Exploring the lack of interest in geriatric medicine

Dear Sir

There is an increasing need for geriatricians to take care of the growing older patient population, but the appeal of geriatric medicine in the UK is lower than most other specialties (McNally 2008). Experience as a junior doctor may affect career decisions to pursue geriatric medicine, but these have been largely ignored in favour of medical students’ beliefs (Chróinín et al. 2013). We interviewed 22 junior doctors (75% participation rate) at an English teaching hospital on whether they intended to pursue a career in geriatric medicine. Descriptions as to why geriatric medicine did or did not appeal to participants were then explored and this resulted in three main themes. In the first theme, limited capacity of geriatricians to make a difference, participants described various ways in which they thought geriatric medicine achieved less than other disciplines. Some participants expressed the belief that older patients often do not fully recover, and often get well enough to be discharged to a different environment only then to come back to hospital shortly after (“a vicious circle, it wasn’t achieving much”). In the second theme, being a “general doctor”, participants reported that geriatricians needed to remain very general in terms of their medical and clinical knowledge. Participants regarded this as negative because they saw it as challenging: geriatricians are “not specialised in a system. You are specialised in seeing patients who are old. So you need to know about everything in older people” and the branch of medicine was described as “vague”. In the third theme, Understaffed and overworked, doctors typically described geriatric wards as “massively unsupported”, so junior doctors felt they “had no idea what we were doing…. as far as we knew, we were resuscitating everyone, treating everyone fully, everyone was for escalation to HDU [High Dependency Unit] to ITU [Intensive Care Unit]”. Overall, even those interested in the speciality were grappling with negative beliefs, in keeping with previous findings regarding the low prestige of geriatrics. Our findings indicate that junior doctors may need focused training that equips them with an understanding of the unique value in maintaining a broad knowledge base in order to treat older patients in geriatrics as well as how geriatrics can improve patients’ quality of life. We believe that without addressing the beliefs of junior doctors with training and education, it becomes more likely that today’s junior doctors will not become tomorrow’s geriatricians.

Declaration of interest: The authors report no conflicts of interest.