In this new series, MIMS aims to highlight less conventionally popular specialisations, which nonetheless remain highly relevant in the current context of local healthcare.

At the age of 68, Jane Gross felt uncertain about seeing a geriatrician, but had been experiencing issues with her memory after sustaining a concussion, and wanted an Alzheimer’s test.

In contrast to her recent 15-minute consultation with her internist however, Gross ended up spending two hours with her geriatrician, who took the time to address her concerns, conduct a mini-mental state examination, administer a pneumonia vaccine, and talk to her about a great deal – from recent sexual activities to softening ear wax with drops before considering hearing aids.

By the end of her session, Gross felt comforted, reassuring herself that everything was alright, and even if “the time came when it wasn’t, I’d be in good hands.”

Geriatrics, a specialty unlike any other

Geriatricians are medical specialists who further their training to become experts in the field of geriatric medicine, a sub-specialty that focuses on providing care that caters to the unique demands and specific needs of the elderly.

More often than not, older people have multiple health conditions – which may affect them differently than younger individuals – and may already be on an array of medications. The elderly are also more susceptible to other issues that other primary care doctors may neglect to address, including social and mental health issues.

“If you’re losing weight, you’re falling, you can’t climb a flight of stairs, you’re tired all the time, you’re unhappy and you’re on 10 or more medications, go see a geriatrician,” said John Morley, a professor of geriatrics at Saint Louis University.

“Much of what we do is get rid of treatments prescribed by other physicians that aren’t working,” he added.

Based on the entrustable professional activities (EPAs) described by Rosanne Leipzig in 2014, geriatricians are able to optimise the functioning and well-being of older patients, facilitate family meetings, and assist senior patients and their families in clarifying, making and achieving care decisions. Geriatricians also serve as primary care doctors and can provide extensive healthcare coordination with allied health professionals such as specialists of rehabilitation medicine and physiotherapists to name a few.

According to the director of the geriatrics medicine fellowship at the University of California Eric Widera, geriatricians are “experts in complexity,” as no one comprehends how multiple problems affect the quality of life in the elderly, or addresses them better than geriatric specialists do.

No doubt, geriatricians play an important role in healthcare. Matching the ageing population across the globe, the demand for geriatric care has rapidly grown in the past few decades – but where are the geriatricians?

Dire shortage of geriatricians

Geriatrics is among the rarest of medical specialties, and is also ranked at the bottom of the list of specialties pursued by young doctors. In 2012, Malaysia had only 16 such doctors in the country to meet the needs of the local elderly population, who accounted for 7% of the country’s population of 28 million. Likewise, Singapore is projected to have 610,000 residents in the above-65 cohort by 2020 compared with 460,000 last year. 

Many younger doctors find geriatrics less interesting than the comparatively vibrant specialties such as cardiology, which offers the excitement of new technologies and offers a good pay. According to the Medical Group Management Association, the median annually income of a geriatrician practicing in the private sector in 2014 was $220,000 – less than half the salary of a cardiologist – making it among the lowest-paying specialties in medicine.

“Part of the reason aging has such a negative connotation is this sense that you can’t cure older people’s problems,” said Dr. Kenneth Brummel-Smith, a professor of geriatrics at Florida State University College of Medicine. Some practitioners of primary care have debated that the roles of geriatricians are unnecessary, as most of the ailments faced by the elderly such as diabetes and heart diseases are similar to those in the middle-aged population.

“And yet a good geriatrician can bring someone back to functional status.” MIMS

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