General Internists and Family Physicians: Partners in Geriatric Medicine?

The articles in the supplement to this issue of Annals(1–4) reveal internal medicine as a discipline commit-ted to geriatric medicine. Internal medicine is not alone. Family physicians, who provide more office-based visits than any other specialty in the United States, are also tak-ing steps to ensure adequate training in geriatrics. Our discipline published its own alert in Family Med-icine in 1995. In this position paper, the Group on Geri-atric Education of the Society of Teachers of Family Med-icine (STFM) offered specific suggestions for enhancing undergraduate medical education, residency training, fac-ulty development, and continuing professional education (5). A subsequent series of articles in the same journal outlined recommendations from a series of retreats for family medicine residency directors (6), an update to the 1995 report from the STFM Group on Geriatric Educa-tion (7), a report of a national survey on the current status of family medicine residency education in geriatric medi-cine (8), and a critical commentary on recent changes in the language of the Family Medicine Residency Review requirements for geriatric education (9). We agree that fellowship training is not going to be the whole answer. Currently, accredited family medicine geriatric fellowship programs offer 68 positions, of which 58 were filled in 2003. General faculty development fel-lowship programs in family medicine offer 144 positions, of which 137 were filled in 2003. Too few family physi-cians are preparing for careers in geriatrics. The goals, strategies, and obstacles identified by gen-eral internists in this issue are similar to those identified by family physicians. This congruence of purpose invites con-tinued, more robust collaboration between general inter-nists and family physicians. To that end, we discuss the patterns of service for elderly patients and try to place ge-riatric education into the broader perspective of primary care. We start by defining “geriatric. ” Most geriatricians set the lower boundary of “geriatrics ” at 75 rather than 65 years of age, and we use that admittedly arbitrary definition. HEALTH CARE FOR ELDERLY PERSONS Internists and family physicians play an important role in the care of older people. The National Ambulator