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Faculty monitor from a control room as students
interview community members with Parkinson’s Disease
in the Clinical Skills Assessment Lab.
By 2030, one in five Americans will be 65 or
older. The senior population will double to 71
million in that year. But there will be only
about 8,000 geriatricians.
Feature
Getting a
grip on the
aging boom
In thirty years, the senior population will nearly
double, while the number of geriatricians
continues to dwindle. OU-COM trains
students to help meet the demand.
By Anita Martin
Photos by John Sattler
“Ok, Stevens, you’re blind. Schilb, you’re deaf. Martin, you’re visually
impaired. Lykens, you have arthritis.”
Sarah McGrew, B.S.N., manager of clinical and community
experiences, passes out assignments to OU-COM students for the
Sensory Changes Lab. The lab is part of their required three-week
block of coursework in geriatrics, the medical specialty focused on
elderly care, before they begin third-year rotations.
Depending on the students’ “conditions”—all reflecting common
afflictions of aging—some wear blindfolds or earphones transmitting loud
static. Others put on goggles covered with semi-opaque plastic wrap or
tape Popsicle sticks to their fingers above the knuckles to hinder dexterity.
For two hours, the students wear their prosthetic impairments through
a series of exercises: from buttoning coats to walking with a cane, while
carrying two bags of groceries and attempting to unlock a door.
“By simulating experiences related to aging, we’re hoping students
gain a sense of empathy for their older patients,” says Deborah Meyer,
Ph.D., R.N., administer and assistant professor for OU-COM’s
Department of Geriatric Medicine and Gerontology.
These future physicians will have more elderly patients than they may
realize, according to an Institute of Medicine study released in April. By
2030, the IOM reports, roughly one in five Americans will be 65 or older
(now it’s about one in ten). The senior population will reach 71 million in
that year, making them the fastest growing national age demographic.
Despite the impending demand, there will be only about 8,000
geriatricians (up slightly from the 7,100 in practice today) in 2030. The
Alliance for Aging Research estimates that the nation will need 36,000.
There are a number of reasons for the discrepancy. According to
a 2006 study by the Association of Directors of Geriatric Academic
Programs (ADGAP), geriatricians are the lowest paid physicians in
the United States—and the only medical specialists who are actually
paid less after completing additional training.
“Geriatric medicine is largely exempt from the usual supply-demand
economics, since Medicare reimbursement is set by the federal
government,” says Wayne Carlsen, D.O., chair of geriatric medicine and
gerontology. “When all other expenses in the practice go up and Medicare
reimbursements either stay the same or get cut, physician salaries go down.”
Meanwhile, medical students typically incur between $120,000
and $160,000 in educational debt, as reported by the Association of
American Colleges of Medicine reported in 2007.
“With the rising costs of medical school, students are worried about
repaying loans, which can deter even very interested students from
becoming geriatricians,” says Katie Wehri, OMS III, who served as
president of the OU-COM Geriatric Medicine Club last year.
Wehri adds that because elderly patients often have multiple chronic
conditions and can present symptoms differently, medical students
may find it overwhelming to care for this population.
It doesn’t help that few American medical schools actually require
geriatric coursework. In 2006, the New York Times reported that of the
145 U.S. medical schools at the time, only nine percent had a distinct
department of geriatric medicine.
“We’re pretty far ahead of the game at OU-COM in terms of what
we offer,” says Meyer, pointing out that the college’s former Geriatric
Medicine/Gerontology Section (then in the Department of Family
Medicine) gained departmental status in 1998. The three-week
intensive geriatrics block of coursework began one year later.
OU-COM students received distinctive geriatric medical training
long before that. The Sensory Changes Lab dates back almost as far
as the college itself, as does the required two- to four-week geriatrics
rotation, which can be completed through any site in the Centers for
Osteopathic Research and Education (CORE) system. And for 23
years, OU-COM medical students have chosen to study international
policy issues related to geriatric medicine in Edinburgh, Scotland,
through the Charles J. Cannon Edinburgh Geriatric Tutorial.
Meyer adds that OU-COM students begin thinking about geriatric
medicine from the start. In 2007, geriatric medicine faculty facilitated 350
hours in small-group, case-based studies; 80 hours in classroom and lab
time and another 432 hours supervising students’ early clinical contact, all
of which takes place within the first two years of medical school.
“This is so important, because (physicians) will encounter more and more
elderly patients in every area of medicine,” Meyer says. Especially in primary
care, she adds, the field of choice for 54 percent of OU-COM graduates.
An unexpected calling
Sarah Snyder, D.O. (’06), wasn’t exactly looking forward to her
required geriatric medicine rotation three years ago. “(The rotation
is) perceived as somewhat sad—not exciting like sports medicine or
cardiology,” she says. “I thought I wasn’t going to like it.”
Snyder originally planned to go into pediatrics. But that changed
when she began her geriatrics rotation.
“There was one patient I interviewed, a female in her 90s, very frail,”
Snyder says, “She talked to me for about an hour about how her life is,
how it used to be.”
When Snyder stood to go, she says the patient began crying. “She
just thanked me for listening to her. She said a lot of docs are in and
out, and that I really made her feel listened to. Right there I thought,
wow. This is it. This is my calling.”
Snyder is currently a family medicine resident at Firelands Hospital
in Sandusky, Ohio. She has completed three additional geriatric medicine
out-rotations as a resident: at Akron City Hospital, the Mountain Area
Health Education Center in Asheville, N.C., and Christ Hospital in
Cincinnati, Ohio.
Snyder also received eight weeks of hospice training this year.
Next she plans to pursue a fellowship in geriatric medicine, followed
by another in palliative care (non-curative medicine aimed at relieving
pain and suffering) before becoming a full-time geriatrician.
“That (initial required geriatrics) rotation is the whole reason I’m
choosing geriatrics. It gave me a new respect for the field,” Snyder
says. “I really thought the experience was much more in line with the
osteopathic philosophy than a lot of my other rotations in terms of
treating the whole patient, physically, mentally and emotionally.”
To illustrate the holistic approach to treating older adults, Snyder
describes how, upon starting her residency in Akron, she was given
a five-page questionnaire to go over with each new patient. It covers
everything from medications, sleep patterns and diet to social habits,
mood trends and living space.
“I found that I really love home visits, seeing people in their own
environment,” Snyder says. “Now I can’t imagine practicing medicine
without understanding how patients function in their everyday lives.”
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