Physician Workforce for An Aging Society

Judith A. Salerno, MD, MS

Institute of Medicine

May 19, 2008

Physician Workforce

Not Enough Specialists and Problem Worsening

• ~7,100 geriatricians – down from @ 9000 in 2000.

• ~1,600 geriatric psychiatrists

First-Year Geriatric Medicine Fellowship Positions

0

100

200

300

400

500

1997 1999 2001 2003 2005 2007

Available

Filled

First-Year Geriatric Psychiatry Fellowship

Positions

020406080

100120140160

1997 1999 2001 2003 2005 2007

Available

Filled

New Certifications in Geriatric Medicine, 1998-

2004

0

500

1000

1500

2000

2500

3000

19

88

19

90

19

92

19

94

19

96

19

98

19

99

20

00

20

01

20

02

20

03

20

04

Practice Pathway Eliminated

Training Requirement Reduced to 1 Year

Why is Recruitment into Geriatric Medicine So

Difficult?A multi-faceted problem:

• Negative stereotypes of older adults

• Lower incomes and low prestige for greater training

Geriatric Care Not on the Radar Screen for Physician Specialties

• None of the following specialties has a subspecialty certificate in geriatrics– Dermatology– Emergency Medicine– Physical Medicine and Rehabilitation– Surgery

• All have certificates in pediatrics

Applying the Three-Pronged Approach to

Building Physician Capacity in Geriatric Care• Enhance geriatric competence of all physicians in

commonly encountered problems

• Increase recruitment and retention of geriatric specialists

• Implement innovative models of care

As Recommended for All Health Professionals -

Licensure, certification, and maintenance of certification for physicians should include demonstration of competence in the care of older adults as a criterion.

Expanded Venues for Training

The training of residents should occur in all settings where older adults receive care, including nursing homes, assisted-living facilities, and patients’ homes.

NEEDED NOW:

Enhancement of reimbursement for clinical services delivered to older adults by geriatric practitioners – particularly acute problem for geriatricians.

Internal Medicine Subspecialties*

Subspecialty Fill Rate (1st year)

Median Compensation (yr)

Geriatric Medicine 54% $163K

Endocrinology 92% $189K

Hematology & Oncology

95% $358K

Infectious Disease 93% $205K

Rheumatology 96% $207K

* General Internists - $175K/yr

Better Financial Incentives Needed

• Loan forgiveness, scholarships, and direct financial incentives for professionals who become geriatric specialists.

• National Geriatric Service Corps

Innovations in Geriatric Care

Needed• Disseminate known models

• Discover newer models

• Expanding individual roles

• Improving capacity

Effective Features of New Models

• Interdisciplinary team care

• Care management• Chronic disease

self-management• Caregiver

education and support

• Pharmaceutical management

• Proactive rehabilitation

• Preventive home visits

• Transitional care

If I had to do it all over again,would I choose geriatric medicine?YES, BUT…

- I would rule out a career in private practice.

- I would hope to pay off my educational loans before age 50

AND - I would wake up every morning, pleased that I chose this rewarding career.