Urgent Changes Needed to Prepare Geriatric Doctors
to Care for Aging America
Most of today's primary care physicians are not
adequately trained to provide the complex care needed by older adults
with multiple chronic conditions
May 5, 2010 For years it has been evident that
the U.S. is rapidly moving toward a period when there will just not be
enough geriatric physicians available to treat the mushrooming senior
citizen population. Now, leading physician policy experts are calling
for changes in medical education policy at multiple levels to ensure
that doctors are prepared to treat the country's aging adult population.
"The geriatric imperative of the 21st century
requires major, rapid changes to our health care system," said Dr.
Steven R. Counsell, M.D., co-author and an Indiana University Center for
Aging Research center scientist.
"Through educational policy reforms at the state
and federal levels, policymakers can catalyze the dramatic workforce
changes necessary for delivery of cost-effective chronic care to the
rapidly swelling ranks of older Americans."
In the May issue of Health Affairs,
co-authors Counsell, Mary Elizabeth Mitchell Professor and director of
geriatrics at the Indiana University School of Medicine and a
Regenstrief Institute affiliated scientist, and colleagues Chad Boult,
M.D., M.P.H., M.B.A., Rosanne M. Leipzig, M.D., Ph.D., and Robert A.
Berenson, M.D. propose several policy solutions to help the United
States prepare for the increasing number of geriatric patients.
The article, entitled "The Urgency of Preparing
Primary Care Physicians to Care for Older People with Chronic
Illnesses," proposes multiple policy-driven solutions. Leading physician
policy experts are calling for changes in medical education policy at
multiple levels to ensure that physicians are ready to treat the
country's growing older adult population.
To ensure a better trained physician workforce as
the demand for geriatric care swells and the number of geriatric
specialists shrinks, policy options proposed by the authors include:
● Increasing funding for geriatrics in medical
schools
● Leveraging Medicare's educational subsidy to
strengthen geriatrics in residency and fellowship programs
● Requiring practicing physicians to complete
geriatric continuing education credits in order to maintain their state
licensures and Medicaid provider certifications
The authors propose modifying Title VII of the U.S.
Public Health Service Act to provide financial support for medical
schools and residency programs that adopt the educational innovations
needed to care for an aging society.
Similarly, the Medicare program, which provides
teaching hospitals with large annual subsidies for graduate medical
education, could make continued educational funding contingent on rapid
reforms in the training of resident physicians and specialty fellows. To
drive swift educational reform, new Medicare policy could link a
significant portion of the teaching hospitals' annual direct and
indirect medical education payments to the amount of training they
provide in primary care, chronic care and geriatrics.
"As Medicare funds are intended to enhance the care
of Medicare beneficiaries, the logic of prioritizing training for
chronically ill older patients is compelling," said Dr. Berenson, a
fellow at the Urban Institute. "Another policy option is to extend
Medicare graduate medical education funding to non-hospital clinical
training sites, such as nursing homes," added Dr. Leipzig, the Gerald
and Mary Ellen Ritter Professor and vice chair of education in the
Brookdale Department of Geriatrics and Palliative Medicine at Mount
Sinai School of Medicine.
To support continuous geriatrics training of the
many physicians already in practice, the authors propose that state
policies could require geriatric continuing education credits for
physicians to maintain their licensure, or to practice as Medicaid
providers or medical directors of nursing homes.
"With just one geriatrician for every 10,000 adults
over 75, primary care physicians are being called on to provide
geriatric care for our rapidly aging population," said Dr. Boult,
director of the Roger C. Lipitz Center for Integrated Health Care at the
Johns Hopkins Bloomberg School of Public Health.
"But most of today's primary care physicians are
not adequately trained to provide the complex care needed by older
adults with multiple chronic conditions. In fewer than 20 years, one of
every five Americans will be over 65, amounting to more than 70 million
people. We need to act now, and act aggressively, to improve the
geriatric education of all physicians."
The Institute of Medicine/National Academy of
Sciences provided financial support for part of this work.
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May 5, 2010 For years it has been evident that
the U.S. is rapidly moving toward a period when there will just not be
enough geriatric physicians available to treat the mushrooming senior
citizen population. Now, leading physician policy experts are calling
for changes in medical education policy at multiple levels to ensure
that doctors are prepared to treat the country's aging adult population.
