Can geriatrics survive?
Can geriatrics survive?
J C LEONARD
British Medical _ournal, 1976, 1, 1335-1336
University Hospital of South Manchester, Manchester M20 8LR
J C LEONARD, MD, FRCP, consultant physician
Summary
Geriatrics has consistently failed to attract enough staff, and hence geriatric units often cannot provide a full service for the elderly. Meanwhile beds in general medical units may be blocked by elderly patients. This division between geriatric and medical units is arbitrary and wasteful. There are no clinical processes or techniques unique to geriatrics, which is probably why the specialty is unattractive; few doctors want to confine their attention only to the elderly. Geriatrics as a separate specialty should therefore be largely abandoned and the care of the elderly reintegrated into general medicine.
Introduction
The paper by McArdle et all on the problem of long-stay patients in acute medical wards has clearly provoked the ire of geriatricians,23 some of whom have suggested that this can best be solved by transferring large numbers of beds from the care of general physicians to that of the geriatricians. The problem that they describe is clearly widespread and causes much illfeeling between medical and geriatric units. In many areas the admission to hospital of elderly patients who fall acutely ill is haphazardly divided between medical and geriatric units. The
medical units are usually reasonably well staffed, but there is often reluctance to admit certain elderly patients because of the well-founded fear that large numbers of beds will be blocked for many months at a time. In my own general medical unit about a third of the women inpatients are awaiting transfer, either to chronic sick wards or to accommodation provided for those in need of care and attention under part III of the National Assistance Act 1948. By contrast, geriatric units are often poorly staffed and are consequently often unable to offer a full service to the elderly. The present arrangements seem to me to be arbitrary, inefficient, unsatisfactory, and uneconomic.
One solution, clearly favoured by some geriatricians, is a massive takeover of general medicine by geriatrics. This conveniently ignores the fact that it has proved impossible to staff geriatric units adequately with British-trained doctors. Although it is over 20 years since the first consultant appointments in geriatric medicine were made, the specialty has consistently failed to attract enough junior and senior medical staff. A recent review4 stated that 600, of senior registrars in geriatrics are from overseas, and already 300o of consultants are from overseas. The author comments that "high prospects are apparently not sufficient to attract doctors in this specialty." If, as is generally expected, the supply from overseas declines, geriatrics will face a further severe crisis in manpower.
