Geriatrics in the Netherlands

De Koninklijke Nederlandsche Maatschappij ter bevordering der Geneeskunst Royal Dutch Medical Association.

Nederlandse Vereniging voor Klinische Geriatrie (NVKG) Dutch Geriatrics Society

Introduction
The Dutch Geriatrics Society was founded in 1999 to promote the interests of elderly in need of medical care, to promote education, training and standards in geriatric medicine for every health care professional, to fight ageism in the health care system and to establish geriatric medicine in every hospital. Prior to 1999, the Dutch Society for Geriatric Medicine was an organization, founded in the 1970’s, in which medical specialists in geriatric medicine worked together with nursing home physicians and physicians caring for elderly in the community (within the community mental health care teams). Because of the rapid development of Geriatric Medicine as an independent specialty, amongst other things, it was not possible to promote the interests of the specialty within the framework of this society, which was dissolved in 1999.

Geriatric medicine was recognised as an independent specialty in 1982. At the moment, 70 out of 110 hospitals in the Netherlands can offer geriatric consultation for their patients by a consultant geriatrician. Some hospitals only have geriatric consultation for inpatients and an outpatient clinic, others have all modalities for geriatric consultation: an inpatient geriatric department, outpatient clinic, a facility to admit patients for one-day screening (Diagnostic Day Centers) and inpatient consultation. In many of the hospitals without some form of geriatric medicine the awareness of the need for geriatric expertise is rapidly growing.
The number of consultant geriatricians is still increasing, at the moment there are approximately 150 registered geriatricians in the Netherlands.

Training
The training to become a consultant geriatrician comprises 5 years of training, 2 years in internal medicine, 2 years in geriatrics (either in a non-university or university hospital), and 1 year in old age psychiatry. The number of residents in training is 60.
Trainees follow an obligatory national course of 14 days during their two years in geriatric medicine and one year in old age psychiatry, with state of the art lectures in the morning, and case presentations and interactive teaching in the afternoon. The teaching is based on the European Academy for Medicine of Ageing (EAMA) model.

Teaching
There are eight medical schools, one has a full professor in Geriatric Medicine (Nijmegen) and 2 others have chairs in Internal Medicine with a special interest in Medicine of Ageing (Groningen, Leiden). There are three university training departments (Nijmegen, Rotterdam, Utrecht). . Although all eight medical schools dedicate part of the curriculum to teaching aspects of Ageing and Geriatric Medicine, both in the undergraduate and in the postgraduate part of the curriculum, there is no standard national curriculum, and a wide variation in the time dedicated to these topics, and in contents, exists. 

Political factors
The Government has become aware of the increasing proportion of elderly people in the population and the demands this will make on the health care system. In November 2007 the Undersecretary for Health Care earmarked 80 million Euros for the National Program for the Care of the Elderly. This program aims to further develop regional networks (programs) for the health care for the elderly, to organize the care for the specific needs of each individual in a cost-effective way, to coordinate what the different providers in the health care system can offer to the elderly in a coherent way, and to boost research into prevention and improving diagnostic tools for health problems in the elderly.
The National Program for the Care of the Elderly is the first national program. As yet, it has not been possible to establish new national research programs on important topics such as falls or dementia. 

Postgraduate Research
As there are only 3 university departments in Geriatrics, all founded in the 1990’s, there were few geriatricians with PhD degrees, but now the amount of PhD research in these departments is increasing. Although it is difficult for geriatricians practising outside the university hospitals to have the time and opportunity to do PhD research, the number of colleagues with PhD degrees is rising. Research within large non-university hospitals is considered now as part of Quality Management Programs.

Organization of the health care system
The health care system is publicly funded, each citizen is insured compulsorily. Since 2007 the insurance companies may make a profit and should compete commercially to attract as many policyholders as possible. The insurance companies are obliged to offer a policy to any citizen, regardless of their current health status or known major health risks (e.g. AIDS, cancer, dementia). Insurance companies are compensated for excessive costs for these patients out of a national fund.

Rehabilitation and long term care is in many countries an integral part of the health care the geriatrician provides. This type of medical care is provided by nursing home physicians in the Dutch nursing homes. This is mainly chronic care, the physician is actually the “GP” for the nursing home residents. There is also a separate specialty in rehabilitation medicine, with separate institutions for rehabilitation, but for most elderly patients the nursing homes provide the rehabilitation services.

Geriatricians provide consultation in nursing homes, but mainly provide the acute hospital admission services. Three “geriatric giants”, dementia, osteoporosis and falling/falls prevention are dealt with in a geriatric diagnostic day-clinic setting in many hospitals. In the hospitals there is extensive geriatric consultation by a geriatric team consisting of a geriatrician and a specialized nurse. In many hospitals there are also specialized geriatric physiotherapists and occupational therapists.

GPs are the “gatekeepers” in the health care system and decide whether diagnosing and treatment of a problem needs a specialist’s attention. Often the geriatrician is consulted by the GP how to manage an acute medical problem in an elderly patient. Health care regions differ in the measure of cooperation between geriatricians and nursing home physicians in supporting the GP to try and treat elderly patients as far as possible in their own environment. GP’s are also assisted by physicians who are trained in the “social management” of geriatric patients living in the community. These physicians are employed by regional organizations for psychiatric treatment outside the hospitals (the community mental health care teams). They treat problems of old age psychiatry and dementia in elderly living in the community.

Organization
Number of members: 220
Membership is open to geriatricians and residents.
Extraordinary membership is open to any medical professional interested.

Journal
Tijdschrift voor Geriatrie and Gerontologie, published 6 times per year
(Journal of Geriatrics and Gerontology)

Congress
Annualy, in February, in cooperation with the Society of Nurses in Geriatric Medicine and the Society for Physicians in social management of frail elderly.

Scientific Meeting
There are 3 meetings every year.

Contacts in the Netherlands

Dr. , MD PhD

Jaap Krulder

jkrulder@vlietlandziekenhuis.nl
+31 108 935 316
MD, PhD

Marianne B. van Iersel

marianne.vaniersel@Radboudumc.nl
+31 24 36 16 722