Aging, the Medical Subspecialties, and Career Development: Where We Were, Where We Are Going

Arti Hurria, MD; Kevin P. High, MD, MS; Lona Mody, MD; Frances McFarland Horne, PhD, MA; Marcus Escobedo, MPA; Jeffrey Halter, MD; William Hazzard, MD; Kenneth Schmader, MD; Heidi Klepin, MD, MS; Sei Lee, MD, MAS; Una E. Makris, MD, MSCS; Michael W. Rich, MD; Stephanie Rogers, MD; Jocelyn Wiggins, BM, BCh; Rachael Watman, MSW; Jennifer Choi, BS; Nancy Lundebjerg, MPA; Susan Zieman, MD, PhD


J Am Geriatr Soc. 2017;65(4):680-687. 

In This Article

Conclusion: Thoughts From Dr. William Hazzard

As subspecialty sections within AGS and the work described here demonstrate, much progress has been made in integrating geriatrics and aging research into the subspecialties under the umbrella of AAIM, the Atlantic Philanthropies, and the JAHF, but the Atlantic Philanthropies is completing its mission in 2015, and the JAHF is pursuing new directions, especially related to the preparation of the workforce required to meet the healthcare needs of the aging U.S. population. Moreover, despite the efforts of the SGIM and SHM in advocating for the inclusion of geriatrics in general internal medicine, these closely related fields are not fully integrated. Thus, progress in merging general internal medicine, hospital medicine, the medical subspecialties, and geriatrics remains a work in progress in a time of uncertain funding for all of these disciplines, especially research and training in academic centers.

The process of healthcare reform, especially since the passage of the Affordable Care Act, in which increasing safety, especially in the hospital and with respect to iatrogenic complications in the care of elderly adults, is a centerpiece of the movement, is deeply affecting efforts to integrate geriatrics and aging research into the subspecialties. Efforts are underway not only to increase safety at the hospital, but also to change the focus of care away from the hospital to postacute care and primary care practices. Under the auspices of the Center for Medicare and Medicaid Innovation under the Affordable Care Act, emphasis (and payment) will shift from the quantity of care provided (notably of high-cost procedure-based care in a fee-for-service model) to supporting measures reflecting the value of care to each individual at the center of attention, often in a multidisciplinary team–based fashion. In this context, the subspecialties will be needed, but the successful subspecialists will be those who are more aware of where people receive their care, offer better care to older adults in a variety of settings, and work in teams. Thus funding agencies and institutions will prize people skills and team-building skills, which are often not specified in the review criteria for extramural grant applications or promotion of faculty, in grant review as they consider faculty promotions and compensation for faculty. Subspecialties will have to account for these skills as they consider how they will train future specialists and meet the needs of the most rapidly growing and vulnerable population needing care: older adults.