Background: There is a critical shortage of Geriatricians in the United States and we are reaching a crisis nationwide without enough trained physicians to care for our rising Geriatric population. We are experiencing a “Silver Tsunami” as the oldest of old population, those above age 85, is expected to quadruple from 5.9 million to an estimated 18 million by 2050 while the overall geriatric population will double from 43 to 84 million. It has been estimated that 20,000 Geriatricians are needed to meet the current demands yet there are fewer than 7500 board certified Geriatricians. According to the Institute of Medicine, the actual number of Geriatricians may decrease because fewer physicians are entering the field for a multitude of reasons including low reimbursement and undefined work hours. In contrast, there is a growing trend of recent internal medicine graduates pursuing careers in hospitalist medicine. Despite the trend towards hospital medicine those entering this field are left unprepared to meet the needs of the frail older hospitalized patients. Hospitalists far outnumber Geriatricians and often have limited geriatrics training which can have deleterious effects on inherently more vulnerable elderly patients.
Purpose: Some key areas where hospitalists would benefit in enhanced geriatric training include care for elderly patients with dementia, polypharmacy, functional and cognitive assessments, fall evaluations and goals of care discussions. The statistics in hospital readmission rates and iatrogenic events such as pressure ulcers, catheter infections, and delirium when comparing Hospitalists to Geriatrician staffed ACE units support the need for more Geriatric training. In lieu of scarcity of geriatric trained Hospitalists, we recognized the dire need for innovative training and educational opportunities for Hospitalists to help improve their ability to take care of medically complex elderly patients.
Description: We created a combined Geriatric Hospitalist Fellowship Program to entice physicians into Geriatric Medicine. The Program offers a comprehensive curriculum that narrows the gaps resulting in highly competent Geriatric hospitalists with heightened sensitivity and experience in treating frail elderly patients. In July 2015, Stony Brook Medicine allowed physicians to participate in an interrupted Geriatric fellowship while working as a Hospitalist part time. The program requires a two year commitment alternating between Geriatric Fellowship and working as a Hospitalist The curriculum focuses on “transitional” care, preventing readmissions, medication reconciliation, poly-pharmacy, prevention of iatrogenic illnesses, delirium, and catheter induced infections which also align with nationwide institutional goals. These physicians will develop expertise in systems of care, Quality Improvement, patient safety and inter-professional collaboration.
Conclusions: This innovative training program can fill in many of the gaps in current training and is needed to meet the changing health care environment. The goal of the Combined Geriatric Hospitalist Fellowship Program is to graduate physicians with leadership skills and a strong clinical knowledge base to care for hospitalized geriatric patients and serve as a teacher for future medical students and house staff.