What is a medical subspecialty?
A medical subspecialty is an area of specialized knowledge or skill within a broader medical specialty. A physician who wants to practice a subspecialty must first complete a residency in a core specialty, such as internal medicine or pediatrics. After residency, they must complete an additional fellowship training program focused on their chosen subspecialty. For example, a doctor who specializes in the heart (a cardiologist) first completes a residency in internal medicine before pursuing a cardiology fellowship.
The path to becoming a geriatrician
To become a geriatrician, a physician must follow a specific educational and training path that builds upon foundational medical knowledge with specialized expertise in caring for older adults. The process is a clear demonstration of geriatrics functioning as a subspecialty.
Step 1: Medical School
The journey begins with four years of medical school, followed by graduation with a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree. This is the same initial training required for all physicians.
Step 2: Residency Training
After medical school, the aspiring geriatrician must complete a residency program. The most common residencies for this path are:
- Internal Medicine: A three-year program focusing on the prevention, diagnosis, and treatment of adult diseases.
- Family Medicine: A three-year program that provides comprehensive healthcare for individuals and families across all ages.
Step 3: Fellowship Training in Geriatric Medicine
Upon completing their residency, physicians who wish to specialize in geriatrics must complete an additional one- to two-year fellowship program. This specialized training is where they gain in-depth knowledge of age-related physiological changes, geriatric syndromes, and the unique healthcare challenges of older adults. The fellowship experience covers a variety of settings, including outpatient clinics, hospitals, and long-term care facilities.
Step 4: Board Certification
After completing the fellowship, physicians can become board-certified in Geriatric Medicine by passing a comprehensive examination administered by the American Board of Internal Medicine (ABIM) or the American Board of Family Medicine (ABFM). To learn more about the requirements, visit the ABIM website.
Geriatrics vs. General Internal Medicine: A comparison
While an internist can treat older patients, their approach and scope differ from a geriatrician's. The specialized training of a geriatrician allows for a more holistic and integrated approach to senior health.
| Feature | General Internist | Geriatrician |
|---|---|---|
| Patient Focus | Adults of all ages, 18 and older. | Primarily older adults, typically 65+. |
| Expertise | Broad knowledge of adult diseases. | In-depth knowledge of aging physiology and geriatric syndromes. |
| Chronic Conditions | Manages one or more chronic conditions. | Manages multiple coexisting conditions (multicomplexity) and considers how they interact. |
| Medication Management | Manages medications. | Expert in polypharmacy (managing multiple drugs) and minimizing side effects in older adults. |
| Holistic Approach | Focuses on physical health. | Considers physical, mental, social, and functional aspects of health. |
| Care Coordination | May work with specialists. | Routinely coordinates care with an interdisciplinary team (pharmacists, social workers, physical therapists). |
| Training | 3-year internal medicine residency. | 3-year internal medicine residency + 1-2 year geriatrics fellowship. |
Why specialized geriatric care is essential for older adults
The aging process brings unique health challenges that benefit from the specialized expertise of a geriatrician. This isn't just about age, but about the specific complexities that often accompany later life.
Managing multiple chronic conditions
Older adults frequently contend with multiple chronic illnesses simultaneously. A geriatrician is trained to understand how these conditions—such as heart disease, diabetes, and arthritis—interact and influence one another, ensuring a coordinated and effective treatment plan.
Expertise in polypharmacy
With multiple conditions comes the risk of polypharmacy, or the use of multiple medications. Geriatricians are experts in simplifying medication regimens and preventing adverse drug interactions and side effects, which are more common in older patients.
Addressing geriatric syndromes
Geriatricians specialize in diagnosing and managing common geriatric syndromes that are often overlooked in general practice. These include:
- Dementia and memory problems
- Falls and balance issues
- Urinary incontinence
- Frailty and functional decline
- Depression and mood disorders
Focusing on quality of life
While internists focus on treating illness, geriatricians emphasize a patient-centered approach that prioritizes quality of life, functional independence, and personal goals. They work to keep older adults as healthy and active as possible.
The future of geriatrics in healthcare
With the continued growth of the senior population, the need for geriatricians is becoming more pronounced. Despite the demand, there is currently a shortage of physicians in this field. This gap highlights the importance of raising awareness about the benefits of specialized geriatric care.
Many healthcare systems are addressing this need by creating dedicated geriatric care teams that include not only geriatricians but also geriatric-trained nurses, social workers, and other specialists. This interdisciplinary approach ensures that the complex needs of older adults are met comprehensively. For seniors and their families, understanding that geriatrics is a specialized field within internal medicine is the first step toward seeking the most appropriate and effective care for the unique challenges of aging.
Conclusion
In summary, geriatrics is indeed a subspecialty of internal medicine, requiring advanced training beyond a standard residency. This additional fellowship provides physicians with the skills and knowledge to address the specific and complex healthcare needs of older adults. For seniors navigating multiple chronic conditions, medication management, and age-related syndromes, consulting a geriatrician can lead to better health outcomes and a higher quality of life.
