2), 102-106.
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About the Author
Sowmya was a Robertson Scholar at the University of North Carolina at Chapel Hill and Duke University, and studied Health Policy and Management at the UNC Gillings School of Public Health. Her past research has focused on clinical outcomes for older adults in emergency departments, global end-of-life care policies, and cultural perceptions of ageing and dying. After her time as a visitor, she will return to the U.S. to attend medical school. She is currently working with Professor Sarah Harper on a project regarding older women's health issues in South Africa.
Opinions of the blogger is their own and not endorsed by the Institute
Comments Welcome: We welcome your comments on this or any of the Institute's blog posts. Please feel free to email comments to be posted on your behalf to email@example.com or use the Disqus facility linked below.