{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Search for Geriatrician Identity: Mary Tinetti, Helen Fernandez, Jerry Gurwitz, Ken Covinsky","description":"Our focus today is on the search for the geriatrician identity, a continuation of the conversation we started with Jerry Gurtwitz on the Future of Geriatrics.  Today\u2019s conversation is prompted by multiple articles in JAGS: (1) an article by Jerry Gurwitz with a title the same as this podcast; (2) an article by Helen Fernandez on \u201cMed-Geri\u201d, a new combined 4 year internal medicine residency and geriatrics fellowship track; and (3) an article by Mary Tinetti titled, \u201cMainstream or Extinction: Can Defining Who We Are Save Geriatrics?\u201d  Of note, Mary\u2019s article is a follow up to her 2017 article in JAGS in which she wrote: Those outside the field have difficulty understanding what geriatrics is and what geriatricians do. We contribute to this lack of clarity. We are experts in complexity but are often bad at communicating simply. Our well-intentioned efforts to be inclusive and comprehensive lead to the creation of long, complex descriptions of what we do that further compromises understanding while eroding interest in, and support of, our field. Today we tackle this problem, discussing: A \u201cfunny if it wasn\u2019t so painful\u201d video and JAGS article in which geriatricians from Johns Hopkins roamed the streets of Baltimore asking lay people \u201cWhat is a geriatrician?\u201d  The responses (something to do with Ben and Jerry\u2019s ice cream? Jury-atrician?) will make you laugh and cry at the same time. 4 different types of geriatricians as described by Jerry in his JAGS paper: the complexivist, the healthful longevitist, the syndromist, and the contextualist. As with the 4Ms, Ken couldn\u2019t help but add a 5th, the \u201cidentityist\u201d, arguing that maybe Geriatricians worry too much in public about their identity, and should instead focus in public on what unites them: shared sense of purpose and mission to focus on whole person care and what matters most to older adults. Ken gave a rousing talk on being a Geriatrician at the Society of General Internal Medicine that received a lengthy standing-ovation (and a Cubs Jersey with his name on it).  Innovative new programs such as Med-Geri and GeriPal fellowship as ways to bring more people into the profession. How to balance our effort between recruiting specialist geriatricians to the profession and teaching all clinicians geriatrics principles and skills.   A paper in JAGS by Richard G. Stefanacci and Ankur Patel in JAGS making the argument that a geriatrician \u201cyields per-patient annual net cost savings of approximately $3495 (specialist consultation avoidance +$1500; ED reduction +$45; hospitalization reduction +$1950)...\u201d and \u201cThe reason fee-for-service fails geriatricians is not that their skills are wrong for primary care\u2014it is that the payment model is wrong for their skills. Payvider programs operating under capitation invert every structural disadvantage of fee-for-service. Under capitation, there are no RVUs. There is no penalty for spending 40\u2009min with a complex patient. There is no revenue loss when the patient is dual-eligible rather than commercially insured\u2014the capitated payment is the same regardless of original coverage source. And every unnecessary specialist referral, every avoidable hospitalization, every ED visit that could have been managed in-house represents a cost to the organization rather than a revenue stream.\u201d Stay until the end when Mary has one of the best answers yet (in over 400 podcasts!) to Eric\u2019s \u201cif you had a magic wand\u201d question. Enjoy! -Alex Smith ","author_name":"GeriPal - A Geriatrics and Palliative Medicine Podcast","author_url":"http:\/\/www.geripal.org","html":"