Enter T.S. Dharmarajan, M.D. In spite of his initial misgivings, in 1992 he helped launch a pilot, 17-bed inpatient geriatrics unit at Montefiore’s North Division. It marked the beginning of a turnaround, not only in his own career, but also in the lackluster reputation of geriatric medicine.
The man who’s often referred to as “Dr. D” didn’t always aspire to being an expert in geriatric medicine. Even when he was asked to start a geriatric medicine division—a real opportunity to make his mark—he balked. A successful nephrologist, he worried about taking his career in this new. But, he says, “Almost no one in the tri-state area had such a program, nor any idea how to develop one.” So in 1992, he launched a pilot geriatrics unit at what was then Our Lady of Mercy Medical Center in the Bronx, and was told to develop a fellowship program to go with it. “In July 1993,” he recalls, “one fellow entered the program—reluctantly.”
Today, 18 years later, the New York Medical College sponsored Geriatric Fellowship Program at Montefiore’s North Division, where Dharmarajan is currently vice chairman of medicine and associate dean, is thriving. With a complement of eight fellows, it is one of the largest and most highly acclaimed in the nation. In 2008 it received five-year approval (the maximum achievable, later increased to six) from the Accreditation Council for Graduate Medical Education (ACGME).
Besides honing their clinical skills, most fellows teach, do research, and at the end of the year-long program, take the geriatric medicine certification exam conducted by the American Board of Internal Medicine. After that, while some fellows enter academic medicine, the majority go into clinical practice.
Geriatric medicine deals with a wide spectrum of patients age 60 and older. Diagnoses run the gamut from constipation and hypertension to type 2 diabetes, hip fracture, dementia and heart failure. In addition to the hospital, the geriatric fellows see patients at local outpatient clinics, nursing homes and adult daycare facilities and in patients’ homes.
Dealing with older patients in a variety of settings teaches key lessons about caring for this population. One of the most important is learning how to distinguish between a person’s chronological and physiological age. Fellows also must learn the difference between physical changes brought about by normal aging and those caused by disease. They also need to understand the potential dangers of polypharmacy—the prescribing of many medications—a critical skill, since up to half of American adults aged 65 years or older take five or more different medications daily, as well as non-prescription remedies and supplements.
Richard G. McCarrick, M.D., vice dean for graduate medical education and affiliations, agrees with the importance of recognizing the breadth and depth needed to be a good geriatrician. “Geriatrics is one of the most challenging fields of medicine, due to the broad range of knowledge required. Like pediatrics, it deals with all diseases encountered in a particular age group, so in addition to general internal medicine, geriatricians must know a great deal of neurology, psychiatry, physical medicine and pain medicine,” he says. “Society’s need for experts in geriatrics is enormous and growing. Because of Dr. Dharmarajan, and with the continuing support of Montefiore Medical Center, the College is a leader in addressing this need.”
Page updated: October 1, 2011