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

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The Association of Directors of Geriatric Academic Programs (ADGAP) Longitudinal Study of Training and Practice in Geriatric Medicine Geriatric Medicine Training and Practice in the United States at the Beginning of the 21st Century Preface/Acknowledgements This report summarizes research from the initial two years (July 2000-June 2002) of the Association of Directors of Geriatric Academic Programs (ADGAP) Longitudinal Study of Training and Practice in Geriatric Medicine. ADGAP was formed in the early 1990s to provide a forum for academic geriatric medicine divisions and program directors. Its purpose is to foster the enhancement of patient care, research, and teaching programs in geriatric medicine within medical schools and their associated clinical programs. ADGAP is affiliated with the American Geriatrics Society (AGS) in New York City and shares offices and staff with the AGS. Members of the initial organizing committee included Itamar Abrass, MD, John Beck, MD, Christine Cassel, MD, Harvey Cohen, MD, Jeffery Halter, MD, and Robert Luchi, MD. The first President was Jerome Kowal, MD. He was followed by David Lipschitz, MD, Jeanne Wei, MD, Gregg Warshaw, MD and David Reuben, MD. The current ADGAP president is John Burton, MD. ADGAP contracted with the University of Cincinnati’s Office of Geriatric Medicine and Institute for Health Policy and Health Services Research (IHPHSR) to conduct the study. The director of the IHPHSR, Alfred J. Tuchfarber, PhD, and the expert IHPHSR staff have been invaluable partners in this effort; their support and talent were critical for carrying out this study. A distinguished National Oversight Panel guided the direction of the project. These leaders, from their diverse perspectives, provided the project team with their knowledge and wisdom, reviewed drafts of surveys and chapters, and were always quick to respond to calls for help or advice. This report represents only a portion of the data collected during the past two years. It presents a “snapshot” of the state of geriatric medicine in the United States in the spring of 2002. ADGAP intends to maintain and periodically update this database as a longitudinal record in the field. Researchers and educators are encouraged to contact the project staff for background details of the study. The practice of geriatric medicine is by its very nature interdisciplinary. Physicians providing care to older adults recognize and depend on the skills of many other health care disciplines. Although the research detailed in this report is limited to physician practice and education, ADGAP and the National Oversight Panel recognize that we have addressed only one aspect of the educational challenge of improving the knowledge and skills of all health professionals caring for the aged. This study and report were made possible through the generous support provided by the Donald W. Reynolds Foundation of Las Vegas. ADGAP sincerely appreciates the Foundation’s commitment to improving the medical care provided to older Americans. Gregg A. Warshaw, MD Martha Betty Semmons Professor of Geriatric Medicine Professor of Family Medicine University of Cincinnati College of Medicine Project Director Elizabeth J. Bragg, PhD, RN Project Manager Ruth W. Shaull, MSN, RN Project Staff 2
National Oversight Panel M. Brownell Anderson Association of American Medical Colleges Robert F. Avant, MD American Board of Family Practice Linda H. Barondess American Geriatrics Society Robin A. Barr, PhD National Institute on Aging John Burton, MD Johns Hopkins Geriatrics Center Thomas Cavalieri, DO American Association of Colleges of Osteopathic Medicine Marsha Goodwin, MSN, RN Veterans Health Affairs Leslie Goode, MHS American Board of Internal Medicine William J. Hall, MD University of Rochester William R. Hazzard, MD University of Washington Seth Landefeld, MD University of California, San Francisco Stephanie Lederman American Federation for Aging Research Susan Lieff, MD American Association for Geriatric Psychiatry Donna Regenstreif, PhD John A. Hartford Foundation David B. Reuben, MD University of California, Los Angeles Judith Salerno, MD National Institute on Aging Joanne Schwartzberg, MD American Medical Association Richard S. Sharpe Donald W. Reynolds Foundation Philip Sloane, MD, MPH University of North Carolina Joan Weiss, PhD, RN Bureau of Health Professions University of Cincinnati, Institute for Health Policy and Health Services Research Project Staff Dave Brewer, BS Mark Carrozza, MA Thomas Chenier, PhD Mary Choate Annette Georgin Linda Goldenhar, PhD Jonathan Kopke, BS Christopher J. Lindsell, PhD Greg Roth, BA Heather Lee Saurs Geriann Thelen, BSN, RN Beth Ann Witherow We would like to acknowledge Richard Allman, MD, John Burton, MD, William Hall, MD, and David Reuben, MD, who reviewed the final draft of this report on behalf of ADGAP. We would also like to thank Marie Marley, PhD for editing the report. We recognize the special assistance provided by: Kathleen Bond, MA, Bureau of Health Professions Josepha Cheong, MD, University of Florida Harvey Cohen, MD, Duke University James Corrigan, formerly with National Institute on Aging Louis J. Grosso, MEd, American Board of Internal Medicine Gary Jackson, American Board of Family Practice Rosanne M. Leipzig, MD, PhD, Mount Sinai School of Medicine Annette Medina-Walpole, MD, University of Rochester Deirdre Terry, Association of Directors of Geriatric Academic Programs While the authors acknowledge the invaluable assistance of many individuals, any errors or omissions in this report are the authors’ sole responsibility. 3
Page 1 and 2: The Association of Directors of Ger
Page 3: The Association of Directors of Ger
Page 7 and 8: The American Geriatrics Society . .
Page 9 and 10: List of Tables and Figures Chapter
Page 11 and 12: Figure 7.4 Figure 7.5 Figure 7.6 Fi
Page 13 and 14: the fastest acceleration in 12 year
Page 15 and 16: esidency review committee provide a
Page 17 and 18: Project Methodology National Oversi
Page 19 and 20: Table 2.2 Secondary Data and their
Page 21 and 22: 3 Historical Development of Geriatr
Page 23 and 24: $195.9 million NIA extramural suppo
Page 25 and 26: important political decision by the
Page 27 and 28: 4 The Practice Of Geriatric Medicin
Page 29 and 30: participants. Geriatricians have be
Page 31 and 32: Table 4.8 Medicaid Recipients and P
Page 33 and 34: Figure 4.1 Distribution of Certifie
Page 35 and 36: Figure 4.3 Geriatric Caseload for P
Page 37 and 38: Table 4.19 Total Annual Compensatio
Page 39 and 40: panel felt were most important for
Page 41 and 42: 5 Academic Geriatrics Programs in U
Page 43 and 44: Table 5.1 Academic Geriatric Progra
Page 45 and 46: Table 5.1 Academic Geriatric Progra
Page 47 and 48: Figure 5.1 Number of Years as Acade
Page 49 and 50: Table 5.4 Women and Minority Facult
Page 51 and 52: Figure 5.6 Physician Faculty Vacanc
Page 53 and 54: Table 5.7 Sources of Geriatric Prog
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Table 5.9 Allopathic Medical School
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Table 5.11 Allocation of Faculty an
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Table 5.12 Allocation of Faculty an
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Table 6.1 Geriatric Medicine and Ge
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Table 6.4 Sources of Financial Supp
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investigators receive $60,000 of su
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Table 6.7 Program Directors Reporte
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Table 6.10 Program Directors Report
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Fellowship Training Activities for
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Table 6.16 Fellowship-Trained Geria
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7 Preparing All Physicians To Care
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General Internal Medicine The 1999
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Trends in GIM Residency Programs Re
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Nursing homes and home care experie
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Geriatric Education Retreats (GERs)
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and GIM programs a mean of 2.8 avai
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chapter. The goals of these student
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This program awarded 20 two-year, $
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Conclusion This report summarizes r
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Bureau of Health Professions, HRSA,
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U.S. Centers for Medicare & Medicai
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APPENDIX A. Research Focus of Curre
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APPENDIX C. RESEARCH FOCUS OF NATIO
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APPENDIX E. SELECTED GERIATRIC MEDI
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Appendix F. Geriatric Medicine and
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Helen Hoenig, M.D., M.P.H., Duke Un
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APPENDIX H. RESIDENCY REVIEW COMMIT
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Appendix H. Residency Review Commit
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Association of Directors of Geriatr
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