Geriatric Medicine Training and Practice in the United States at the ...

Table 4.14 Home Health and Hospice Care of Aged
Patients, 1998
Characteristic Home Health Hospice
Number of Patients 1
65 and over 6,598,000 440,000
85 and over 1,594,000 108,000
Percent of Total Patients 2
65 and over 69 77
85 and over 18 20
Payment Source (percent)
65 and over Medicare 85
Medicaid 6
Private insurance 6
Own income 3
1 Active and inactive patients, patients could be included more than once if
multiple episodes of care.
2 Aged patients/Total patients of any age.
Source: U.S. National Center for Health Statistics, 2001
Current Number and Distribution
of Practicing Geriatricians and
Geriatric Psychiatrists
As described in Chapter 3, the ABIM/ABFP began certifying
geriatricians in 1988, the ABPN started certifying geriatric
psychiatrists in 1991, and the AOBIM /AOBFP began certifying
osteopathic geriatricians in 1992. The practice pathway option for
certification ended for geriatric medicine in 1994, geriatric psychiatry
in 1996, osteopathic geriatric internal medicine in 1994, and
osteopathic family practice in 2002. The total number of CAQs
awarded from 1988 through 2001 includes: 9,907 ABIM/ABFP
certificates, 2,508 ABPN certificates (Table 4.15) and 503 AOBIM and
AOBFP certificates (Personal communication, Armando Ramirez,
American Osteopathic Association, 2001). The end of the practice
pathway accounts for the decline in new CAQs awarded from FP and
IM since 1994 and by psychiatry since 1996.
In 2000, the distribution of geriatricians varied considerably
by state. For example, New York had 8.4 geriatric medicine
Table 4.15 Geriatric Certificates of Added Qualifications Issued by the American Board of Family Practice,
American Board of Internal Medicine, and American Board of Psychiatry and Neurology, 1988-2001
Subspecialty 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Total
Geriatric Medicine,
Family Practice (FP) 752 -- 473 -- 597 -- 771 -- 254 -- 102 28 27 21 3025
Geriatric Medicine,
Internal Medicine (IM) 1654 -- 1204 -- 1254 -- 1568 -- 291 -- 336 183 200 192 6882
Total FP and IM 2406 -- 1677 -- 1851 -- 2339 -- 545 -- 438 211 227 213 9907
Geriatric Psychiatry -- -- -- 490 359 -- 422 376 713 -- 65 -- 83 -- 2508
Source: ABMS, 1997 and 2001 & Personal communication, Lou Grosso, ABIM, 2002
affluence, the services of a geriatrician are needed; in times of
austerity, their services are considered less essential” (Reuben,
Zwanziger, Bradley et al., 1993:451). Using three economic scenarios,
Reuben calculated the number of geriatricians needed: Scenario I:
moderate growth; Scenario II: recession growth and Scenario III,
steady growth. Using the steady growth forecast (a fair representation
of the 1990s economic growth), Reuben estimated that 9,705
geriatricians would be required by the year 2000. Scenario I resulted
in 6,335 geriatricians being needed and Scenario II resulted in 3,668
geriatricians being needed.
The Center for Health Workforce Studies at the School of Public
Health, University at Albany, State University of New York, was recently
awarded a contract to prepare a report titled The Aging of America:
Implications for the Health Workforce. The report, funded by the Health
Resources and Services Administration
(HRSA), will include projections of the number
of physicians needed and trained in geriatric
medicine. (See http://chws.albany.edu
for more information about this project.)
specialists/10,000 people over the age of 75 and the ratio in California
was 5.7/10,000. However, in other populous states, the number of
geriatricians was much lower. For example, in Florida the ratio was
3.4/10,000 and in Texas, 3.9/10,000. Arizona had 4.0 geriatric
medicine specialists/10,000 people over the age 75. The current
distribution of certified allopathic geriatricians and geriatric
psychiatrists in the U.S. are shown in Figures 4.1 and 4.2.
Geriatric medicine and psychiatry CAQs are valid for ten years,
with re-certification required to extend certification. Re-certification
in allopathic geriatric medicine began with the November 1996
examination (Table 4.16). Re-certification in osteopathic geriatric
medicine for Internal Medicine does not begin until October 2002.
(Personal communication, Gary Slick, Executive Director, ABOIM, May
2002). Family Practice osteopathic physicians with CAQs awarded
Table 4.16 Re-certification in Geriatric Medicine and Geriatric Psychiatry
Specialty 1996 1997 1998 1999 2000 2001
Internal Medicine 19 -- -- -- -- --
Internal Medicine &
Family Practice -- 308 758 317 653 338
Geriatric Psychiatry -- -- -- -- 190 331
Sources: ABPN Newsletter, 2001 and ABIM web page http://www.abim.org/
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