April 16, 2008 -The U.S. health care work force is
"too small and woefully unprepared" to meet the geriatric care needs of
the 78 million aging baby boomers, according to a report released on
Monday by the
Institute of
Medicine, the Wall Street Journal reports (Francis/Fuhrmans,
Wall Street Journal, 4/15). The report, titled "Retooling for an Aging
America: Building the Health Care Workforce," estimates that currently
there is one certified geriatrician for every 2,500 seniors.
In three years, the first of the baby boomers will
turn 65 years old, and by 2030, all 78 million will have reached that
age -- nearly double the number of people older than age 65 in 2005,
according to the report. The U.S. would need 36,000 geriatricians by
2030 to meet the need, according to the report. The report says there
are 7,128 certified geriatricians today (La Ganga,
Los Angeles Times,
4/15).
IOM attributes much of the shortfall to misplaced
financial incentives. The average pay in 2005 for a physician
specializing in geriatrics was $163,000, compared with $175,000 for a
general internist with no specialty training.
Other specialists can earn more than twice as much
(Wall Street Journal, 4/15). The report also says that Medicare's low
reimbursement rates; focus on treating short-term problems, rather than
managing chronic conditions; and lack of coverage for preventive care
may exacerbate the problem (Schmid,
AP/San Francisco
Chronicle, 4/15).
The report also cites a high rate of turnover among
direct-care workers, such as nurse's aides and home health aides, and
lack of knowledge by "informal caregivers," such as family members,
friends and others who provide care for seniors in their homes.
According to the report, 71% of nurse's aides
change their jobs annually, and as many as 90% of home health aides find
a new job within two years (Reichard,
CQ HealthBeat,
4/14). The report says that 90% of seniors receiving care at home get
help from family and friends and 80% rely solely on them.
Recommendations
Although the report calls for increasing the number
of geriatricians, it also recommends that physicians, nurses and others
receive more geriatric training during their general medical education
(Wall Street Journal, 4/15). In addition, the report recommends that
Medicare, Medicaid and private insurers increase payment for geriatric
care to attract workers.
The report says that creating initiatives at local
hospitals and community groups to help train informal caregivers could
help the situation. It also recommends that state attorneys general
recognize such training at hospitals as justification for their
tax-exempt status (CQ HealthBeat, 4/14).
In addition, IOM recommends that states and the
federal government create programs that would forgive student loans for
people caring for older adults (Los Angeles Times, 4/15).
"This could be seen as evidence that our society
places little value on the expertise needed to care for vulnerable,
frail older Americans," John Rowe, chair of the committee that wrote the
report and a former chair and CEO of
Aetna,
said. He added, "We're not saying every (old) person needs a
geriatrician any more than every person who has a heart needs a
cardiologist, but we need to enhance the care they do receive" (Wall
Street Journal, 4/15).
Senate Finance
Committee Chair Max Baucus (D-Mont.) on Friday said that he
wants to
increase
Medicare payments to primary care physicians, which include
geriatricians, as part of a Medicare package due on the Senate floor in
mid-May.
AARP
said it is lobbying for a bill (S
2708), co-sponsored by Sens. Barbara Boxer (D-Calif.) and
Susan Collins (R-Maine), that would bolster geriatric and long-term care
training. The legislation also would create a panel that would track
geriatric and long-term care and issue recommendations for improving the
fields (CQ HealthBeat, 4/14).
