“With just one geriatrician for every 10,000
adults over 75, primary care physicians are
being called on to provide geriatric care
for our rapidly aging population,” said
Boult.
“But most of today’s primary care physicians
are not adequately trained to provide the
complex care needed by older adults with
multiple chronic conditions.
"In fewer than 20 years, one of every five
Americans will be over 65, amounting to more
than 70 million people. We need to act now,
and act aggressively, to improve the
geriatric education of all physicians.”
The article, entitled “The Urgency of
Preparing Primary Care Physicians to Care
for Older People with Chronic Illnesses,”
proposes multiple policy-driven solutions to
ensure a better trained physician workforce
as the demand for geriatric care swells and
the number of geriatric specialists shrinks.
Policy options proposed by the authors
include:
• Increasing funding for geriatrics in
medical schools
• Leveraging Medicare’s educational subsidy
to strengthen geriatrics in residency and
fellowship programs
• Requiring practicing physicians to
complete geriatric continuing education
credits in order to maintain their state
licensures and Medicaid provider
certifications
The authors propose modifying Title VII of
the U.S. Public Health Service Act to
provide financial support for medical
schools and residency programs that adopt
the educational innovations needed to care
for an aging society.
Similarly, the Medicare program, which
provides teaching hospitals with large
annual subsidies for graduate medical
education, could make continued educational
funding contingent on rapid reforms in the
training of resident physicians and
specialty fellows.
To drive swift educational reform, new
Medicare policy could link a significant
portion of teaching hospitals’ annual direct
and indirect medical education payments to
the amount of training they provide in
primary care, chronic care, and geriatrics.
“As Medicare funds are intended to enhance
the care of Medicare beneficiaries, the
logic of prioritizing training for
chronically ill older patients is
compelling,” said Berenson, a Fellow at the
Urban Institute.
“Another policy option is to extend Medicare
graduate medical education funding to
non-hospital clinical training sites, such
as nursing homes,” added Leipzig, the Gerald
and Mary Ellen Ritter Professor and Vice
Chair of Education in the Brookdale
Department of Geriatrics and Palliative
Medicine at Mount Sinai School of Medicine.
To support continuous geriatrics training of
the many physicians already in practice, the
authors propose that state policies could
require geriatric continuing education
credits for physicians to maintain their
licensure, or to practice as Medicaid
providers or medical directors of nursing
homes.
“The geriatric imperative of the
twenty-first century requires major, rapid
changes to our health care system,” said
Counsell, the Mary Elizabeth Mitchell
Professor and Director of Geriatrics at the
Indiana University School of Medicine.
“Through educational policy reforms at the
state and federal levels, policymakers can
catalyze the dramatic workforce changes
necessary for delivery of cost-effective
chronic care to the rapidly swelling ranks
of older Americans.”
The Institute of Medicine/National Academy
of Sciences provided financial support for
part of this work.
