The American Geriatrics Society (AGS) estimates that a total of 30,000 geriatricians will be needed to meet care needs by 2020, and there is currently a shortfall of approximately 13,000 geriatricians. The AGS projects that the shortfall will worsen without greater numbers of graduates of geriatrics training programs. However, some healthcare leaders believe that the needs of the aging population can be met by other physicians – including primary care providers – in addition to professionals such as occupational therapists and nurse practitioners. This two-stage project will examine current and emerging roles for geriatricians in the US healthcare system. This first report provides a comprehensive review of the scholarly literature that addresses how healthcare organizations are currently utilizing geriatricians, including their role as part of healthcare teams working in different care settings, and how these roles are expected to change in the future. Findings from this report were used to inform the project’s second stage, a series of key informant interviews with field experts focused on identifying emerging roles for geriatricians, how these roles are being shaped by value-based care payment models, and how changes in geriatric care delivery are influencing professional training and development needs. The second report, Geriatrician Roles and the Value of Geriatrics in an Evolving Healthcare System, can be found here.
Key Questions
- What roles do geriatricians play on healthcare teams?
- How are geriatricians used in different types of health care delivery systems (e.g., integrated group-model HMOs, accountable care organizations, free-standing hospitals, etc.)?
- What is the current scope of practice and setting of geriatric clinical care, and how are geriatrician roles changing?
For questions, contact: Timothy Bates, MPP, Senior research analyst at UCSF’s Philip R. Lee Institute for Health Policy Studies and the Center for the Health Professions, [email protected]
Report
UCSF Health Workforce Research Center authors Aubri Kottek, MPH, Timothy Bates, MPP, and Joanne Spetz, PhD have published their report: The Roles and Value of Geriatricians in Healthcare Teams: A Landscape Analysis. While it is difficult to know the true number of practicing geriatricians, the supply has been negatively affected by tightening certification requirements, relatively low income and negative return on investment. There appears to be consensus that clinical care by geriatricians should be reserved for the most complex patients, and, therefore, that the future workforce focus should be on ensuring that every clinician caring for older adults is competent in geriatric principles and practices, rather than on increasing numbers of board-certified geriatricians.
Experts in geriatric medicine are pushing the field to focus more on leadership, education, and designing new older adult care systems. In this framework, consultant and leadership roles will continue to be important. In addition, it appears that clinical care settings of geriatricians are moving away from outpatient facilities toward SNFs and other care facilities, with the expectation of more home care and visits but less hospital care in the future.
There is general agreement on the need to shift the focus from shortages and unpopularity of the specialty toward a culture in which geriatric principles and practices are taught in mainstream education. This will ensure a primary care workforce that is competent in geriatric medicine and will allow the limited supply of specialized geriatricians (whether CAQ diplomates or not) to focus on higher level needs.
The second report, Geriatrician Roles and the Value of Geriatrics in an Evolving Healthcare System, can be found here.