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Discussion in 'Pre-Medical - MD' started by gioia, Apr 17, 2004.
Anyone choosing a career in Geriatrics?
If so, to which school are you planning to attend or apply?
I am not personally, but MSSM has one of the top ranked programs in Geriatrics.
Sounds like several people are interested in geriatrics. . which leads me to ask:
Is there really such a thing? I have never heard of a . . . geriatrician? . . . nor have I heard of a residency in geriatrics. Is it some sub-spec. of IM?
Yup. I think the fellowship is also open to FM docs.
I am interested in working with the elderly. Geriatrics seems like a logical choice. I will definitely explore it, however I will also look at other specialties(like hem-onc, pulmonary, etc). I am hoping to get into UMass to do this.
Fairly new field. VERY high in demand right now.
and will only be getting larger. geriatric psych is gonna be huge as well. aging baby boomers = tons of gomer and gomeres.
Yup, exactly. Certain fields - geriatrics, child psych - are in HIGH demand right now, across the country.
YUP!!!! By 2030 the aging population will have DOUBLED!
Yeah, as mentioned, there is right now and will be a huge demand for people specially trained in geriatrics. We've had a few lectures already in geriatric principles, and a lot of things are different from internal med. For example, elderly patients' livers and kidneys do not work as well as those in adults, so you can't give them the same drugs as what they may be accustomed to taking for many years prior. They're therapies need a lot of fine tuning and tweaking in order to get the best results with the least side effects for them. Not to mention most are dealing with chronic conditions and taking 20 pills a day, it can be quite the challenge.
geriatrics isn't really all that different from IM. Almost everyone on the medicine inpatient wards are very old and very sick. The outpatient management is a little different however. Keep in mind that geriatrics requires more patience than peds.
Have you guys had exp. with the aged during rotations?
My only "real" experience to date is at a free health clinic that I used to volunteer at. Most of our patients were older or elderly, most have many many chronic problems they had to deal with simultaneously, and most were taking from 10-20 different medications. So they can have complicated cases and histories, however, you'll find that they are also very rewarding to work with. Most enjoy talking with you and telling you little things. Most are also very open to being helped by students in the learning process.
I think that some people consider that an offensive term (no, not baby boomer) -- just for your information. I'm sure you weren't trying to be offensive.
The observed need compells me to pursue Geriatrics as a career. I was an elderly woman's assistant for four years and worked with the elderly since I was 12.
However, I don't meet many people that are interested in Geriatrics and wondered if SDNers were a different lot. They really need our help.
I'm really considering geriatrics. If the insurance problem is still crap by the time I graduate, I will most likely abandon OB/GYN for geriatrics. Just waiting for my rotations to confirm these perceived desires.
I know SLU has a great rep for geriatrics. I only know because I'm headed there next year, so I don't really know where else is good. Probably most good primary care schools can offer what you're looking for.
If the malpractice thing is a killer, what do you think of the fact that every elderly person has the same Medicare insurance, which consistently gives reimbursements of quite a bit less than half of what private insurance does? Would you rather your practice get reimbursed say $800K and have to pay out $100K for malpractice and $500K for rent, employees, equipment, lab tests, etc., or be covering all Medicare patients and get $300K in reimbursements, pay $20K in malpractice, and have $200K in practice expenses?
If you love working with the elderly, enjoy their gratitude, etc., go with it. Just realize, as long as medicare grossly underpays for care, geriatrics will not be a lucrative field.
Everyone is on target when they say that geriatricians are in high demand. You can subspecialize in geriatrics in either FM or IM. The biggest deterrent for most people is that most of the money in geriatrics is medicare. However, with the increasing older population, there will HAVE to be changes to the reimbursement system currently in use. Moreover, elderly patients require more time and effort from the clinician. Thus, a geriatrician sees fewer patients per day. Many physicians also shy away from situations where the illnesses cannot be cured. Even oncology provides some hope for a cure in many cases, but there is no cure for old age.
I have always enjoyed working with older people. It is my desire to care for these often ignored individuals. It is a challenge I welcome.
I have a masters in clinical gerontology, so I may be able to answer any questions you may have.
I'm working in a Geriatric Psychiatry department and prior to that, I thought I wouldn't like dealing with old folks.
But now I have considered Geriatrics, as this population is underserved and really deserves more respect than they get....this society treats their elderly horribly and it's a shame...
Working with this population can be hard, because they are suffering from health problems that will only get worse, but they are so grateful for your time and they have so much wonderful advice to give and so many stories. It's really helped me to appreciate where I am. They all say to me "I wish I'd done more at your age".
I really appreciate your feedback!
My father is a "geriatrician". He loves it, and for his personality this was perfect.
There is no doubt that there is VERY HIGH demand already exists for it. However, its not for everybody. Dealing with Alzheimer's on a nearly daily basis, for example, can unnerve certain people. I'm definitely considering geriatrics as well, but I'm a loooong ways off from there.
I guess some people on here still haven't realized that there are other reasons for wanting to do things other than the all mighty buck.
Not sure what you're talking about. Pretty much every field of medicine is intellectually rewarding, personally gratifying, and societally edifying. OTOH, if you're sitting on $200K in debt and would like to procreate prior to your 40s, you'd have to be incredibly naive to not consider whether your specialty choice will be getting you $100K or $250K a year when you finish your residency. If someone is head over heels passionate about working with the elderly and can't see him or herself doing anything else, I would certainly not suggest letting money guide you away from that. But, if, as with most med students, you have several fields that you're interested in, and only slightly prefer one particular field to another field, it's entirely reasonable to let money push you in one direction.
I guess living in a particular area could also influence your decision, but there are lots of "low income" docs (relatively speaking) out there doing just fine and not needing 200K+ to get by.
I don't expect to have a "rich" standard of living once I'm in practice. I don't need the sports cars, big house or yacht. I just want to be able to provide for my family. Yes there are a lot of factors that take away from doctors' incomes but I think most people try to shoot for a higher standard of living than what is reasonable.
EVMS has a rotation in geriatrics. I don't think most schools do. I think they are big on it at EVMS as they are essentially the only medical institution for a huge area.
I am looking forward to geriatrics as a career and like the feedback on this thread.
Shadows of these posts remind me of that book, Do What You Love and the Money Will Follow:
I met the most unhappy OBGYN last year who blamed all his problems on externals. He went into it for the money and had it for a while. Lo and behold, women began to realize that he didn't love his job or listen to his patients. Hmmm.. Now he wants to be a writer.
To thine own self be true.
To the poster that asked about what Geriatrics is:
Geriatrics is a subfield of the department of internal medicine at most medical schools.
I don't know if you know vince farindani at our university. Because Vince, and my friend Nonna are both wanting to go into geriatrics.
Actually Nonna is currently shadowing one of the main residency instructors in the USF Geriatrics department, subdivision of the Internal medicine department.
The doctor she shadows works at the nursing home associated with the James a Haley VA hospital.
Just wanted to add one more thing, I currently shadow in neurology and physical med and rehab which I know isn't Geriatrics, but for the most part the patients are older, and it is sooooo cool there.
I always wanted to work with kids, but I think I may also look into working in a VA hospital some day because they are soooooooo friendly in VA's. I've heard good things about the other VA hospitals too.
I've heard good things about the residency instructor in geriatrics that my friend shadows too. If you would like to talk to her or email her before you go off to medical school, just PM me and I'll try to get you introduced to her.
I will get back in touch w/ you.
Wow, I don't know about the VA system being cool (with years of clinical oncology exp. and elderly person assistance under my belt I've heard horror stories) but I am glad that the exp. has given you a good perspective of geriatrics.
really? about 99% of disease cannot be cured. when was the last time anyone cured hypertension, heart disease, diabetes, or arthritis?
what you may perceive as "friendly" is actually extreme laziness that is rampant at every single VA hospital in the country. You'll have a different view of things as a physician: nothing ever gets done, and most people just sit on the asses all day long.
I guess I don't know all there is to know about the VA. I was just saying as a student observer, they have been really good to us, about letting students see what they do there. But then again, I don't know, I am not a doctor yet much less a medical student, so I wouldn't know.
I have always heard and seen our VA as a real busy place, and what not. The lady I shadow even went to John's Hopkins for her residency and is a residency instructor. Many of the physicians I have met are residency instructors who seem to care about their work. But like I said, I am not a doctor yet much less a medical student so I don't really know how it is.
Also one more thing, my friend whom wants to go into surgery is a gerontology major. She has done several years of internships in gerontology at the Moffitt Cancer Research Center, and has gotten to see all sorts of things that have been very interesting such as bone marrow transplants and what not.
I agree that there are a lack of people wanting to go into the field. So where do you work or what kind of experiences did you have through your years??
By the way, I just meant that the VA has been really good to students and allowing students to see different kind of fields of medicine and get to understanding elderly care.
If you will notice, the diseases you listed primarily affect the elderly. I think most people understood my point. Even diabetes has a higher mortality and morbidity rate in older patients.
I just found this thread.
I've been considering Geriatrics myself, and want to learn more about it.
There doesn't seem to be tons of information available (compared to other, bigger specialties.) I'd like to be able to do a rotation in MS to check this out.
Any other SDNers/future geriatricians?
I'd especially like to get an words of wisdom from current Residents/Fellows/Attendings about their experiences with this field... but maybe I need to start another thread in Internal Medicine.
I am a future geriatrician. Man, the tidal wave is coming. In less than 10 years, America is really going to feel the impact of the Baby Boomers and will need caring physicians!
I've been investigating and will post some links. Feel free to PM me.
Sounds great! Thanks.
I've found The American Geriatrics Society, but would appreciate any other info you could point me towards.
I don't even know if my school offers a geriatric rotation, but I'd be willing to do an away rotation or something... I definately want to experience this.
I'm not ready to commit until I experience this first hand but it seems like geriatricans love what they do. It also seems like a good fit to my personality and strengths... ie I want lots of patient contact, building relationships with patients, etc... I'm a good listener, and I think I'll enjoy intellectual problem solving over lots of proceedures.
Also, maybe I'm wrong to think this... but I think that older patients will appreciate their doctors more/ more rewarding...
hah hah hah GOMERs and GOMERES.... that's hilarious...
I shadowed a Geriatrician, and was quite active in that endeavor. It is a rewarding field, the supporting staff is generally excellent (despite the high CNA turnover) and you can work or not work as much as you want. Lifestyle is good - it's totally up to the physician as to how many nursing homes he or she works. You never have to skip lunch or dinner, since a lot of time is spent traveling from one nursing home to another. Once you get into the groove of things and know all the patients, it's a matter of doing your monthly visits and keeping physical exams up to date. The only bad thing - you get an ungodly number of phone calls at all times of day. But even those only take two minutes to complete, never requires that the physician actually go to the home (that's when they're sent to the ER).
Also, more than any other field I shadowed in, geriatricians get a lot of free rides from pharmaceutical reps. They have a vested interest in nursing home patients - that's where they make a lot of money - so they'll do just about anything to keep you using their particular products.
Overall, I was impressed with the field. There are no disadvantages other than having to deal with chronically ill patients. BTW, alzheimers sucks.
Do you know what the salary ranges are for a physician that strictly rotates nursing homes?
Thanks for the info - geriatrics is looking better and better. Especially for someone who might have to balance working with a family, and I'm not getting any younger!
I posted this before but I do research in geriatric psychiatry so I see a lot of depressed elderly and hear a lot of the demented patients screaming from the nearby post-doc offices - which is a little scary - and I've screened patients that were beginning to show signs of it - but I've never directly worked with full blown AD patients before. It's really sad. Hopefully my boss will let me go with her to the unit sometime before I quit here, cuz I'm really curious, almost morbidly so.
Where do you see the future of geriatric psychiatry going? I'm sure there must be related posts on the psychiatry forum, but I often wondered what their working conditions were like and what the salary ranges were because I heard that a shortage of them exists yet the working ones are under paid?? I have no clue.
I did research with adult dual diagnosis and am limited to the clinical mental health arena there and my conversations with the staff psychiatrist. My geriatric work was as an elderly woman assistant. I have spent considerable time in nursing homes, none of which exposed me to the psychiatric side of geriatrics though I am interested.
Aging related links and sources
National Institute on Aging
Administration on Aging
this is the worst reason I have ever, EVER, heard of anyone choosing a field of medicine.
The money for the ridiculous amounts of marketing that drug companies do and "free rides" they give away, has to come from somewhere, and it's unfortunately right out of the pockets of seniors, who can barely afford these medications on their fixed incomes.
Please, please, please educate yourself about this very complicated issue before you do any more running around, talking about what a fantastic opportunity it is to get free things from smarmy drug reps.
as for "having to deal with" chronically ill patients, many of us would consider that an advantage and, in fact, a privelege. it's why some people choose to go into medicine in the first place.
i suppose i shouldn't just start criticizing people's posts without actually contributing something to the thread
AMSA has a Geriatrics interest group. There's also a list serve you can join, which hasn't seen much action lately, so it would be great to have some enthusiastic people to start discussions and post useful information. You don't need to be an AMSA member to join.
Check out http://www.amsa.org/ger/
I am not making an argument on whether a person should or should not pursue a career in geriatrics. I am reporting what I saw.
Thus, the financial or ethical considerations of dealing with parmaceutical reps is left up to you. Similarly, whether seeing the chronically ill is enjoyable or not is also left to the reader.
My personal opinion of both have been, and remain, unspoken.
You know, I'm gonna ask the post docs to see what they have to say about these things, since my answers would be guesses at best....stay tuned!
awesome - i'm so glad to see this thread! geriatrics has basically been my top choice for as long as i've been interested in medicine (of course, i'm still far off from having to make that decision - only applying to med schools this year). I've just really enjoyed the activities i've done that have involved interaction with elderly populations. here i was, thinking i was kinda weird, since i didn't know of anyone else into doing it
so yeah, thanks for the info / links people! i wonder which schools on the east coast have strong geriatrics programs... if such things exist...
Mount Sinai is pretty much # 1 when it comes to geriatrics, or so I hear.
Anyone know of other schools that are strong in Geriatrics (for rotations or residencies, as where I'm goin for the MD is pretty much determined.)