When Paul Beeson wrote on this subject in the 1984 CONTEMPO issue,1 he pointed to the ongoing debate about whether geriatrics should be certified as a subspeciality. Many internists who already see preponderantly older adults as patients may oppose the development of another speciality that threatens to take away these patients or implies that they are providing less than excellent care. Manpower studies suggest that the addition of any certified subspeciality creates more physician visits and fragmentation of health care. In the worst case, the elderly person would now go to six physicians instead of five, adding a geriatrician to the panoply of subspecialists.
But there is growing acceptance of the special knowledge and skills needed in the care of older adults; a clear role for academic geriatricians is beginning to emerge. The content of fellowship training in geriatrics has varied significantly from program to program, but now a