The PRMS Blog

Guest Blog: We are needed

 


As a part of PRMS’ ongoing commitment to behavioral health, we invited James Bouknight, MD, PhD, in Charleston, SC, to be featured as one of our guest bloggers this month. 

The growth in the geriatric population both in the United States and worldwide presents issues and opportunities for the medical community in general and psychiatry in particular.  According to the National Institutes of Health (NIH) the percentage of people 65 and older worldwide is expected to double to 1.6 billion by 2050.  In the United States the numbers reflect the global trend with a population of 88 million geriatric individuals by 2050. Even more remarkable is the world growth in the “oldest old,” people age 80 and over, which is expected to triple to almost 447 million by 2050. The reasons for the dramatic growth in the geriatric population are multiple: extended lifetimes, decreases in risk behaviors such as tobacco use and advances in controlling infectious diseases all contribute to the growth of the geriatric population. 

In the United States, a major contributor to the growth of the geriatric population is the aging of the Baby Boomers, that group born between approximately 1946 and 1964. Living longer is not necessarily synonymous with living better. With increasing age cardiovascular, endocrine, renal, orthopedic and pulmonary conditions tend to worsen.  In my work, I observe increases in mood disorders and, most particularly, with neurocognitive disorders caused by Alzheimer’s disease, vascular dementia, Lewy Body Dementia, Parkinson’s Disease and other less common causes of neurocognitive disorders.  An often neglected aspect of psychiatry in the aging population is substance abuse which is becoming more prevalent in the geriatric population as the Baby Boomers age.

As a former program director of a geriatric psychiatry fellowship program and teacher to our general psychiatry residents and medical students, I was often asked “Why become a geriatric psychiatrist?” Many people both in and out of medicine see treating geriatric patients as more of a burden than an opportunity. I have had my students say that geriatric psychiatry is depressing “because your patients die.”  It then became incumbent upon me to point out that ALL of our patients die, it’s only a question of when. My response to the question of why become a geriatric psychiatrist is multiple:

1. Every part of our patients’ lives has value and the privilege of being a participant in their lives is an honor. Children and middle aged adults are not necessarily less challenging than geriatric patients.

2. In geriatric psychiatry, the patient’s family and caregivers are usually a part of the treatment. This gives us the opportunity to be a part of the environment in which the patient lives rather than a 55 minute session once every three months as is often the case with adults.

3. We are needed. The American Association for Geriatric Psychiatry estimates that an additional 2,500 geriatric psychiatrists will be needed by 2030. Geriatric patients received most of their psychiatric care from primary care providers, physicians, nurse practitioners or physicians’ assistants. While these non-psychiatrist providers do their best to treat their geriatric patients, they are not specialists and suboptimal care is often the result.

4. Financial security is guaranteed in a field with such a dramatic shortage of physicians. Medicare is the primary payer for geriatric patients but many physicians choose to “opt out” of Medicare and only accept cash payment. In either case, incomes are reasonable and above those of many medical specialties.

5. There are innovative ways of delivering medical care to geriatric patients which are outside of the usual office based practice. One of the most effective ways of distributing our expertise in geriatric psychiatry is through Telepsychiatry which is especially important in rural, underserved areas.

6. Career satisfaction should rank high in the reasons to choose a specialty. The data indicate that geriatric psychiatrists report high rates of career satisfaction than many other subspecialties.

7. Research into neurocognitive disorders and treatments is very active with new approaches to these illnesses being developed on many fronts. This gives the geriatric psychiatrist the opportunity to participate in research which could benefit our patients.

8. Finally, the satisfaction of being a part of a patient’s life makes geriatric psychiatry particularly rewarding. These patients have experienced aspects of life that we may never experience.  I have had the honor of treating members of “The Greatest Generation” and they have taught me about life and resilience.

Although I am “semi-retired” now, I am still active in geriatric psychiatry.  I serve as an expert witness for both defense and plaintiff in legal proceeding.  I also participate in evaluations of geriatric patients for the probate court system.  These are usually determinations of the need for a guardian and/or conservator to protect the interests of the geriatric patient.  Physical, emotional and financial abuse of older individuals is rampant in our society and we as geriatric psychiatrists are the advocates for our patients.  I can truly say that geriatric psychiatry provided me with career satisfaction that I don’t believe I would have received from another medical specialty. 

 

James Bouknight, MD, PhD

Dr. James Bouknight earned a doctor of medicine from the Medical University of South Carolina, Charleston, South Carolina. Prior to his medical degree, he received a bachelor of arts in economics from Wofford College, Spartanburg, South Carolina; a master of arts in economics from Duke University, Durham, North Carolina; and a Ph.D. in economics from the University of South Carolina, Columbia, South Carolina.

After serving a residency at William S. Hall Psychiatric Institute, Columbia, South Carolina, Dr. Bouknight was employed by the Columbia Area Mental Health Center and WJB Dorn Department of Veterans Affairs Medical Center, Columbia, South Carolina; and Charter Rivers Hospital, West Columbia, South Carolina. During five years at Charter Rivers Hospital he served as Director of the Partial Hospitalization Program, Director of the Geriatric Psychiatry Service and president of the medical staff. Dr. Bouknight joined the faculty of the USC School of Medicine in 1993, and was named Director of Geriatric Psychiatry in 2004.

Board certified in psychiatry and geriatric psychiatry, Dr. Bouknight has added qualifications in geriatric psychiatry. His special interests are in the treatment of dementias and mood disorders.

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