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AAMC Reporter: June 2008IOM Report Finds Health Care Workforce Unprepared for Elderly
Millions of aging baby boomers are facing a health care workforce unprepared to meet their needs, according to a new report from the Institute of Medicine (IOM). The report, "Retooling for an Aging America: Building the Health Care Workforce," calls for more geriatrics training for all health professions, including medicine. In addition, the report recommends that insurance plans offer financial incentives to boost recruitment and retention of geriatrics specialists, and remove barriers for incorporating innovative care models. The report urges that all of its recommendations be implemented by 2030. "One of the report's key suggestions is that all health care workers need to appreciate and understand the needs of the aging population," said M. Brownell Anderson, the AAMC's senior director of educational affairs. "Geriatrics care is not always perceived to be the most exciting area for medical students, but this report underscores the opportunities to demonstrate how important this topic is. Thanks to funding from the John A. Hartford Foundation, the AAMC and many U.S. medical schools have made real strides on this front over the past several years, and we welcome this report as a means of furthering our work in this important area." The importance of geriatrics knowledge will only increase in the coming years. By 2030, 78 million Americans, or 20 percent of the population, will be 65 years of age or older. Older patients, of course, also have additional—and more complex—health problems: The average 75-year-old has three chronic conditions and takes four or more prescription medications. Moreover, many health care workforce experts say there is already a geriatric workforce shortage, because the field attracts fewer specialists than other disciplines, and turnover rates are high among direct-care workers. IOM report panelist Marie Bernard, M.D., Donald W. Reynolds Chair in Geriatric Medicine at the University of Oklahoma College of Medicine, said that every physician should know how to care for older patients. "Given this aging tsunami, there is no way that we'll have enough geriatricians," Bernard said. "The rest of the health care workforce will need to handle some geriatric issues." To boost physicians' understanding of elder care, the report recommends more residency training in nursing homes, assisted living facilities, and other traditional elder care arenas. Other care providers should also have better training. The IOM panel concluded that direct care workers should have at least 120 hours of training, rather than the current standard of 75. Informal caregivers—often friends and family members—should receive special training from private, public, or community organizations, according to the report. Developing, recruiting, and retaining geriatric caregivers can be challenging, especially in medicine, due in large part to a gap in compensation. According to the Association of Directors of Geriatric Academic Programs, the average geriatrician earned $163,000 in 2005, compared with $175,000 for a general internist, even though geriatricians require more training. Low Medicare reimbursement rates for primary care is one of the biggest reasons cited for this gap, as Medicare comprises most of a geriatrician's income. To help make this field more financially appealing, private and public payers should offer incentives, such as education loan forgiveness plans, according to the report. The report also urges increased Medicare reimbursement rates and better coverage for innovative delivery models, such as interdisciplinary team care. This July, however, the government is scheduled to cut Medicare physician payments. Congressional leaders have indicated that they will not allow the cuts to take place, but the proposed cuts nevertheless symbolize the current Medicare physician payment environment, in which payment increases have not kept pace with inflation in recent years. The report singles out medical education as one area for improvement. However, several initiatives within the academic medicine community have been created or are underway to help prepare tomorrow's doctors to care for senior citizens. One was a 2007 consensus conference hosted by the AAMC, which resulted in the creation of a list of geriatric competencies for medical students. Some medical schools are already teaching elder care. In 2000 and 2001, the Hartford Foundation provided about $6 million in grants to 40 medical schools to help advance their geriatric and gerontology curricula. The University of Arizona College of Medicine used one of these grants to integrate elder care into its entire curriculum, beginning in 2006. "In our nervous system instruction block, for instance, we focus on learning and memory, and how age affects these issues," said Nancy A. Koff, Ph.D., M.A., Arizona's senior associate dean for medical student education. "In the cancer block, students learn about cancer and the elderly." At the University of South Carolina School of Medicine, students are matched with a senior citizen "mentor" to perform hands-on activities and make specific observations that mirror their classroom learning. When senior mentor Ellen Cooper, 71, had triple bypass surgery, students saw how the healing process takes longer for seniors. "They get first-hand experience with people who are 'old,'" said Cooper. "They see we have different needs." Megan Wilson, M.D., a 2008 South Carolina graduate, said the school's intensive geriatric focus helped influence her career path. Wilson will enter an internal medicine/pediatrics residency program, and plans to ultimately treat seniors and children. "I always had an interest in geriatrics, but these experiences helped solidify in my mind that, yes, this is a population I want to work with." —By Elissa Fuchs |
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