To become a subspecialist in geriatric medicine, first a student must go through the typical arc of medical schooling. That is, four years in an undergraduate degree program, four years of medical school and then at least three years of residency in either family medicine, internal medicine or psychiatry. Then there’s an additional one to two years in a geriatrics fellowship, in which physicians spend time with older patients in a clinic or nursing home setting and learn the specific knowledge and skills for how to provide a continuum of care for them. “Essentially, you have to know just how the body wears and tears as it ages,” says Louisiana geriatrician Teresa Garrison, M.D.
While the fellowships are often sponsored by big hospitals or agencies like the U.S. Department of Veterans Affairs, “These folks are coming out with phenomenally huge medical student debt,” Saunders says. “Physicians who go into geriatrics need to be able to make a living.”
But Saunders says the issue runs deeper, to something more systemic in our society and the place it makes for older people. “There is no doubt about it: We are a throwaway society,” she says. “Youth is better. And medical students are ending up with negative stereotypes, which further ingrains a stereotype against older people.” Additionally, she says, medical school teaching is oriented toward curing people, whereas doctors who treat older adults more often need to be focused on managing disease and slowing decline — a very different mindset.
By the end of April, more than 3,000 coronavirus cases had been reported at assisted living facilities in Louisiana, and state officials reported 637 deaths of residents at nursing homes and other assisted living facilities across the state. The five nursing homes Batie visits are all in a full-scale war on the virus, but none has had the sort of tragic breakout of the virus that has developed at many facilities across the country.
Batie’s practice is in the eastern part of Baton Rouge, where 1 out of every 4 residents live in poverty. “It’s the inner city,” he says. Many patients use a local hospital as their primary care provider, believing that, “I only go to the emergency room for my health care,” he says. “And if you are sick enough to go to the ER as a senior citizen, chances are, when we do intervene, it is going to take a lot of work.”
The reliance of many older Americans on emergency rooms worries Batie. Too many ER visits and too many different doctors often leads to a situation called polypharmacy, in which older patients wind up with numerous, sometimes contraindicated, prescriptions. Which is why he encourages his younger patients to bring their parents and grandparents in to see him, too.