U.S. not training enough doctors in geriatric medicine, expert on aging says

BOSTON — BOSTON -- The United States is lagging so far behind other nations in the training of geriatricians that when the "baby boomers hit Golden Pond, they will drown," warns one of the foremost experts on aging.

The lack of doctors trained in the care of elderly people is not only "unbelievable," but "imprudent" and "unconscionable," especially since 40 percent of all hospital revenues come from Medicare payments for patients older than 65, said Dr. Robert N. Butler, chairman of the geriatrics department at the Mount Sinai Medical Center in New York.


Speaking yesterday at a conference in Boston sponsored by the American Association of Homes for the Aging, Dr. Butler said only one of the nation's 126 medical schools had a full-fledged department of geriatrics: his own, the Mount Sinai School of Medicine.

About 15 others have smaller programs in geriatrics or blend geriatric medical training into already existing courses. But only a full-fledged department, Dr. Butler says, has the clout to insist on such things as a full curriculum in geriatrics and a mandatory "rotation" in which medical students work under supervision with geriatric patients in a hospital or nursing home, just as they do rotations in surgery.


By contrast, Dr. Butler said, all medical schools in Britain have geriatrics departments and a third of all British doctors who specialize are geriatricians, making geriatrics the third largest British specialty. In Japan, he added, 10 percent of medical schools have geriatrics departments.

In the United States, geriatrics has for so long had second-class status that there is still no process through which a doctor can become board-certified in geriatrics. The closest an interested doctor can come is to take a special exam offered by certifying boards in family practice, psychiatry and neurology or internal medicine. Passing this exam allows a doctor to claim "special added competency" in geriatrics.

So far, Dr. Butler said, only a few thousand of the United States' 650,000 doctors have become qualified geriatricians through this route.

A 1987 report by the Institute of Medicine of the National Academy of Sciences showed that by the year 2000 the country would need 2,100 faculty members at medical schools to train and care for the aging U.S. population. So far, there are only a few hundred, said Queta Bond, executive officer of the Institute of Medicine.

Richard Green, spokesman for the Association of American Medical Colleges, cautioned that such statistics could lead to the conclusion that the teaching of geriatrics was "woefully inadequate," but he said this "would do readers a disservice."

While few schools have full-fledged geriatrics departments, he said, 103 offer electives in geriatrics and 106 teach some geriatric medicine as part of existing required courses.

Without more and better training of geriatricians, added Dr. Butler, the country will be "ill-prepared" to meet the medical needs of its aging population.