To Meet Future Needs, College Expands Geriatrics Program

When it comes to medical care for older Americans, the rules of supply and demand don’t seem to apply. On the one hand, the number of us over 65 has swelled to 1 in 8. And the US Census Bureau projects those numbers will double to 70 million by 2030, making 1 out of every 5 people 65 or older. On the other hand, while older Americans are among the major users of health care services, the number of US physicians certified to diagnose and treat the ailments that accompany aging is shrinking.

So critical is the shortage of trained geriatric physicians, a recent AARP Bulletin article terms today’s older men and women “America’s ‘Forgotten’ Patients.” Only about 9,000 doctors – or fewer than 2% of the 650,000 physicians nationwide – now specialize in geriatric medicine. The private, not-for-profit Alliance for Aging Research estimates that more than twice that number are needed. A recent article about the shortage in a Time magazine Bonus Section on Geriatrics said that only “a handful of medical schools have begun to boost their geriatric programs.”

One of those few is the Medical College of Wisconsin.

In April 2001, the Medical College was 1 of just 10 American medical schools to be awarded a $2 million grant from the Donald W. Reynolds Foundation to strengthen and expand its geriatrics education and training over four years.

Kate Kowalski, MSSW, Reynolds Program Manager, said the grant authors decided to develop a comprehensive program focusing on four areas:

• Generating student interest in geriatric medicine from the day they begin medical school.
• Increasing medical student knowledge of geriatrics by creating curriculum offerings to highlight what occurs as humans age.
• Developing the country’s first Combined Geriatrics and Internal Medicine (Med-Ger) Residency Program.
• Creating a Geriatric Medical Education Fellowship to prepare physicians for the role of Academic Geriatrician to teach the next generation of medical students, residents and fellows.

Student Interest Exceeds Expectations
First- and second-year students, especially, have responded enthusiastically to the newly formed student chapter of the American Geriatrics Society, which brings in campus and community speakers to discuss a variety of topics related to geriatrics, including careers in geriatric medicine, healthy aging and caregiving. Planners hoped at least 20 students would turn out for the meetings; the actual attendance has averaged 80 to 100.

Speakers have included the co-principal investigator of the Reynolds grant, Edmund H. Duthie, MD, Professor of Medicine and Chief, Division of Geriatrics. He interviewed a fit, healthy 87 year-old man who ran marathons and competed in bike races. Another meeting focused on the stresses placed on family caregivers.

Altogether, the group held six events last year, each well-attended, Ms. Kowalski said. Students have also had opportunities to take part in other Medical College programs to enhance interest in the study of geriatrics. The Center for Healthy Communities in the Department of Family and Community Medicine brings health education programs to the residents of City of Milwaukee public housing buildings; during the sessions medical residents and students provide information and lead discussions on health topics related to aging chosen by the building occupants, such as diabetes, depression, heart health, arthritis and HIV/AIDS.

Working in pairs, all 200 first-year Medical College of Wisconsin students have interviewed older adults residing in the community (either public housing residents, residents of independent-living facilities or continuing-care retirement communities) and written their reflections as part of their patient interview exercise.

The student interest component of the grant is led by Tovah E. Bates, PhD, Director of Student Outreach for the Reynolds grant and an Assistant Professor of Family and Community Medicine, working with the Healthy Aging Initiative in the Center for Healthy Communities; and Mary E. Cohan, MD, Assistant Professor of Medicine (Geriatrics). Earlier this fall when Dr. Bates addressed incoming students, she handed out questionnaires surveying their attitudes and knowledge about aging patients. She is currently analyzing the results of that exercise.

College Produces CD-Rom Case Studies
To enhance student knowledge of geriatrics, the Medical College is currently producing five “virtual patient” CD-Rom case studies that feature actual patient cases, with professional actors playing patient roles and faculty physicians playing themselves. The case studies for the series were designed by faculty and staff to highlight health changes and disease processes common in an older adult as he or she ages. It uses professional actors. Two of the five cases are now complete, and filming on a third has begun. The virtual-patient case studies are used in basic science classes taken by first- and second-year students, and in clinical courses for third- and fourth-year students. Overseeing this segment of the grant is Deborah Simpson, PhD, Professor and Associate Dean for Educational Support and Evaluation.

Faculty Development Proceeding on Schedule
Typically, after graduation from medical school, a new physician interested in specializing in geriatrics serves a three-year residency at a medical center, then completes a fellowship of one or two years there or elsewhere before beginning to practice. The new Internal Medicine-Geriatrics Residency developed by the college under the Reynolds grant is a four-year combined residency-fellowship. Last year, the details of the combined residency were developed, and recruitment of candidates to fill the two slots that will be open each year to young physicians from around the world began. In July, the Medical College welcomed its first two residents into the new program. Recruitment is now under way for the 2003-2004 academic year. The residency – the first of its kind in the country – has generated inquiries from other medical schools, Ms. Kowalski said. Edith Burns, MD, Associate Professor of Medicine (Geriatrics and Gerontology), serves as Program Director for this segment of the grant.

The Medical College of Wisconsin has developed a national reputation for its support of faculty whose aim is to ensure the highest quality educational experience possible for students (medical and graduate), residents, fellows and practicing physicians. With the support of the Reynolds Foundation, the Medical College has developed a one-year fellowship for internists or family physicians who are board eligible or board certified in geriatric medicine, and who are interested in preparing for roles as academic geriatricians. Two of the seven board-certified and board-eligible geriatric physicians on staff are involved in this endeavor, Diana Kerwin, MD, Assistant Professor, Geriatrics and Gerontology (Medicine), and Kathryn Denson, MD, Assistant Professor of Medicine. Drs. Duthie and Simpson lead the fellowship.

Never in history have such large numbers of people lived into old age. The implications of that for society are huge, requiring major adaptations. One of these challenges is finding a way to attract more geriatric specialists to the practice of medicine, and the Medical College of Wisconsin is helping to lead that charge.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.