Geriatrician in Latviawhere to get treatment, how to verify certification, what this doctor does

A geriatrician is a doctor specialising in the treatment of older people. The geriatric patient is characterised by several chronic conditions at once, atypical presentations of illness, and geriatric syndromes. The doctor assesses health as a whole, reconciles medicines, and plans care, including at home and in long-term care settings.

• Instability and falls
• Immobility and restricted movement
• Incontinence
• Dementia and other cognitive impairment
• Depression, and vision and hearing loss
• Flare-ups of several chronic conditions and medication reconciliation

The family doctor is enough while chronic conditions are stable and the medicine list is manageable. A geriatrician is needed when conditions start to interact, when the medicine list grows long, or when the ability to self-care is slipping.

Geriatrics in Latvia has no separate sub-specialties. What differs in practice is the setting: some geriatricians work in hospital treating flare-ups of chronic disease, while others consult in outpatient clinics or plan care in long-term care institutions.

• Six years of medical study and a doctor's degree, at RSU or the University of Latvia.
• Residency in geriatrics. The RSU programme runs 5 years, 330 ECTS, tuition 5,800 EUR per year, led by Lect. Daina Zepa. Programme page: RSU residency programme.
• Practical training takes place in internal medicine, surgery, trauma, orthopaedics and neurology clinics, in multi-profile hospitals, and in outpatient settings.
• The state examination covers theory plus defence of a research project.
• The certificate is valid for 5 years. Recertification requires 250 continuing education points, at least 60 per cent tied to the base specialty, plus a 48.38 EUR fee.
• Entry in the practitioners register must be renewed every 5 years.

• Availability. There are few geriatricians in Latvia, so in practice the choice is between the Gerontology Clinic and a small number of private clinics.
• Languages. Consultations run in Latvian, and in most institutions in Russian too.
• Age groups. Geriatricians see adults, in practice mainly patients aged 65 and over.
• Appointment length. A scheduled geriatric consultation runs longer than a standard specialist visit, because every diagnosis and medicine has to be reviewed. Premium Medical's price list sets it at 60 minutes.
• Second opinion. Patients may freely choose the doctor and institution, including seeking an internist's or neurologist's view alongside the geriatrician's.

• Bring a list of every medicine taken with doses, including over-the-counter products and supplements, hospital discharge summaries, and the most recent test results.
• It helps if a relative or carer comes along, since they can fill in what daily life, falls and memory actually look like.
• A referral from a family doctor or another specialist is needed for a state-funded consultation.
• At the visit the doctor assesses not only diagnoses but mobility, balance, cognition, mood and self-care, then reconciles the medicine list.
• The output is often a care plan that also involves relatives, social services or home care.

In the public system, with a referral, a specialist visit carries a 4.00 EUR patient co-payment, while a family doctor visit from age 65 costs 1.00 EUR. Several population groups are exempt, and co-payments in one calendar year are capped at 570.00 EUR. At the Gerontology Centre, inpatient and day hospital care are also offered as paid services.

• Scheduled geriatric consultation, 60 minPrice EUR: 90.00Provider: Premium Medical
• Patient co-payment for a specialist visitPrice EUR: 4.00Provider: NVD
• Patient co-payment for a family doctor visit from age 65Price EUR: 1.00Provider: NVD
• State-funded day hospital treatmentPrice EUR: 7.00 per dayProvider: NVD

No dedicated geriatrics association appears in the our records.

Certificates in geriatrics are issued by the Certification Council of the Latvian Medical Association, founded in 1988. The sector regulator is the Health Inspectorate.

If you have doubts about the quality of care, raise them first with the institution's management, which must operate a complaints and suggestions system. If that does not resolve it, a written submission goes to the Health Inspectorate no later than two years after the alleged infringement, and is reviewed within 30 days, extendable to four months in complex cases. If the patient cannot file the complaint themselves, an authorised representative may do so. The procedure is set out on the Health Inspectorate site.