Status of geriatric medicine in the United States

Geriatrics has experienced a gradual and cyclical evolution in the United States. A considerable amount of attention has recently been focused on the status of geriatric medicine and the issue of specialty recognition. Numerous organizations within established medicine have developed position documents and are in the process of re-examining their status. In the United Kingdom, physicians can now be designated as having a special interest in geriatric medicine, and Canada is proceeding with the development of a certificate of special competence in geriatric medicine under the auspices of the Division of Medicine, Royal College of Physicians and Surgeons. This paper presents hypotheses to account for the lack of organization status in geriatrics, and arguments are examined regarding the need for specialty recognition. There is general consensus that geriatrics has an identifiable body of knowledge and skills and that there is need for a cadre of academic geriatricians and educators in geriatrics for students and residents. However, specialty recognition introduces conflict within established specialties that consider care of the elderly crucial to their existence. The options for special recognition, including a certificate of special competence, are described with their advantages and disadvantages. Substantial arguments favor some form of specialty recognition.