General Internal Medicine and Geriatrics: Building a Foundation To Improve the Training of General Internists in the Care of Older Adults

7 October 2003 | Volume 139 Issue 7 | Pages 609-614

Internists—"doctors for adults"—provide most of the medical care given to older Americans, especially those with serious chronic disease. Nonetheless, the United States lacks an adequate physician workforce with mastery in caring for older persons and with expertise in building knowledge about how best to provide this care. This supplement aims to strengthen the physician workforce by fostering incremental and sustained improvements in the training of internal medicine residents in the care of older adults and in the development of geriatrics-oriented general internal medicine faculty. It identifies 3 major barriers to these improvements: lack of adequately trained teachers and mentors, the belief that explicit training in geriatrics has little to offer the generalist, and inadequate funding. Three strategies offer particular promise in overcoming these barriers: engaging directors of internal medicine residency programs, funding centers to promote collaboration between teaching and research programs in general internal medicine and geriatrics, and providing substantial incremental funding on the national level to pay for the time required to care for frail older patients and to teach and do research about this care. The barriers and strategies identified in this supplement may also inform efforts to enhance the skills of practicing physicians and improve training and faculty development in family medicine and other disciplines.

Author and Article Information

From the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California; Regenstrief Institute and Indiana University, Indianapolis, Indiana; and Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Grant Support: In part by a grant to the Society of General Internal Medicine from the John A. Hartford Foundation, Inc., and by grants to the University of California, San Francisco, from the National Institute on Aging (K-07 AG00912) and the John A. Hartford Foundation, Inc. (2000-0455). Dr. Landefeld is a Senior Scholar in the Department of Veterans Affairs National Quality Scholars Program.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: C. Seth Landefeld, MD, Box 1265, University of California, San Francisco, San Francisco, CA 94143-1265; e-mail, sethl{at}medicine.ucsf.edu.

Current Author Addresses Dr. Landefeld: 4150 Clement Street, University of California at San Francisco, San Francisco, CA 94121.

Dr. Callahan: Center for Aging Research, Indiana University, 1050 Wishard Boulevard, RG6, Indianapolis, IN 46202.

Ms. Woolard: Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157.