Do We Need More Geriatricians or Better Trained Primary Care Physicians?

reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page Editorial The demand for more specialists in general geriatric medicine is intensifying as the proportion of people above the age of 65 years is expected to increase exponentially. Some estimates predict that in less than 20 years, about 20% of the U.S. population will be above the age of 65 years. The question, however, is, " Do we need more specialists in general geriatric medicine or do we need primary care physicians better trained in geriat-ric medicine? " There is no good reason for general geriatric medicine to be a specialty different from general internal medicine or family practice. In fact, it makes much more sense that the internist or family physician who has provided medical care to the patient throughout adult life continues to provide care after the age of 65 years. Throughout the years that physician has established a position of trust with the patient (and often family) and is intimately knowledgeable about the patient's condition as well as psychological make-up, sense of values, stressors, and spiritual and social background. Such knowledge is an asset as the medical management strategy for older patients is not only dictated by the pathology , but is often modulated by the patient's individual circumstances: physical, mental, spiritual, and social. It is quite traumatic for the person who reaches the age of 65 years to be told by the primary care provider— who has been providing medical care for a number of years and is considered a " friend " —that another physician should take over medical care, especially as around this time, the person experiences a number of losses associated with retirement including sense of identity, physical abilities, and financial status. There is no doubt general geriatricians have developed a special expertise at handling atypical presentations of diseases, multiple pathologies, polypharmacy, often ill-defined " normal " levels, and the need to develop a management strategy that takes into account the patient's physical, mental, spiritual, and social background. However, shouldn't internists and family physicians be able to do that? It is unrealistic to expect to produce enough geriatri-cians to provide medical care to all people above the age of 65 years or even 75 years. And if this were possible, there would be significantly less work for internists and …