Subtle rewards of geriatrics

As Australia’s population ages, demand for geriatricians is set to further increase

Geriatricians treat older people with often complex comorbid medical conditions. The specialty includes the medical management of the full range of older people’s illnesses, and it is this variety of practice that often attracts doctors to the specialty.

Dr Robert Prowse, president of the Australian and New Zealand Society for Geriatric Medicine, says he chose the specialty because of this breadth.

“I always enjoyed all the specialties in physician training, but I never found one that I liked more than another. One of the things about geriatric medicine is that it provides an opportunity to be quite broad in your practice”, he says.

“It’s a way of keeping general but, because of the contact with older people and their needs, there’s a lot of specialist knowledge which sets it apart from general medicine”, he adds.

Some geriatricians choose to focus on a particular area within geriatric medicine, such as rehabilitation or dementia, but most manage a range of comorbidities in older people.

Dr Prowse, who is a geriatrician at Royal Adelaide Hospital, says patients also tend to be very different from one another in this age group.

“As people get older, they deal with the effects of ageing and acquired illness very differently. They have different life experiences and social circumstances … that increased heterogeneity as we age means that no one presentation is the same. It’s very difficult to get bored in geriatric medicine.”

Traditionally, geriatric medicine was considered to involve patients aged 65 years and over, but Dr Prowse says the average age of geriatricians’ patients has tended to increase as older people’s health has improved. Now, he says, his typical patient would be an 82-year-old woman with complex comorbidities. 

“Most geriatricians are looking after patients in their 80s, and increasingly in their 90s and above”, he says.

In addition to the variety of presentations, geriatric medicine also offers a range of working environments, from hospital inpatient care to ambulatory services or rehabilitation clinics.

Private sector work opportunities are increasing, as the fee-for-service environment becomes more financially rewarding and private hospitals increasingly recognise the importance of geriatric medicine.

Dr Prowse says there is substantial scope for geriatricians to change the mix of working options over the course of their career, which again keeps things interesting.

Part-time work is common and valued by most specialists in the field, says Dr Prowse. As such, the specialty is well suited to doctors who want to combine their professional responsibilities with raising a family and attracts a lot of female trainees.

Dr Prowse says the specialty also tends to attract people with “a lot less ego” than some specialties.

“When I go to conferences, there are always a lot of like-minded people. They all have views but they respect other people’s views as well. The camaraderie is very strong and that makes for a nice specialty.”

Geriatricians need to be excellent communicators, particularly as the specialty involves considerable teamwork with other medical and allied health professionals.

Dr Prowse says that, as the population ages, other hospital departments are increasingly relying on the skills of geriatricians. Opportunities for collaboration are increasing, for instance, between oncologists and geriatricians.

Geriatricians also need great listening skills and, crucially, need to value and respect older people.

For instance, Dr Prowse relishes the chance to hear his older patients discuss the twists and turns of their lives.

“I always find those life stories tremendously fascinating … what brought them to be the person they are now”, he says.

Professor Len Gray, professor of geriatric medicine at the University of Queensland, says his favourite aspect of the specialty is its complexity.

“Some people may see it as messy, but the complexity is what makes it interesting. Geriatricians generally like the complexity and the people aspects of the specialty.

“The challenges are complex from a medical perspective, but also because of the difficulties older people and their families experience. “

Professor Gray says solutions are often subtle and focus on a “whole person” approach to care. For instance, for a person with mobility difficulties, geriatricians may be involved in everything from stabilising their blood pressure to organising a walking aid or someone to help them at home.

Professor Gray says the rewards of geriatric medicine are also often more subtle.

“Surgery, for instance, is a different style; you can fix a lot with one action. With geriatrics you don’t weave magic at any one moment, but over time you get a lot of rewards seeing gratified older people and their families”, he says.

Professor Gray says the specialty therefore suits doctors who don’t need immediate results to gain professional satisfaction.