Specialty spotlight – geriatric medicine

Professor David Oliver explains what is best about working in geriatric medicine, how the medical field will change in the future, and shares some personal insights and advice.

Introduction to geriatric medicine

Geriatric medicine is an exciting and rapidly growing speciality focused on the care of older people living with frailty, who have multiple conditions and complex care needs. Geriatricians lead a varied life providing care within acute hospitals, outpatient clinics, community units, day hospitals, rehabilitation settings, and patients’ own homes.

Geriatricians have a breadth of medical knowledge covering all medical specialities but can also choose to subspecialise. The practice of geriatric medicine involves teamwork with other health professionals in conjunction with professionals in the voluntary and social sectors to ensure that older people receive the highest possible standard of care. There are well established opportunities for academic training and research into the scientific, clinical and social aspects of disease in old age, and an increasing emphasis on quality improvement research and systems design.

Why did I choose geriatric medicine and why I would recommend it to others?

Geriatric medicine is one of the few medical specialities which treats a plethora of medical conditions and provides an intellectual challenge on a daily basis. Presentations of illness in older people are often non-specific and call for highly trained physicians with specialist medical skills, focused on providing patient-centred rather than disease-focused care. Treating a cohort of patients who are genuinely grateful for your input is immensely rewarding, especially when you acknowledge that small gains in health or functional status can lead to major improvements in wellbeing and quality of life for patients and their families. Coupled with this there are excellent career prospects and less than full time working is routinely accepted for both registrars and consultants. In summary, geriatric medicine provides immense diversity and challenge whilst being enjoyable and fulfilling.

Dr Clare Hughes, SpR geriatric medicine and chair, British Geriatrics Society trainees committee, Birmingham, West Midlands

Training and working in geriatric medicine

Five key facts about training in geriatrics from the Specialty Advisory Committee for Geriatric Medicine (SAC):

  1. Breadth of knowledge and skills required - non-specific presentation means we get fascinating selection of diseases to manage, from psychiatric disease to acute surgical problems through to palliative care.
  2. Multipathology / polypharmacy - Often this broad range will appear in the same patient; it's hugely rewarding being able to go through each issue, balancing treatment for one against the other, and having the patient feel they've been fully assessed and involved with their care
  3. Sub-specialising - Within this, great opportunity to sub-specialise, from the immediate excitement of hyperacute stroke care to the long term relationships you can build up with patients on the rehabilitation wards or with caring for those with chronic diseases such as Parkinson's
  4. Ethical issues - can be very challenging and makes providing care far more interesting; much less driven by protocols and algorithms as these often don't suit our patients
  5. Flexibility - lots of geriatricians develop interests beyond the immediate clinical work, such as in education roles, research.

You can find more information on the training pathway from the Joint Royal Colleges of Physicians Training Board. Learn more about the recruitment and interview process by visiting the ST3 recruitment page.