Graham Center Policy One-Pager

Refocusing Geriatricians’ Role in Training to Improve Care for Older Adults

ELIZABETH J. BRAGG, PhD, RN; GREGG A. WARSHAW, MD; STEPHEN M. PETTERSON, PhD; IMAM M. XIERALI, PhD; ANDREW W. BAZEMORE, MD, MPH; and ROBERT L. PHILLIPS JR., MD, MSPH

Am Fam Physician. 2012 Jan 1;85(1):59.

The current number of geriatricians cannot keep up with the health care needs of the growing number of older adults. To fill the gap, more geriatricians should focus on training primary care and other specialty physicians to care for older adults.

Geriatricians, experts in the care of older adults with multiple chronic conditions, are family medicine or internal medicine physicians who complete specialized training in geriatrics. Academic geriatrics leaders believe that geriatricians should maintain focus on direct care for the most complex and vulnerable older patients.1 However, the number of geriatricians is not keeping pace with the rapid growth in the older adult population, leading policy experts to recommend a shift to preparing other physicians for a larger role in geriatrics care.2–4 First, we need to understand how many geriatricians are currently working in these roles.

An analysis of the American Medical Association’s 2010 Masterfile revealed that 8,654 practicing physicians with a primary or secondary specialty are listed as geriatrics (8,137 allopathic and 517 osteopathic).5 Less than 4 percent list medical teaching as their primary activity. Most geriatricians’ major professional activity is related to direct patient care (89 percent; see accompanying table).5 A 2010 survey of allopathic and osteopathic medical schools identified 1,200 geriatric faculty, but they typically spent only one-third of their time teaching.6

Table
Major Professional Activities of Geriatricians

Major professional activity		Family medicine geriatricians	Internal medicine geriatricians	Total (%)
Patient care activities
	Office-based	1,775	4,761	6,536 (75.5)
	Hospital staff	189	933	1,122 (13.0)
	Locum tenens	7	12	19 (0.2)
Non–patient care activities
	Administration	115	302	417 (4.8)
	Medical teaching	138	178	316 (3.7)
	Medical research	14	181	195 (2.3)
	Other	15	34	49 (0.6)
Total		2,253	6,401	8,654 (100)

Information from reference 5.

Geriatrician training programs cannot ramp-up fast enough to meet the needs of the rapidly growing numbers of older adults. It may be more efficient to increase the number of geriatricians who spend most of their time teaching in medical schools and residency training programs, or in cooperative extension models, in order to prepare many more physicians of all specialties to meet the specific needs of a growing older population. This targeted policy option may appeal to federal agencies charged with improving the health and health care experience of the older population, while reducing per capita costs of health care.

Author disclosure: No relevant financial affiliations to disclose.

REFERENCES

1. Warshaw GA, et al. Which patients benefit the most from a geriatrician’s care? J Am Geriatr Soc. 2008;56(10):1796-1801.

2. Boult C, et al. The urgency of preparing primary care physicians to care for older people with chronic illnesses. Health Aff (Millwood). 2010;29(5):811-818.

3. Boult C, et al. Perspective: transforming chronic care for older persons. Acad Med. 2008;83(7):627-631.

4. Peterson LE, et al. Rural-urban distribution of the U.S. geriatrics physician workforce. J Am Geriatr Soc. 2011;59(4):699-703.

5. American Medical Association. AMA Physician Masterfile; 2010.

6. Association of Directors of Geriatric Academic Programs and the American Geriatrics Society Geriatric Workforce Policy Studies Center 2010 survey of US allopathic and osteopathic medical schools geriatrics academic programs. http://www.adgapstudy.uc.edu. Accessed November 22, 2011.

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.

Policy One-Pagers are available from the Graham Center at http://www.graham-center.org.

A collection of Graham Center Policy One-Pagers published in AFP is available at http://www.aafp.org/afp/graham.

Copyright © 2012 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.