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

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CHAPTER 7 Preparing All Physicians To Care For The Aged: Graduate Medical Education . . . . . . . . . . . . .73 Background......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 Current Status of Graduate Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Primary Care Graduate Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 General Internal Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Survey of General Internal Medicine Program Directors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 Characteristics of Responding GIM Residency Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 Geriatric Medicine Curriculum in GIM Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 Faculty Resources in GIM Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 Trends in GIM Residency Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 Barriers to Implementation of Geriatrics Curricula in GIM Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 Family Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 AAFP Residency Assistance Program (RAP) Consultations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 Curriculum Retreats for Family Practice Residency Program Directors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 Survey of Family Practice Program Directors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 Characteristics of Responding FP Residency Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 Geriatric Medicine Curriculum in FP Residency Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 Faculty Resources in FP Residency Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Trends in FP Residency Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Barriers to Implementation of Geriatrics Curricula in FP Residency Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Best Educational Practices in FP Residency Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Other Initiatives in Internal Medicine and Family Practice Residency Education— The Stanford University Geriatric Education Resource Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Psychiatry ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Obstetrics/Gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Internal Medicine Subspecialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Surgical and other Medical Specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81 Interdisciplinary Team Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Implications........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Family Practice and General Internal Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Psychiatry and Obstetrics/Gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83 Specialty Residents and Subspecialty Fellows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83 CHAPTER 8 Preparing All Physicians for the Care of the Aged: Medical Student Education . . . . . . . . . . . .84 Background ........ ............................................................ . . . . . . . . . . . . . . . . . . . . . . . .84 Current Status of Medical Student Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84 AAMC/Hartford Foundation Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86 Reynolds Foundation Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87 Implications ................................................................... . . . . . . . . . . . . . . . . . . . . . . . . .87 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90 Appendix A. Research Focus of Current Veterans Health Administration Geriatric Research, Education, and Clinical Centers (GRECCS) . . .94 Appendix B. John A. Hartford Foundation Centers of Excellence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96 Appendix C. Research Focus of National Institute on Aging, Claude D. Pepper Older Americans Independence Centers: FY 2000 and/or 2001 Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97 Appendix D. National Institute on Aging, Alzheimer’s Disease Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98 Appendix E. Selected Geriatric Medicine Educational Resources for Practicing Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99 Appendix F. Geriatric Medicine & Geriatric Psychiatry Fellowship Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100 Appendix G. The Paul Beeson Physician Faculty Scholars in Aging Research Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106 Appendix H. Residency Review Committees’ Recommendations For Geriatrics Training In Selected Allopathic Specialties With Effective Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109 Appendix I. List of Interdisciplinary Leadership Group of the American Geriatrics Society Project to Increase Geriatrics Expertise in Surgical and Medical Specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112 6
List of Tables and Figures Chapter 2 Table 2.1 Table 2.2 Project Background Data Sources Secondary Data and their Sources Chapter 3 Historical Development Table 3.1 National Institute on Aging Awards by Component and Funding Mechanism FY 1990-2001 Figure 3.1 Figure 3.2 Geriatric Medicine in the United States: A Selective Timeline National Institute on Aging Funding History of Older Americans Independence Centers (Pepper Center) and Alzheimer’s Disease Centers (ADC) Chapter 4 Practice of Geriatrics Table 4.1 Critical Components for Ambulatory Geriatric Clinical Care and Services Table 4.2 Most Common Chronic Health Conditions in Americans Age 65 and Older, 1996 Table 4.3 Limitations of Activity Caused by Chronic Conditions in Non-institutionalized Older Adults, by Selected Characteristics: United States, 1997-1999 Table 4.4 Most Common Reasons for Office Visits and Most Common Final Diagnoses Among Older Patients, All Physicians, 1999 Table 4.5 Leading Causes of Death and Numbers of Deaths, Age 65 Years and Over: United States, 1980 and 1999 Table 4.6 Aged Medicare Enrollees: 1980-1999 Table 4.7 Medicare Disbursements for the Aged: 1980-2000 Table 4.8 Medicaid Recipients and Payments to Adults Age 65 or Over, 1990-1998 Table 4.9 Ambulatory Visits to Physicians By Specialty, Patients 65 Years or Older Table 4.10 Skilled Nursing Facilities, 1980-1999 Table 4.11 Nursing Homes and Related Care Facilities, Selected Characteristics: 1985-1999 Table 4.12 Ownership of Nursing Homes 1999 Table 4.13 Nursing and Related Care Homes, Residents 65 Years and Older, Selected Characteristics, 1997 Table 4.14 Home Health and Hospice Care Aged of Patients, 1998 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 Table 4.16 Re-certification in Geriatric Medicine and Geriatric Psychiatry Table 4.17 Projection: Estimated Certified Geriatricians in the United States 1998 - 2004 Table 4.18 Medicare Allowable Payments for Selected Physician Services - 2002 Table 4.19 Total Annual Compensation for Private Practice Physicians, 1999 Figure 4.1 Distribution of Certified Geriatricians in the United States, 2001 Figure 4.2 Distribution of Certified Geriatric Psychiatrists in the United States, 2001 Figure 4.3 Geriatric Caseload for Psychiatrists by Survey Year Figure 4.4 American Geriatrics Society (AGS) and American Medical Directors Association (AMDA) Membership Trends Chapter 5 Academic Geriatrics Programs Table 5.1 Academic Geriatric Programs in Allopathic Medical Schools Table 5.2 Academic Geriatric Programs in Osteopathic Medical Schools Table 5.3 Academic Staff in Geriatric Programs Table 5.4 Women and Minority Faculty in Academic Geriatric Programs Table 5.5 Medical School Faculty Total Compensation 2000-2001 Table 5.6 Sources of Geriatric Programs Revenues for AY 2000-2001 Table 5.7 Sources of Geriatric Programs Revenues for AY 2000-2001, Allopathic Schools Table 5.8 Sources of Geriatric Programs Revenues for AY 2000-2001, Osteopathic Schools 7
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: The American Geriatrics Society . .
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
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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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