TABLE 6 Ambulatory Visits to Various Medical Specialties by People Age 65 and Older

 

Percentage of Total Visits in:

Specialty

1978

1981

1985

1991

All specialties

16.1

18.4

20.1

23.2

General/family practice

17.1

19.3

19.6

19.9

Internal medicine

31.1

34.4

39.2

37.7

Cardiology

39.1

46.1

47.2

53.4

Opthalmology

30.0

39.3

43.8

55.0

Urology

29.9

37.6

39.6

45.8

General surgery

21.9

20.1

27.2

32.2

Neurology

13.2

17.7

21.0

19.9

Dermatology

12.2

13.4

18.3

27.9

Otolaryngology

14.1

16.9

17.0

17.7

Orthopedic surgery

10.9

13.7

13.9

17.9

Psychiatry

4.5

4.6

6.5

7.0

Obstetrics/gynecology

2.2

2.6

3.3

4.5

Other

5.0

6.0

10.2

12.2

SOURCE: National Ambulatory Medical Care Survey, National Center for Health Statistics.

The preparation of trainees in non-primary-care specialties for caring for older people has been limited. In their survey of surgical residency programs, Friedman and colleagues (Trustees of Boston University, 1989) determined that only 24–31 percent of surgical residency programs (including general surgery, otolaryngology, orthopedics, urology, and obstetrics and gynecology) provided formal training on mental status assessment. Between 22 and 50 percent (the highest being orthopedics) provided formal training on functional status assessment. That study also identified factors limiting the introduction of geriatrics into residency programs. The most commonly cited factors included limited time in residency, insufficient numbers of trained faculty, insufficient funds, lack of organization of geriatrics specialists, and lack of special clinical units for geriatric patients.



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