Geriatric Medicine in the United States - 2010 Update
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    Geriatric Medicine in the United States - 2010 Update Geriatric Medicine in the United States - 2010 Update Presentation Transcript

    • Geriatrics Workforce Policy Studies Center Geriatric Medicine in the United States: 2010 Update Elizabeth “Libbie” Bragg, PhD, RN Gregg A. Warshaw, MD
    • Methods Primary Data Collection
      • 2001, 2005, 2007 & 2008 Surveys of Medical Schools GM Program Leaders (Allopathic & Osteopathic)
      • 2001, 2004 & 2008 Surveys of FM Residency Program Directors
      • 2002, 2005 & 2008 Surveys of IM Residency Program Directors
      • 2001 & 2007 Surveys of GM and GP Fellowship Program Directors
      • 2006 Survey of Psychiatry Residency Program Directors
    • Methods Secondary Data Sources
      • AAMC
      • AMA
      • ABIM, ABFM, & ABPN
      • ABMS
      • VHA
      • National Ambulatory Medical Care Survey (NAMCS)
      • Medical Group Management Association (MGMA)
    • Results
      • Practice of Geriatrics
      • Academic Geriatric Medicine
      • Fellowship Programs
      • Graduate Medical Education
      • Medical Student Education
    • Practice of Geriatric Medicine
    • Figure 1.3 Comparison of Number of Certificates Awarded to Number of Active Certificates in Geriatric Medicine (Family Medicine and Internal Medicine) To maintain their certification in geriatric medicine, family medicine physicians must also maintain their primary certification in Family Medicine. Since July 2006 Internal Medicine recognized geriatric medicine as a subspecialty of Internal Medicine. Source: Lou Grosso, ABIM & Gary Jackson ABFM. Compiled by AGS/ADGAP Geriatrics Workforce Policy Studies Center March 2010
    • Certification and Re-certification in Geriatric Medicine by Year of Original Certification As of March 2010. Source: ABFM and ABIM. Data compiled by Geriatrics Workforce Policy Studies Center Year Family Medicine Internal Medicine Certified First Re-certification Second Re-certification Certified First Re-certification Second Re-certification 1988 753 64% 35% 1659 49% 22% 1990 473 67% --- 1204 46% --- 1992 597 62% --- 1254 51% --- 1994 771 53% --- 1568 48% --- 1996 254 48% --- 291 56% --- 1998 102 40% --- 337 60% --- 1999 28 54% --- 183 48% --- 2000 27 26% --- 200 --- ---
    • Total Annual Compensation for Private Practice Physicians Net median clinical salary (not including benefits) Source: Medical Group Management Association. Physician Compensation and Production Survey Practice Area 2006 2009 % + Change Urology 336,364 390,678 16.1% Gastroenterology 406,345 465,509 14.6% Rheumatology 199,810 226,206 13.2% FM without OB 164,021 183,999 12.2% GIM 177,059 197,080 11.3% Geriatrics 161,888 179,950 11.2% Pediatrics 174,353 192,000 10.1% PM & R 220,991 241,115 9.1% Neurology 220,000 237,918 8.1% Psychiatry 185,957 191,267 2.9% Nephrology 291,977 290,986 -0.3%
    • Current Geriatricians
      • 3.7 Geriatricians/10,000 75+
        • Range 1.4 to 7.4
      • 0.9 Geriatric Psychiatrist/10,000 75+
        • Range 0.1 to 2.3
    •  
    •  
    • Academic Geriatric Medicine
    • Academic Staff in U.S. Medical Schools (FTEs, Mean ) Geriatrics Workforce Policy Studies Center Survey of Geriatric Medicine Program Directors 2001, 2005, 2007 & 2008 Academic staff 2001 2005 2007 2008 MDs 7.5 9.6 9.6 10.2 First year fellows 2.4 2.7 2.8 2.9 Second year fellows 0.9 0.9 1.2 1.2 PhD Postdoctoral staff 0.9 1.0 1.0 1.2 Research faculty 2.5 3.0 4.2 3.7 Nurse Practitioners 1.9 1.8 2.0 2.5 CNS 0.7 0.6 0.7 0.6 PA 0.3 0.3 0.5 0.5 Pharmacists 0.3 0.5 0.6 0.6 Social Workers 1.0 1.3 1.4 1.6
    • Distribution of Physician Faculty FTEs Among U.S. Medical School Geriatrics Programs in 2001, 2005, 2007 and 2008 Geriatrics Workforce Policy Studies Center Survey of Academic Leaders in Geriatrics at US Medical Schools 2001, 2005, 2007 & 2008 Physician Faculty FTEs Percent Medical Schools
    • Medical School Faculty Compensation median salary AAMC Report on Medical School Faculty Salaries, 2008-2009, April 2010 Department Instructor Assistant Professor Associate Professor Professor Chief En docrinology 102,000 135,000 170,000 210,000 227,000 Family Medicine 155,000 151,000 170,000 188,000 213,000 Gastroenterology 132,000 223,000 260,000 280,000 349,000 Internal Medicine 157,000 154,000 175,000 211,000 228,000 Geriatrics 130,000 140,000 172,000 205,000 246,000
    • U.S. Medical School Geriatric Medicine Faculty and Staff Time Allocated by Program Mission (% effort, mean ) Geriatrics Workforce Policy Studies Center Survey of Academic Leaders in Geriatrics at US Medical Schools 2001, 2005, 2007 & 2008 Category 2001 2005 2007 2008 MS education 13.6 13.1 11.4 11.5 Residency education 12.6 11.6 11.9 11.0 Fellowship training 10.7 9.9 8.6 9.0 Continuing education 3.9 4.4 3.8 3.9 Clinical practice 36.6 36.9 36.9 36.9 Research/scholarship 18.2 15.3 18.6 17.0 Administration NA 8.4 8.1 8.5 Other 4.4 0.4 0.7 2.3
    • Source of Programs Revenues Mean Percent Geriatrics Workforce Policy Studies Center Survey of Academic Leaders in Geriatrics at US Medical Schools 2001, 2005, 2007 & 2008 Category 2001 2005 2007 2008 Clinical Practice 26.8 27.1 29.8 28.3 College of Medicine 24 20 18.4 19.3 Research Grants 15.2 12.8 15.6 16.0 Hospital Support 8.8 10.2 11.2 11.0 VHA 11.3 10.3 9.6 9.7 Educational Grants 8.4 9.7 6.8 7.8 Endowments 4.4 5.1 5.3 5.4 Other 0.3 4.9 3.4 2.7
    • Annual Budgets
      • In 2001, 26% had budgets < $250,000
      • By 2008 this ↓ to 19%
      • In 2001, 42% had budgets > $1,000,000
      • By 2008 this ↑ to 57%
      Source: Geriatrics Workforce Policy Studies Center Surveys of Geriatric Academic Leaders in US Medical Schools in 2001 & 2008
    • Obstacles to Achieving Goals of U.S. Medical Schools Geriatric Programs 2001, 2005 & 2008 Geriatrics Workforce Policy Studies Center Survey of Academic Leaders in Geriatrics at US Medical Schools 2001, 2005 & 2008
    • Fellowship Programs
    • Geriatric Medicine Fellowship Programs (Family Medicine and Internal Medicine) Source: AMA and AAMC data from the National Survey of GME Programs compiled by Geriatrics Workforce Policy Studies Center AY Programs Fellows All Yrs Fellows Beyond Year 1 1 st Yr Positions Available % filled 1 st year Positions 92/93 97 215 -- -- -- 95/96 99 223 106 206 57% 00/01 119 321 74 337 73% 06/07 139 287 34 468 54% 07/08 140 292 28 468 56% 08/09 145 320 27 470 62% 09/10 148 296 23 488 56%
    • Geriatric Psychiatry Fellowship Programs Source: AMA and AAMC data from the National Survey of GME Programs compiled by Geriatrics Workforce Policy Studies Center AY Programs Fellows All Yrs Fellows Beyond Year 1 1 st Yr Positions Available % filled 1 st year Positions 95/96 38 38 3 -- -- 00/01 61 86 7 125 63% 05/06 61 92 5 137 64% 06/07 58 72 4 142 48% 07/08 60 60 2 136 43% 08/09 57 57 1 132 42% 09/10 58 55 1 130 42%
    • Graduates of Geriatric Medicine and Geriatric Psychiatry Fellowship Programs Source: AMA and AAMC data from the National Survey of GME Programs compiled by Geriatrics Workforce Policy Studies Center
    • IMGs in U.S. GME Programs
      • Overall 27% of all Residents and Fellows are IMGs
        • Endocrinology -- 42%
        • Cardiology -- 35%
        • Ophthalmology -- 7%
        • Emergency medicine -- 7%
      • Geriatric Medicine fellows – 66%
      • Geriatric Psychiatry fellows –56%
      Source: AMA and AAMC data from the National Survey of GME Programs, 2009-2010. Note: IMGs= International Medical Graduates. IMGs do not include Canadians but do include U.S. citizen IMGs GME = Graduate Medical Education
    • Graduate Medical Education Primary Care Specialties
    • Geriatric Physician Workforce Pipeline
      • 9,666 MDs graduated from FM & GIM residency programs in 2008
        • 3% entered a GM fellowship in 2009
      • 985 MDs graduated from Psychiatry residency programs in 2008
        • 6% entered a GP fellowship in 2009
      Source: AMA and AAMC data from the National Survey of GME Programs 2008/2009 & 2009/2010.
    • Required Time devoted to clinical instruction in Geriatric Medicine
      • During 3 year Internal Medicine and Family Medicine Residency program
        • 20 days (Median) Internal Medicine
        • 12 days (Median) Family Medicine
      • During 4 year Psychiatry Residency Program
        • 23 days (Median)
      Geriatrics Workforce Policy Studies Center. Surveys of Program Directors in Internal Medicine (2008), Family Medicine Residency Programs (2008) , and Psychiatry Residency Program(2006). Updated 10/10
    • Geriatric Medicine Training in FM, IM & Psychiatry Residency Programs as rated by Program Directors
      • Curriculum conflicts #1 obstacle to implementing GM curriculum
      • Geriatrics rated second most important curriculum area by IM and FM, third by psychiatry
        • ICU/CCU first for IM
        • Ambulatory Adult Medicine first for FM
        • Emergency Psychiatry first by Psychiatry
      Geriatrics Workforce Policy Studies Center. Surveys of Program Directors in Internal Medicine (2008), Family Medicine Residency Programs (2008) , and Psychiatry Residency Program(2006).
    • MD Faculty Available to Teach Geriatric Medicine Mean and ± sd Full Time Equivalents Geriatrics Workforce Policy Studies Center Surveys of Program Directors in Family Medicine Residency Programs in 2001, 2004, 2008; Surveys of Program Directors in Internal Medicine Residency Programs in 2002, 2005, 2008; and Survey of Program Directors in Psychiatry Residency Programs Family Medicine (average 22 residents) 2008 2004 2001 1.3 (±1.6) 1.3 ( ± 2.7) 0.8 ( ± 1.1) Internal Medicine (average 53 residents) 2008 2005 2002 3.8 (± 4.5) 3.5 (± 4.6) 2.2 (± 2.8) Psychiatry (average 28 residents) 2006 N/A N/A 2.8 (± 3.2)
    • Ambulatory Care Visits to Primary Care and Specialist Physicians, United States, Patients Age 65 and over Source: CDC, NCHS, National Ambulatory Medical Care Survey 1980 1990 2006 2007 Specialist Primary Care Specialist Primary Care Specialist Primary Care Specialist Primary Care 38% 62% 47% 53% 59% 41% 59% 41%
    • Percent of U.S. Medical Schools at which GM and GP Faculty Teach Geriatrics to Residents in Other Specialties Geriatrics Workforce Policy Studies Center Surveys of US Academic Medical Schools. 2007 response rate = 75%, 2005 response rate = 68% 2007 87% 2005 75%
    • Percent of Geriatric Medicine and Geriatric Psychiatry Programs that Teach Principles of Geriatric Care to other Selected Specialties 2007 Specialties taught/medical school: median 5.0 (range 1-14) Geriatrics Workforce Policy Studies Center 2007 Survey of Academic Medical Schools Specialty Percent Psychiatry 71% Gynecology 62% Emergency Medicine 50%
    • Percent of Medical Schools Where Faculty from Other Selected Specialties Teach Principles of Geriatric Care to their Own Residents 2007 Specialties teaching their own residents/medical school: median 4.0 (range 1-11) Geriatrics Workforce Policy Studies Center 2007 Survey of Academic Medical Schools Specialty Percent Psychiatry 71% Neurology 44% PM & R 42%
    • Medical Student Education
    • Medical student geriatrics curriculum
      • 23% of medical schools require a geriatric clerkship in 2005 and in 2008
      • 48% integrated geriatrics into a required clinical rotation in 2005 and this ↑ to 56% by 2008
      Schools could report more than one type of experience Geriatrics Workforce Policy Studies Center Surveys of Geriatric Academic Leaders in US Medical Schools 2005 & 2008.
    • Medical student geriatrics curriculum
      • 34% said curriculum experience depended on faculty interest in geriatrics in 2005 and this ↑ to 37% by 2008
      • 17% had some exposure, but no objectives in 2005, but this ↓ to 12% by 2008
      Schools could report more than one type of experience Geriatrics Workforce Policy Studies Center Survey of Geriatric Academic Leaders in US Medical Schools 2005 & 2008.
    • Percent of graduating medical students who thought adequate time was devoted to instruction in Long Term Care Source: AAMC, Medical School Graduation Questionnaire, All Schools Report 1997 56% 2002 65% 2007 75% 2008 74% 2009 79% 2010 791%
    • Percent of graduating medical students who thought adequate time was devoted to instruction in End of Life Care Source: AAMC, Medical School Graduation Questionnaire, All Schools Report 2001 64% 2004 76% 2007 78% 2008 79% 2009 78% 2010 80%
    • Percent of graduating medical students who agreed or strongly agreed with the following statements. Source: AAMC, Medical School Graduation Questionnaire, All Schools Report Statement 2009 I can identify situations where co-morbid conditions, life expectancy, and/or functional status should modify (or override) standard recommendations for screening tests in older adults 81% I can anticipate and identify hazards of hospitalization for older adults 86% I can identify those medications that should be avoided or used with caution in older adults 71% I can describe the differences in the presenting signs, symptoms, and laboratory findings of common conditions in older, as compared to younger, adults 73%
    • Percent of graduating medical students who agreed or strongly agreed with the following statements. Source: AAMC, Medical School Graduation Questionnaire, All Schools Report 2008 ADL = Activities of daily living; IADL = Instrumental activities of daily living Statement 2009 I can differentiate the clinical presentations delirium, dementia, and depression in older adults 88% I can assess a patient’s self-care/functional capacity, e.g. ADLs and IADLs 77% I can assess on older patient’s fall risk, identify underlying causative factors, and make recommendations for further evaluation and initial management 72%
    • Contact Information
      • www.ADGAPstudy.uc.edu
      • Libbie Bragg, PhD, RN
      • Department of Public Health Sciences
      • The University of Cincinnati
      • [email_address]
      • 513-558-8792