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

Table 4.19 Total Annual Compensation for Private Practice
Physicians, 1999 1
Sample Size Median ($)
Geriatrics 17 141,679
Family Practice without OB 3,240 141,493
General Internal Medicine 3,358 145,375
Psychiatry 229 151,132
Nephrology 172 217,726
Rheumatology 176 156,521
Endocrinology 147 157,489
Gastroenterology 530 264,500
Neurology 297 178,197
PM&R 132 172,311
Urology 488 268,825
1 Net clinical salary (not including benefits)
Source: MGMA, 2001
2001 and 2002 distribution (American Geriatrics Society, 2001).
The AGS sponsors a monthly scientific journal, The Journal of the
American Geriatrics Society, and is affiliated with the monthly clinical
journals, the Annals of Long-Term Care: Clinical Care and Aging and
Clinical Geriatrics.
To encourage practicing physicians and nurses to participate in
geriatrics CME programs, the AGS has established the Geriatrics
Recognition Award (GRA), which recognizes physicians and nurses
committed to increasing their knowledge of geriatrics through CME
programs. One of the requirements for physicians receiving this award
is to earn a minimum of 150 credits from CME programs in geriatrics
within four years or less. Three hundred ninety-seven physicians have
received this award (www.americangeriatrics.org, June 2002).
American Medical Directors Association
The American Medical Directors Association (AMDA) is the national
professional association for nursing home medical directors and other
physicians who practice in the long-term care continuum. It was
established in 1976 and is committed to the continuous improvement
of patient care quality, which it promotes by providing education,
advocacy, information, and professional development to its members.
The AMDA currently has more than 8,700 members and a database
of more than 2,000 nursing home attending physicians. Figure 4.4
displays trends of AMDA membership over time. The Association’s
broad goals are:
• To expand and diversify its membership to reflect and
represent the changes in physician practice throughout the
long-term care continuum.
• To preserve and strengthen the role of the physician in all
settings throughout the long-term care continuum.
• To be the premier source of information on physician practice
throughout the continuum of long-term care services.
• To strengthen the role of the physician as educator to peers
and other long-term care professionals.
• To promote the image of the physician through the CMD
program and other vehicles to demonstrate competency,
cost-effectiveness, and impact on quality of care.
AMDA sponsors a Certified Medical Director (CMD) program. CMD
certification requires that physicians attain indicators of competence
in both clinical medicine and medical direction/administrative
medicine in long-term care. The certification process is based on an
experiential model that requires participation in existing programs
such as fellowships, board certification, CME programs offered by
major provider organizations and AMDA-approved comprehensive
courses. Currently, no specific examination or testing is required.
Certification lasts for six years. Since the program’s inception, 1,633
physician medical directors have received the CMD designation and
720 of these directors also have a CAQ (Personal communication,
Lorraine Tarnove, Executive Director, AMDA, May 2002). AMDA
sponsors a bimonthly scientific and clinical journal, the Journal of
the American Medical Directors Association, and a monthly clinical
newspaper, Caring for the Ages.
American Association for
Geriatric Psychiatry
The American Association for Geriatric Psychiatry (AAGP) is a national
association representing and serving its members in the field of
geriatric psychiatry. Founded in 1978, it is dedicated to promoting the
mental health and well being of older people and improving care for
those with late-life mental disorders. Membership has been steady
over the past several years. AAGP had 1,569 members in 2000 and
1,675 members in 2001 (Personal communication, Carrie Stankiewicz,
AAGP, April 23, 2002). AAGP’s mission is to enhance the knowledge
base and standard of practice in geriatric psychiatry through
education and research, and to advocate for strategies to meet the
mental health needs of older Americans. The AAGP sponsors a
bimonthly scientific journal, The American Journal of Geriatric
Psychiatry.
American Academy of
Home Care Physicians
The American Academy of Home Care Physicians (AAHCP) is a
national organization representing and serving the needs of physicians
and related professionals interested in improving care of patients in
the home. Founded in 1984, the AAHCP currently has over 700
members (www.aahcp.org). The AAHCP sponsors an educational
meeting each year in association with the annual meeting of the
American Geriatrics Society. The AAHCP organizes home health care
medical director training seminars that lead to medical director
certification. The AAHCP is affiliated with Home Health Care
Consultant,a monthly clinical journal.
Continuing Medical Education
(CME)
Most practicing physicians, especially those whose formal training
ended before 1985, received limited organized instruction in geriatrics
during their medical school or residency training. Many professional
medical organizations provide CME and written materials with
geriatric content. (See Appendix E for a list of educational resources
for the practicing physician.) Traditional methods of CME have been
shown to increase physician knowledge and change attitudes on a
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