Identity Crisis or Opportunity? Reflections on Professional Identify Formation as a Family Physician and Geriatrician

Timothy Farrell by Tim Farrell

Family medicine residents often ask me why I decided to pursue a career in geriatrics.  Upon entering residency training in 2004 at Brown University/Memorial Hospital of Rhode Island, I envisioned practicing full-spectrum family medicine and had never considered geriatrics.  It was during my second year that I had the privilege to work with the residency’s geriatrics educator, an internist who had just completed geriatrics fellowship training.  She noticed that I enjoyed caring for the older adults on my patient panel and that I preferred longer visits with patients.   She also pointed out that a career in geriatrics would allow me to develop my emerging interests in scholarship and teaching, and as a result, she challenged me to consider pursuing a geriatrics fellowship.

This challenge from my residency program’s geriatrics educator confronted me with several difficult questions.  How would it feel to give up caring for younger adults and children?  Would I become bored caring for one age demographic exclusively?  Would I maintain my family medicine identity?  I ultimately decided to take the leap to pursue a geriatrics fellowship at Brown University/Rhode Island Hospital and, coincidentally, became the first family physician to enter this internal medicine-based fellowship program.

Since completing geriatrics fellowship training in 2009, the questions I had considered during residency about my family medicine identity still resurface occasionally, but I worry much less about them now.   It has become increasingly evident to me that the patient-centered approach across the continuum of care that is so highly valued among family physicians is equally valued among geriatricians, including internal medicine-trained geriatricians.  As such, my family medicine identity has very much been reinforced by focusing on older adults.  Although I do miss seeing  younger patients, this is offset by the challenges and rewards of caring for older adults as well as the  satisfaction inherent in training the next generation of family physicians to provide outstanding geriatric care.

The “silver tsunami” of aging Baby Boomers is no longer an approaching crisis, but rather a wave that has crested and is now crashing on the shores of the US health care landscape.  Older adults are expected to comprise up to 30% of an average family medicine practice, and primary care physicians far outnumber geriatricians as the workforce who will care for these patients.   The crisis for family medicine-trained geriatricians seems to me not to relate to the maintenance of professional identity as family physicians, but rather to the urgent need to prepare trainees to care for this “silver tsunami” that has reached Utah, the state with the fastest-growing older adult population in the nation.  With only 7,500 board-certified geriatricians currently practicing in the US (mainly concentrated in urban and not rural areas where many older adults reside), a projected need of 30,000 geriatricians by 2030, and only 239 physicians completing geriatric medicine fellowships in 2014 (Brummel-Smith K, J Am Board Fam Med 2015), it will take the combined efforts of both family physicians and geriatricians, including leadership training to develop a sufficient supply of geriatrician mentors for family medicine residents, to adequately care for older adults both locally and nationally.

Tim Farrell, MD is an Assistant Professor in Geriatrics at the University of Utah School of Medicine. He maintains his Family Medicine board-certification.

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