Pin It Baby boomers are turning 65 at a rapid pace, and the supply of geriatric care experts is not keeping up with the demand.
In a recent report of the Select Committee on Aging of the U. If we are to achieve our goal of increasing the number of trained academic geriatricians, we need to create incentives for physicians to choose a career in geriatric medicine, to provide greater opportunities for clinical research training, to increase geriatric content of undergraduate and postgraduate medical programs, to improve attitudes towards geriatrics by medical students, housestaff, and academic administrative leaders, and to develop public policy initiatives that will mandate increased geriatrics training and facilitate the development of clinical programs targeting older persons.
A considerable effort must be made to overcome some of the significant factors currently impacting negatively on the interest of people in geriatrics careers. Currently reimbursements are skewed towards high technology subspecialties such that brief evaluations of procedures or tests generate more income in a few minutes than the hours of intense care for very sick patients Kowal, The following strategies have been suggested or follow from the issues identified in previous chapters of this report.
Among the approaches that he suggests can be used to improve the situation are creating modifiers that denote patients with multiple functional impairments, expanding the number of payment codes for evaluation and management services and further increasing the assigned value for these services, creating a set of payment codes for comprehensive geriatric assessment, and developing Medicare Part B reimbursement for graduate medical education or allowing the time spent by residents in home care, office, and nursing home settings to be reimbursed by Medicare Part A graduate medical education funds.
They also propose the creation of a National Geriatrics Development Fund to be cosponsored by multiple foundations and individual donors to augment the initial grant to each leadership center.
The alliance envisions as many as 10—15 leadership centers in geriatrics at U. The document outlines a number of specific strategies for addressing the work force shortage in geriatrics, the lack of leaders in geriatric medicine, and the lack of support for training in geriatrics medicine by administrative heads of academic programs.
Among the strategies proposed are 1 higher salaries for trainees and geriatric fellows, 2 low-interest loans for the development of academic careers in geriatric medicine, 3 a loan forgiveness program for physicians entering training in geriatrics medicine programs, 4 improved reimbursement for interdisciplinary care of geriatric patients, 5 training programs that are aimed at amplifying and fostering the research skills of geriatrics fellows, 6 increased funding for Claude D.
Pepper Older Americans Independence Centers and Geriatric Academic Programs, and 7 creation of a 4-year dual certification program that would combine 2 years of training in general medicine and 2 years of training in geriatrics medicine.
The report also recommended the development of an aggressive marketing campaign targeted at administrators and students to effect a major change in attitudes toward geriatric medicine. It emphasized the need for marketing professionals to be at the core of this effort.
He also recommends similar awards to residency programs for the addition of mandatory training in geriatrics. The ADGAP proposal also recommends the development of public policy initiatives that will require institutions that receive a great deal of revenue from Medicare to offer appropriate geriatric training experiences in suitable clinical settings.
Work with residency program directors to a sensitize them to the need for more training in geriatrics, b develop a cadre of leaders with additional expertise in geriatrics, and c develop a model core curriculum for training programs. Work with credentialing bodies to review the national medical examinations for their geriatrics contents, to test performance on geriatrics questions, and to explore the development of additional questions on geriatrics.
Encourage joint educational activities between geriatrics and non-primary care disciplines.
Support research in geriatrics-related topics within each discipline. Work with medical specialties that decide to support graduate courses and symposia on geriatrics topics and special interest groups in geriatrics. It was felt that this was particularly applicable in the early stages of the evolution of geriatrics as a field of medicine.
This model had been followed in a number of other areas of medicine that were provided core funding to undertake both research and training activities. These centers were expected to supply both personnel and techniques of care to the larger medical field, and the recommendation emphasized that, given the small number of currently qualified individuals available at that time and the broad range of needed talents and disciplines, this approach had very real appeal.
That report also emphasized that this consolidation strategy would raise issues of how best to allocate research and training support and pointed out that the Centers of Excellence approach would be of maximal benefit in the early days of faculty training, when most of the needed products of training would not have been deployed.
The Institute of Medicine IOM report on leadership for academic geriatric medicine also recommended the creation of centers of academic excellence. The conferees at the IOM prereport writing conference had clearly been influenced by the recognition of the need for contributions from several of the relevant disciplines involved in academic training programs in order to implement strong clinical and research programs in geriatrics in academic medical centers.
The report emphasized that the Centers of Excellence would focus on the training of faculty geriatricians in an environment with model teachers for educational training, vigorous basic, clinical, and health services research; and a variety of clinical opportunities. Since publication of the IOM report, the Centers of Excellence concept has developed slowly on the national scene.
Most, if not all, centers have been pieced together from multiple funding sources from both the public and the private sectors. This funding has been of varying duration and has been influenced by the national economic constraints of the day.
The resulting instability of the support mechanism for the Centers of Excellence approach threatens the continuance of many centers. There is anecdotal evidence, for example, that the recent major reduction in funding by the Bureau of Health Professions in support of its two major programs on aging may make it impossible for some of the established Centers of Excellence to survive.
Physicians have been admitted to the examination through one of four pathways: (1) the completion of 2 years of advanced training in geriatric medicine; (2) the completion of 2 years of advanced fellowship training in general internal medicine, including 1 year of acceptable training in geriatric medicine; (3) certification by the American. Institute of Medicine (US) Committee on Strengthening the Geriatric Content of Medical Education. Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions. Washington (DC): National Academies Press (US); Doctors who specialize in geriatric medicine receive training in long-term care, ambulatory care, hospice and home care, and rehabilitation for elderly patients Top school choices include the Mt. Sinai School of Medicine (New York, NY), Duke University (Durham, NC), the University of Washington (Seattle, WA) and the University of Pittsburgh.
As part of national policy, it would seem to be critical to ensure the survival of those centers that are meeting national needs in training and research in geriatrics. Geriatrics can clearly benefit from the history of academic programs in other areas, most pertinently, oncology.
The environment, however, is very different from that when academic programs were established, in that most of the other special areas matured in times of abundant economic resources and not in the current period of economic austerity.
Oncology was an unattractive area until the federal government spurred an interest in all research related to cancer. The national commitment guaranteed stable and adequate financial support through the National Cancer Institute, and as a result, oncology developed a high-quality academic identity on the basis of its clinical care, training, and research efforts.
This experience provides a valuable model for the future development of academic geriatrics, because there are important parallels between oncology and geriatrics: Perhaps the most compelling evidence for the value of the Centers of Excellence model stems from the U.
Louis University School of Medicine, personal communication, The staffing model adopted for each GRECC specifies 12 full-time equivalent employees, including a director, three associate directors research, education and evaluation, and clinicalfive researchers a combination of basic and clinical scientistsand three administrative support staff.
These Centers of Excellence have had remarkable success in meeting each of their missions research, education, and clinical service. In fact, funding from non-DVA sources has made up an increasing proportion of their total research funding from 48 percent in to 79 percent in As mentioned above, approximately geriatric medicine fellows have been trained sinceand the GRECCs train more than 1, medical, dental, nursing, and associated health trainees on an annual basis.
GRECCs have been instrumental in the development of geriatric evaluation and management units and dementia units as well as other clinical programs.Focus on Geriatric Training in Medical School Experts say medical students should learn about both inpatient and outpatient geriatric health care.
Conclusion: Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings.
Geriatric physicians are primary care doctors who are specially trained in the aging process. Geriatricians provide comprehensive medical care for people later in life.
They are board certified, usually in either family medicine or internal medicine, and have received additional training and certification in geriatric medicine.
Training Physicians in Geriatric Care: Responding to Critical Need As the nation’s older population grows, the U.S. will require a well-trained workforce of health care. The clinical settings in which geriatric medicine is practiced are quite varied.
Many geriatricians continue in primary care practice, and geriatrics training uniquely equips clinicians for work in rehabilitation, extended care, and home health settings.