[The development of dual specialization: the clinical geriatrician and the nursing home practitioner, 1945-1990]

Why are there in the Netherlands two geriatric disciplines and how have the professions of clinical geriatricians and nursing home practitioners been developed? Only written sources have been used for the research: articles, annual reports, archives of scientific associations and umbrella organisations. For the elderly chronic patients increasingly less space was available in hospitals after 1945. These patients obstructed circulation in this institution, which focused more on treatment rather than nursing. Although everyone acknowledged the need for more medical attention for this old age group, there was a lot of opposition against the development of special geriatric units in hospitals. Other specialists agreed that they could effectively treat the elderly patient and felt no need for a geriatrician. Contrary to the geriatric units in hospitals, the development of nursing homes flourished. In these facilities, the nursing home medicine evolved and, as opposed to geriatrics in hospitals, less resistance was encountered. The system of registration of medical specialists made it impossible to recognise only one geriatrician, since they worked in both hospitals as well as in nursing homes. The professional development of nursing home practitioners and clinical geriatricians was delayed partly as a result of the general hesitation of the KNMG in acknowledging new medical disciplines and as a result of internal domain discussions.