Is geriatrics a primary care or subspecialty discipline?

OBJECTIVE

To determine how much of the clinical care provided to older persons by geriatricians is primary versus consultative.

DESIGN

National Survey.

PARTICIPANTS

Candidates for the 1988 certifying examination in geriatrics, physicians who expressed interest in the examination but did not register for the examination, and physicians who expressed no interest in the examination (comparison group physicians).

RESULTS

Based on a 72% response rate, 78% of the care rendered by certified internal medicine geriatricians and 90% of the care rendered by certified family practice geriatricians to older persons was primary care. Internal medicine geriatricians spent a greater percentage of their care of older persons providing primary care compared with internists with no interest in geriatrics. Although internist geriatricians who were formally trained or had additional subspecialty certification provided less of their care as primary care compared with geriatricians who had no formal training, the majority of care (approximately 70%) provided by each of these two subgroups was primary care.

CONCLUSIONS

The vast majority of care provided to older persons by geriatricians is primary care, and these physicians should be considered as generalists for health policy and educational purposes.