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Geriatric Medicine: A Clinical Imperative for an Aging Population (Full report is a PDF File - Adobe Reader Required)
For Immediate Release:
April 27, 2004
For Further Information:
Scott Kramer, AGS Communications
(212) 308-1414, ext. 329
(917) 751-1989 - Mobile
Washington, D.C.-Babyboomers who are counting on a long and healthy life may not find doctors who can provide appropriate treatment as they age. That's because there is a critical shortage of physicians and other health providers trained in geriatrics, the branch of medicine devoted to treating the special health problems of an aging population.
According to a new report entitled Geriatric Medicine: A Clinical Imperative for an Aging Population by the Association of Directors of Geriatric Academic Programs (ADGAP) and the American Geriatrics Society (AGS), there are approximately 7,500 certified geriatricians in the nation, while estimates suggest some 14,000 are currently required to care for today's elderly population. By 2030, some 36,000 trained clinical geriatricians will be needed. The report cites statistics from various sources including two ADGAP studies, Geriatric Medicine Training and Practice in the United States at the beginning of the 21st Century (July 2002) and GME Must Prepare All Physicians to Care for the Aged. (February 2004)
The situation is complicated by a lack of academic geriatricians teaching in medical schools. Only 900 academic geriatricians are employed today (full time equivalents) and it is estimated that 2,400 academic geriatricians are actually needed.
A 1987 Institute of Medicine advisory panel recommended that at least nine faculty trained in geriatrics be part of each medical school. But only 30 percent of medical schools have reached this target according to the ADGAP survey.
"Medical schools must take the responsibility to give geriatric medicine new prominence in the medical training programs." says Dr. Gregg Warshaw, Professor of Geriatric Medicine at the University of Cincinnati and Past President of the AGS and ADGAP. "If we fail," notes Dr. Warshaw, "we will fail to meet the needs of this rapidly expanding aging population with serious consequences for the health of the nation."
The report notes that most American medical schools still concentrate on training for critical care, but most people in the aging population are likely to require care for chronic diseases that need treatment over the long term. They're also the patients likely to receive multiple prescriptions for medications, seek alternative medicine treatments, and spend many more years in the workforce than previous generations. As a result, they are most likely to suffer complications from side effects of medication interactions. These are symptoms that trained geriatric health care providers are taught to recognize.
The gap in geriatric training is likely to have serious consequences for the treatment of chronic diseases like hypertension, diabetes, and arthritis, diseases particularly prevalent in older people. These are the diseases that tax the Medicare system, which most geriatricians depend upon for payment. The low Medicare reimbursement levels and high patient caseload are a major disincentive to enroll in geriatric training programs and at the same time are driving many practicing physicians into early retirement.
"As Baby Boomers begin to retire, demand for quality care will increase, and we will need physicians who understand the complex health problems that aging inevitably brings," Senator Blanche Lincoln (D-AR) said. "That's why it's important to provide incentives that encourage our physicians to enter the field of geriatrics. We must begin today to prepare for our future so our nation will not be ill-prepared for what lies ahead.
"That is why I've introduced the Geriatric Care Act, bipartisan legislation to modernize the Medicare program to reflect chronic care management and the importance of geriatricians."
The report notes that given the number of physicians in training programs, over 350 new geriatricians should enter practice each year. However, geriatric fellowship training programs graduate an average of 270 new geriatricians each year, and they operate at about 75 percent of enrollment capacity, largely because of financial disincentives and a lack of geriatric academicians.
Among its recommendations, the report asks Congress to make changes to the Medicare reimbursement system that would reimburse physicians for geriatric assessment and care coordination services. Medicare should also develop a risk adjuster to account for the time and complexity involved in treating frail elderly patients.
"Greater access to geriatric care will help senior citizens live longer, more independent lives, said Senator Harry Reid (D-NV). "Congress should take the recommendations in this report seriously and pass legislation to increase Medicare's reimbursement for doctors and provide more incentives to specialize in geriatrics. If we fail to act, we won't be able to adequately meet the health care needs of our aging population."
The report also calls for loan forgiveness and other incentives to encourage training in geriatrics including adequate funding Title VII geriatrics program training under the Public Health Service Act.
Graduate Medical Education (GME) is the primary financing system for physicians training programs. The report calls on Congress to increase the number of slots for geriatric trainees at hospitals across the nation.
The American Geriatrics Society (AGS) is the premier professional organization of health care providers dedicated to improving the health and well being of all older adults. With an active membership of over 6,000 health care professionals, the AGS has a long history of effecting change in the provision of health care for older adults. In the last decade, the Society has become a pivotal force in shaping attitudes, policies and practices regarding health care for older people.
The Association of Directors of Geriatric Academic Programs (ADGAP) was founded in the early 1990s by a group of twenty leaders from the American Geriatrics Society (AGS). ADGAP is dedicated to providing support to education and research programs in geriatric medicine within U.S. medical schools, and to directors of academic geriatric programs in order to improve patient care and research. ADGAP is an integrated group within the AGS that works both independently and along side the society in pursuit of its mission.
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