INITIATIVES TO RECRUIT GERIATRICS HEALTH CARE PROFESSIONALS

Thirty years ago, Dr. Robert Butler published his groundbreaking Why Survive? Being Old in America. The Pulitzer Prize–winning exposé of the neglect of older adults in the United States helped galvanize critical support for the National Institute on Aging (Dr. Butler became its founding director) and numerous other initiatives to improve the well-being and care of older adults.

Over the intervening three decades, we’ve seen particular improvement in health care for the elderly. Geriatrics has made tremendous progress, establishing itself as a key discipline in American medicine. Among other things, the field has broadened its knowledge and skills bases, developed new models of care, improved the treatment of common geriatric conditions, and advocated for the heath care needs of older adults. A key component of geriatric medicine is the management of multiple, chronic, and sometimes degenerative health conditions in the elderly. Consequently, geriatricians must be particularly adept at coordinating care with other caregivers across various settings, including nursing homes and other community-based, long-term care sites. (Roughly two-thirds of those needing long-term care are elderly.)

But as the American Geriatrics Society’s recent report, “Caring for Older Americans: The Future of Geriatric Medicine,” attests, health care for older adults is now at a crossroads. According to the report—released at the AGS annual meeting last month—the number of Americans age 65 and older will double, topping 71 million by 2030, when the youngest of the nation’s 76 million baby boomers reach retirement age.

Though demand for health care professionals trained to meet the unique needs of older adults is rising, supply is actually declining. Not only are established geriatricians leaving the field, but new medical school graduates are bypassing it. Medicare reimbursement is a leading (though not the only) disincentive. Unless major steps are taken to recruit and train these specialists, the AGS report estimates there will be only one geriatrician for every 7665 older adults by 2030.

Not only will there be a shortage of physicians to treat elderly patients, there will be a shortage of geriatricians offering training to medical students, primary care physicians, nurses, and others who provide acute and long-term care. As a result, these fields will see worsening shortages of caregivers with expertise in the care of older adults as well. Geriatrics research will also suffer. In 2003, there were only 62 physician-fellows in their second or subsequent years of training in geriatrics research nationwide. Compounding that problem, funding for geriatrics research has stagnated in recent years, and numerous research proposals have gone begging, the report notes.

In The Future of Geriatric Medicine, the AGS identifies current obstacles for geriatricians and other caregivers, and outlines strategies to overcome them. It sets forth the following goals:

• Ensure that every older person receives high-quality, patient-centered health care.
• Expand the geriatrics knowledge base.
• Increase the number of health care professionals across settings who employ the principles of geriatric medicine in caring for older persons.
• Recruit physicians and other health care professionals to careers in geriatric medicine.
• Unite professional and lay groups in the effort to influence public policy to continually improve the health and health care of seniors.

To reach these goals, the task force that authored the AGS report has come up with recommendations aimed at the government, organizations, agencies, foundations, and other partners whose collaboration will be essential. Safeguarding elder care, the task force noted, will require broad participation, consensus building, and perseverance. And that’s where you come in. These goals, though ambitious, can be reached if geriatricians and other physicians and health care professionals work together, along with consumer groups and lawmakers. We need you to get involved. You can take a first step by visiting our website at www.amerciangeriatrics. org. You’ll find this watershed report posted on the website.