Focus on Gerontology, Part 2: Turning Students to Geriatrics
John Norbury is a second-year medical student at Case Western Reserve University.
John Norbury (talking to patient): So Mr. Fleming, what did you come in for today?
Since his first year, he's been meeting with patients like Matthew Fleming at the Louis Stokes Veterans Affairs Clinic.
Matthew Fleming: I'm 80 years old. Right now I'm taking care of an older brother and an older sister. My older brother's 91, my sister's 86.
Norbury has always had a soft spot for older people. For his Eagle Scout project, he put together a juggling act that he performed at nursing homes. On this day, Norbury gets down on one knee to be at eye-level with Matthew Fleming. He nods a lot and listens intently, asking questions and taking notes.
John Norbury: I think that a lot of the exposure that happens to medical students when they see patients who are geriatrics happens in patient settings where they see a more depressing side to it.
That's why many med schools are trying to get students in contact with older people earlier on and in different settings. Case's Family Clinic Program is one example. Students can spend time with patients in a clinical setting through a partnership with the VA, and through home visits organized by a partnership with MetroHealth. VA Staff Geriatrician Muralidhar Pallaki has taken John Norbury under his wing. Pallaki says it's a way to teach students important skills. It's also a way to acquaint them with the kind of people that will make up a big part of their patient population after they graduate.
Muralidhar Pallaki: We felt because geriatric patients have a tendency to not only just do with the medical care but also the social issues and stuff, plus they do like to sit down and talk about their life history. We thought this would be a good way to lead into not only learning history taking but also seeing a person as a whole.
Still, John Norbury has heard plenty of discussions among his peers about why geriatrics remains an unpopular choice.
John Norbury: The biggest thing that people have said and it's absolutely true, is the debt. You have that riding over your head and it makes you think hard about you know, if you could go into a field and make you know, twice or three times as much, and if it's something you could be happy doing, it's a very difficult decision to make.
Maria Schimer is Director of the Office of Geriatric Medicine and Gerontology at the Northeastern Ohio Universities College of Medicine. She says concerns of dealing with debt that's often upwards of a hundred-thousand dollars does not help the shortage of geriatricians that already exists in the state. Schimer says there's a lobbying effort ongoing to get Congress to consider a loan forgiveness program for geriatric students. But she says even if you get students interested in geriatrics, their minds often change after learning about its realities.
Maria Schimer: Medicare reimbursement is going down, Medicaid reimbursement is going down, the number of patients that you need to see in a day is fairly high and you can't see lots of older adults well in a short period of time and be in an economically feasible practice.
Margaret Sanders is also with the Office of Geriatric Medicine and Gerontology at NEOUCOM. She says there's also a different way of thinking when it comes to caring for older adults that may sometimes by disappointing to a student.
Margaret Sanders: With older adults, most often you're managing chronic illnesses. You're probably not going to make that patient better, perhaps increase their function or make their quality of life better but you're not going to beat a disease.
Officials at Case Medical school say that while a couple dozen students may be interested in working with aging people in their first year, by graduation time, that typically dwindles to a number you can count on one hand. Although John Norbury has been part of The Family Clinic program for two years, he says he still not sure if he'll end up a geriatrician.
John Norbury: I'm keeping things open but it's certainly, it's on my top three, I'd say, list.
His other choices are oncology or physical medicine and rehab. Medical schools meanwhile are taking a closer look at their curriculum, making sure that all students, regardless of their focus, get ample exposure to geriatric training. But even that's a challenge, since there's also a shortage of geriatric teachers. In Cleveland, Renita Jablonski, 90.3.