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  • Number of geriatricians are down from around 9,000 in the year 2000 and may continue to decrease due to many geriatricians choosing not to recertify, and few physicians choosing to enter the fields.
  • We need specialists to train the rest of the workforce, provide care to patients with the most complex needs, and perform research.
    Geriatricians stand to lose $7,000 annually for pursuing geriatrics (as opposed to general internists)
  • Note that numbering of recommendations reflects their location in the report. Therefore, Recommendation 4.2 is the second recommendation in Chapter 4.
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    1. 1. Physician Workforce for An Aging Society Judith A. Salerno, MD, MS Institute of Medicine May 19, 2008
    2. 2. Physician Workforce Not Enough Specialists and Problem Worsening • ~7,100 geriatricians – down from @ 9000 in 2000. • ~1,600 geriatric psychiatrists
    3. 3. First-YearGeriatric Medicine Fellowship Positions 0 100 200 300 400 500 1997 1999 2001 2003 2005 2007 Available Filled
    4. 4. First-YearGeriatric Psychiatry Fellowship Positions 0 20 40 60 80 100 120 140 160 1997 1999 2001 2003 2005 2007 Available Filled
    5. 5. New Certifications in Geriatric Medicine, 1998-2004 0 500 1000 1500 2000 2500 3000 1988 1990 1992 1994 1996 1998 1999 2000 2001 2002 2003 2004 Practice Pathway Eliminated Training Requirement Reduced to 1 Year
    6. 6. 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
    7. 7. Geriatric Care Not on the RadarScreen forPhysician 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
    8. 8. 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
    9. 9. As Recommended forAll Health Professionals - Licensure, certification, and maintenance of certification for physicians should include demonstration of competence in the care of older adults as a criterion.
    10. 10. Expanded Venues forTraining The training of residents should occur in all settings where older adults receive care, including nursing homes, assisted-living facilities, and patients’ homes.
    11. 11. NEEDEDNOW: Enhancement of reimbursement for clinical services delivered to older adults by geriatric practitioners – particularly acute problem for geriatricians.
    12. 12. 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
    13. 13. BetterFinancial Incentives Needed • Loan forgiveness, scholarships, and direct financial incentives for professionals who become geriatric specialists. • National Geriatric Service Corps
    14. 14. Innovations in Geriatric Care Needed • Disseminate known models • Discover newer models • Expanding individual roles • Improving capacity
    15. 15. 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
    16. 16. If I had to do it all overagain, 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.

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