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

More documents

Recommendations

Info

Table 6.15 Fellowship-Trained Geriatricians (1990-1998 Cohort), Current Academic Credentials and Professional Activities Respondents Category Credentials/Activities (n=490) 1 Percent 2 Academic Appointment 332 69 Rank Instructor 64 20 Assistant Professor 237 72 Associate Professor 25 8 Professor 1 0.3 Higher Level Degree/Training 127 26 Degree Master of Public Health (MPH) 71 14 Other Master’s Degree 48 10 Doctoral Degree (PhD) 11 2 Teaching Commitment 378 78 Disciplines Medical Students 240 64 Residents 294 78 Geriatric Fellows 215 57 Nurses 105 28 Other Health Professionals 95 25 Continuing Medical Education 67 18 Principal or Co-Investigator 187 39 Focus of Clinical 120 65 Research Epidemiology 46 25 Health Services 45 24 Education 27 15 Basic Science 16 9 Publications 214 44 Types Abstract 142 29 Research Article 131 27 Non-research Article 93 19 Book 5 1 Book Chapter 96 20 Book Review 20 4 Professional Society Member Organizations American Geriatrics Society (AGS) 410 84 American Medical Directors Association (AMDA) 138 28 Gerontological Society of America (GSA) 122 25 1 Frequencies do not total 490 in every case due to missing data. 2 Percentages do not total 100% in every case due to rounding. Source: Medina-Walpole, Barker, Katz, et al., 2002 of two or more year fellows with the same amount of post-fellowship time (Table 6.16). Seventy-three respondents had completed one year of training; 145 had completed two or more years of training during this time. While clinical activity during training and in their current careers were similar between the two groups, there were significant differences regarding career development. Respondents with two or more years of fellowship training were more likely to have made their career decisions based on their positive medical school experience and their attraction to the multidisciplinary nature of the field. Regarding overall professional activities, fellows with more than one year of training were more likely to have conducted research, published research articles, and submitted abstracts for presentation at scientific meetings during or since their fellowship training. They were also more likely to currently participate in national professional geriatric societies and be involved in teaching. Their practice focus was “essentially all geriatrics” and they were more likely to work as multidisciplinary team members and have a greater number of geriatrician colleagues. Additionally, fellows with two or more years of training were more likely to have completed formal coursework. Implications Graduates of these fellowship programs will be the next generation of geriatrics clinical and academic leaders. One hundred nineteen geriatric medicine programs and 62 geriatric psychiatry programs are now accredited by the ACGME and 7 programs are accredited by the AOA. Only 73% of first-year positions in geriatric medicine and 63% in geriatric psychiatry allopathic fellowship programs were filled for AY 2001- 2002. Several factors may account for the relatively small number of applicants to geriatrics fellowship programs and the small number of USMSGs. The percent of fellows who are USMSGs is one measure of trainee pool quality. During 1997- 1998 USMSGs filled 75% of residency and fellowship positions (Council of Graduate Medical Education (COGME), 1999). Geriatric medicine and psychiatry training programs fall below this mean. As discussed in Chapter 7, physician interest in primary care is correlated with interest in geriatrics, and the increased interest in primary care that began in the late 90s is now weakening. A significant factor in career choice is medical student debt. Over 80% of U.S. medical school graduates are indebted upon graduation; the average debt is just shy of $100,000 (Cohen, 2001). As presented in Chapter 4, salaries for both academic and non-academic primary care physicians and geriatricians remain relatively low compared to procedure-oriented disciplines. Variation exists among fellowship programs. Most programs are small, with only 15 medicine programs and 2 psychiatry programs 70
Table 6.16 Fellowship-Trained Geriatricians, (1996-1998 Cohort) Analysis of Respondents with One Year Versus Two or More Years of Fellowship Training One Year ≥ Two Years Total Fellowship Fellowship P Category n=218 1 n=73 n=145 Value 2 n (%) n (%) n (%) Career Decision Prior to / During Medical Making School 52 (24) 9 (13) 43 (40) .005 1 Frequencies do not total 218 in every case due to missing data; percentages do not total 100% in every case due to rounding. 2 Chi-square analysis. Source: Medina-Walpole, Barker, Katz, et al., 2002 Influencing Factor: Medical School Experience 29 (13) 5 (7) 24 (17) .05 Influencing Factor: Multidisciplinary Specialty 69 (32) 13 (18) 56 (39) .002 Overall Principal or Co-Investigator on Professional Fellowship Research Project 153 (72) 25 (36) 128 (90) .001 Activities Principal or Co-Investigator on Current Research Project 68 (32) 15 (21) 53 (37) .02 Principal Author During or Since Fellowship 108 (50) 25 (34) 83 (57) .001 Authored Research Articles 55 (25) 9 (13) 46 (32) .002 Authored Abstracts 75 (35) 16 (22) 59 (41) .007 Teaching Involvement in Current Position 159 (74) 47 (66) 112 (78) .06 Completed Coursework During Fellowship 75 (34) 10 (13) 65 (45) .001 Current Professional Focus: Essentially All Geriatrics 79 (37) 15 (21) 64 (46) .001 Multidisciplinary Team Member 144 (69) 37 (53) 107 (77) .001 Median Number Geriatrician Colleagues (Range) 3 (0-40) 2 (0-27) 4 (0-40) .03 American Geriatrics Society Member 182 (83) 55 (75) 127 (88) .02 reporting having more than four first-year fellows. Only 51 medicine and 10 psychiatry programs now report offering training beyond the one year required clinical experience. Among these programs, only 5 medicine PDs reported having more than two second-year trainees and only 2 geriatric psychiatrists were reported as second-year trainees during AY 2001-2002. Finally, 60% of medicine and 62% of psychiatry programs reported having none or only one USMSG firstyear fellow during AY 2001-2002. Since program growth has been rapid the quality of training may not be uniform across programs. On the other hand, for a young discipline the establishment of a fellowship program represents a “beach-head” at many academic centers. Our study found that PDs are utilizing a variety of funding sources to support the stipends of their fellows. Our data are limited in that we 71
Page 1 and 2:
The Association of Directors of Ger
Page 3 and 4:
The Association of Directors of Ger
Page 5 and 6:
National Oversight Panel M. Brownel
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
Page 55 and 56: Table 5.9 Allopathic Medical School
Page 57 and 58: Table 5.11 Allocation of Faculty an
Page 59 and 60: Table 5.12 Allocation of Faculty an
Page 61 and 62: Table 6.1 Geriatric Medicine and Ge
Page 63 and 64: Table 6.4 Sources of Financial Supp
Page 65 and 66: investigators receive $60,000 of su
Page 67 and 68: Table 6.7 Program Directors Reporte
Page 69 and 70: Table 6.10 Program Directors Report
Page 71: Fellowship Training Activities for
Page 75 and 76: 7 Preparing All Physicians To Care
Page 77 and 78: General Internal Medicine The 1999
Page 79 and 80: Trends in GIM Residency Programs Re
Page 81 and 82: Nursing homes and home care experie
Page 83 and 84: Geriatric Education Retreats (GERs)
Page 85 and 86: and GIM programs a mean of 2.8 avai
Page 87 and 88: chapter. The goals of these student
Page 89 and 90: This program awarded 20 two-year, $
Page 91 and 92: Conclusion This report summarizes r
Page 93 and 94: Bureau of Health Professions, HRSA,
Page 95 and 96: U.S. Centers for Medicare & Medicai
Page 97 and 98: APPENDIX A. Research Focus of Curre
Page 99 and 100: APPENDIX C. RESEARCH FOCUS OF NATIO
Page 101 and 102: APPENDIX E. SELECTED GERIATRIC MEDI
Page 103 and 104: Appendix F. Geriatric Medicine and
Page 109 and 110: Helen Hoenig, M.D., M.P.H., Duke Un
Page 111 and 112: APPENDIX H. RESIDENCY REVIEW COMMIT
Page 113 and 114: Appendix H. Residency Review Commit
Page 115: Association of Directors of Geriatr
show all

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

Create successful ePaper yourself

Delete template?

Save as template?