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Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions
time on each patient visit. Over half of the formally trained geriatricians reported that they spent more then 40 minutes on each new patient. This is in comparison with a reported 28 minutes for internists and 17 minutes for family physicians seeing new patients over age 65 (Radecki et al., 1988). Assuming that there are no differences in efficiency, this would suggest either that the geriatrician's patients are more complex or that the geriatrician is providing a different type of clinical service. Both of these possibilities are supported by the fact that geriatricians reported in the survey that they use interdisciplinary services extensively.
Of those who responded to the survey, 93 percent were either satisfied or very satisfied with their decision to pursue a career in geriatrics. Greater satisfaction with geriatrics was reported by those physicians whose current activities most closely resembled the model advanced by the professional leaders in the field (i.e., an academic leadership role). Characteristics that were independently predictive of satisfaction included practices in which more than 50 percent of the patients were over age 75, practices in which more than 50 percent of the patients were prepaid, practices in which the geriatrician accepted patients through Medicare assignment, the geriatrician had a role as a clinician-researcher, and the geriatrician had a medical school appointment (Siu and Beck, 1990). They expressed the least satisfaction with resource-related issues. Their responses indicated that they were relatively dissatisfied with their work force and personnel resources and their abilities to meet the complex needs of elderly patients. Similarly, they reported low levels of satisfaction with their own salaries and incomes. The relationship between lower income (the rule among geriatricians) and professional satisfaction has been reported by others (Kravitz et al., 1990). These frustrations with resources were not surprising given the limited reimbursements available for cognitive evaluation and management services of elderly people.
Barker and Podgorski (1991) reported somewhat different figures on the basis of a survey of physicians who completed geriatric fellowships from 1980 to 1988. More than 60 percent reported currently active participation in research, and 85 percent reported that they did some teaching in geriatric medicine.
A nationwide survey of geriatrics faculty in five specialties (internal medicine, family practice, neurology, physical medicine and rehabilitation, and psychiatry) in 1989 indicated that a minority (46 percent of internist faculty and 38 percent of family practice faculty) had received formal training in geriatric medicine. These faculty in geriatric medicine spent their professional time teaching, primarily in association with patient care delivery (32 percent across all specialties), research (13 percent), and administration (8 percent). Of particular note, 30 percent of the time of geriatrician faculty was spent providing nonteaching patient care or care to people younger than age 65 (Reuben et al., 1991).