Integrating geriatrics into the subspecialties of internal medicine: introduction.

William R. Hazzard, M.D. T Nancy Woolard he John A. Hartford Foundation has a long history of initiating and supporting projects designed to educate physicians on the special needs and requirements of the rapidly aging patient populaBowman Gray School of Medicine of Wake Fortion. Examples of this commitment include an Institute of Medicine est University, J. Paul Sticht Center on Aging, report on ways to strengthen physician training in geriatrics, an AmerWinston-Salem, North Carolina. ican Geriatrics Society (AGS) award to improve geriatric training in nonmedical specialties, an initiative that addresses training for generalists in internal medicine called ‘‘Geriatrics in Primary Care Residency Training,’’ and the substantial participation of the foundation in the prestigious Paul Beeson Faculty Scholar Award, a 3-year junior faculty research development award. Equally vital targets in this process of ‘‘gerontologizing’’ the education of physicians are subspecialists in internal medicine. For several decades the best, most academically oriented graduates of medical schools who chose internal medicine residencies did so planning subsequently to pursue subspecialty fellowship training and certification. Although there are signs of a shift toward generalist careers by medical school graduates, opportunities to advance biomedical knowledge for such prevalent geriatric problems as cancer, arthritis, and heart or lung disease rest on capturing the interest of academic subspecialists. Clinical management of the elderly patient may involve subspecialists, who act not only as consultants but also as primary (‘‘principal’’) care physicians, often assuming responsibility for the ongoing management of a cancer patient or a patient with serious chronic heart or lung disease. Optimal training of current and future physicians, as well as clarification of patient management options Presented at Oncology Geriatric Education Reand needed research for diseases whose prevalence and complexity treat: Integrating Geriatrics into Oncology Training, San Juan, Puerto Rico, February 21–26, increases with longevity, require that the domains of internal medi1997. cine’s subspecialists, geriatricians, and generalists be strongly and explicitly bridged. Supported by a grant from the John A. Hartford To address this imbalance, a grant was made in 1994 by the Foundation of New York to the American Geriatrics Society with program administration proHartford Foundation to the AGS to develop a program to ‘‘Integrate vided by The Bowman Gray School of Medicine Geriatrics into the Subspecialties of Internal Medicine.’’ This project, and the J. Paul Sticht Center on Aging. administered by the authors of this article at the J. Paul Sticht Center on Aging of the Bowman Gray School of Medicine of Wake Forest Address for reprints: William R. Hazzard, M.D., University, is designed to raise awareness and foster collaboration J. Paul Sticht Center on Aging, Bowman Gray School of Medicine, Wake Forest University, within each of the medical subspecialties through: Medical Center Boulevard, Winston-Salem, North Carolina. 1) Heightening the sensitivity of academic leaders to the specific Received May 9, 1997; accepted May 21, 1997. needs, opportunities, and challenges of caring for an aging pa-