Exploratory survey study of differences in knowledge, attitudes, and practices of outpatient older adult clinical care between dermatologists, primary care physicians and geriatricians across three academic medical centers

According to the United States Census Bureau, the population aged ≥ 65 years is projected to increase, and the percentage of office visits from older adults to specialist physicians, such as dermatologists, will also increase. Despite older adults comprising an estimated 40% of dermatology visits currently, there is no formalized postgraduate curriculum on outpatient geriatric clinical care. Here, we performed an exploratory study to assess whether differences in the knowledge, attitudes and practices that are universal to outpatient geriatric clinical care exist among dermatologists compared to primary care or geriatric medicine, fields with formalized postgraduate curricula on outpatient geriatric clinical care. Following Institutional Review Boards’ approvals, a voluntary, anonymized online survey was conducted in 2023 of faculty physicians from Dermatology, Primary Care (Internal Medicine/ Family Medicine) and Geriatric Medicine departments/divisions at three academic centers, Stanford University, University of California San Francisco and Emory University. Validated survey items were used whenever possible. All statistical tests applied to the results were adjusted for multiple comparisons. The overall response rate was 30.4% (146 completed surveys out of 480 invited). Knowledge of the 4Ms geriatric clinical framework was lowest amongst dermatologists (3.9%), followed by primary care physicians (17.8%) and geriatricians (100%). Attitudes on whether training program(s) provided adequate number of didactic lectures on clinical care of older adult patients indicated dermatologists responded with the lowest level of agreement (mean Likert score (MLS) 2.3, standard deviation (SD) 1.0) compared to primary care physicians’ responses (MLS 2.9, SD 1.1) and geriatricians (MLS 4.2, SD 1.4), padjusted < 0.05 for all comparisons. Practice differences in screening for mentation status were found, with dermatologists responding with lowest frequency (MLS 1.9, SD 1.2), followed by primary care physicians (MLS 3.7, SD 0.8), and geriatricians with highest frequency (MLS 4.5, SD 0.7), padjusted < 0.0001 for all comparisons. Our data suggests that differences exist in the knowledge, attitudes and practices of outpatient clinical care of older adults in specialty fields (in this case dermatology) compared to primary care and geriatric medicine, and are actionable findings. Additional investigation into whether these differences are found in other specialized fields could inform future postgraduate training and research.