- Out of 1,415 hospitalist programs, 11 reported geriatric innovations.
- Four developed core clinical activities, four used geriatric QI measures, three used comprehensive geriatric assessments, and two had specific protocols for elderly patients discharged to nursing facilities; and
- In terms of staffing, four had hospitalists with no special geriatric training, four employed fellowship-trained geriatricians, two had general hospitalists and geriatricians, and four used advanced practice nurses with and without geriatric training.1
Adding to the difficulty of building a cadre of geriatric hospitalists is the national paucity of geriatricians. According to the American Geriatrics Society (AGS), there were 9,000 board-certified geriatricians in 1998. A decade later there are 7,600—and the pipeline is narrow. Of 9,780 medical school graduates in 2004, only 321 were geriatricians. The AGS estimates that the United States needs 14,000 geriatricians now and 36,000 in 2030, when there will be an estimated 70 million adults 65 years and older.
But there’s hope. Hospital medicine programs, growing by leaps and bounds, offer a new career path for physicians interested in geriatrics. As the number of hospitalists continues to grow, there’s room for physicians to have an impact by staying tuned in to the special clinical, psychosocial, emotional, spiritual, and environmental needs of elderly patients.
According to Leslie Libow, MD, distinguished clinical professor at the Jewish Home and Hospital of New York in Manhattan, physicians who pursue a career in geriatrics do so because they have the right psychological make-up to work with elderly people.
He should know. In 1968, Dr. Libow petitioned the American Board of Internal Medicine (ABIM) to recognize geriatrics as a sub-specialty of internal medicine. Shortly after ABIM recognition, Dr. Libow established a geriatric residency/fellowship at Mount Sinai—still a national leader in geriatric education.
Being a geriatric hospitalist allows physicians with a simpatico set of personality traits to thrive. One study of geriatricians who had been practicing for up to 25 years found that they shared these traits:
- Highly value enduring relationships;
- Enjoy making small but potent changes in their patients’ lives;
- Like to make a difference personally and for society;
- Prefer working in a multidisciplinary team;
- Prefer democratic, not autocratic, decision-making;
- Desire the intellectual challenges of geriatric medicine and like to teach; and
- Perceive that they have a distinct and different career path than other physicians.2
That essentially describes Purnima Joshi, chief of medicine, at Kaiser-Permanente Mid-Atlantic States at Washington Hospital Center in Washington, D.C. She directs a group of 12 hospitalists, is the group’s only geriatrician at the 800-bed tertiary care facility, and enjoys teaching residents about geriatric medicine. A family physician by trade, she was grandfathered into geriatrics in 1992 and recertified in 2002.
“I love working with the frail elderly and practicing Kaiser’s brand of medicine because I don’t do billing—I just treat patients,” Dr. Joshi says. Additionally, Kaiser simplifies record-keeping on inpatient and outpatient treatments and makes communicating with Kaiser’s outpatient doctors about post-discharge care smooth and efficient.