It's a sign of the times, or the age, or the aging of the U.S. population.
New York-Presbyterian Hospital/Weill Cornell Medical Center says this month it will launch the first of its kind -- a one-year fellowship in geriatric emergency medicine, and possibly something more.
Neal Flomenbaum, M.D., emergency physician-in-chief at the New York City hospital and a professor of clinical medicine at Weill Medical College of Cornell University, will be one of the clinical leaders of the program, along with geriatric specialists Mark Lachs, M.D., professor of medicine, and Ron Adelman, M.D., associate professor of medicine at Weill Cornell.
Although William Beaumont Hospital in Royal Oak, Mich., started a fellowship program several years ago that provides physicians trained in emergency medicine with exposure to geriatric medicine, Flomenbaum says the New York program will pioneer an entirely new medical subspecialty.
Flomenbaum knows the pioneer trail.
A graduate of Albert Einstein College of Medicine of Yeshiva University in the Bronx, he completed his residency in internal medicine at Bronx Municipal Hospital, now Jacobi Medical Center, and helped found the emergency department there in 1976, three years before emergency medicine was first organized as a medical specialty.
In 1979, Flomenbaum left Bronx Municipal for Bellevue Hospital, where, in collaboration with the New York Poison Control Center under the medical directorship of Lewis Goldfrank, M.D., he helped develop medical toxicology as specialty.
"So I guess there is some logic in seeing a need and developing a specialty for it," Flomenbaum said. And the need is there, he said.
"We see large numbers of patients coming into the emergency departments in the middle of the night in their 90s and 100s."
The New York Presbyterian/Weill Cornell fellowship will include research but will also involve hands-on clinical care, including what Flomenbaum is touting as "the reinvention of the house call for the 21st century."
"The geriatric program already has a home visit program with internal medicine, but they are not trained in emergency medicine," he said. "They are not trained in reductions of fractures, managing trauma around the house, or suturing."
Flomenbaum said he's seen more than a dozen instances in which an elderly patient needed emergency room care, but refused to leave home to go to the hospital.
As the population of America ages, Flomenbaum predicts more and more people will face this dilemma.
"We need people who are not afraid to roll up their sleeves do those things (in the home) and feel comfortable doing it because they're trained to do it," he said. The home visit also will give the physician the opportunity to see the place where the injury occurred.
Using a broken bone as an example, Flomenbaum said, "They can look around this house and say, I wonder why this person fell? That's bringing a lot of thought into the house that you can't do just by staying in the emergency department."
The fellowship's first candidate is to be announced later this month.