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Elizabeth “Libbie” Bragg, PhD, RN Gregg A. Warshaw, MD

Geriatrics Workforce Policy Studies Center Geriatric Medicine in the United States 2012 Update (September 25, 2012). Elizabeth “Libbie” Bragg, PhD, RN Gregg A. Warshaw, MD. Methods Primary Data Collection.

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Elizabeth “Libbie” Bragg, PhD, RN Gregg A. Warshaw, MD

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  1. Geriatrics Workforce Policy Studies CenterGeriatric Medicine in the United States2012 Update(September 25, 2012) Elizabeth “Libbie” Bragg, PhD, RN Gregg A. Warshaw, MD

  2. Methods Primary Data Collection • 2001, 2005, 2007, 2008, & 2010 Surveys of Medical Schools GM Program Leaders (Allopathic & Osteopathic) • 2001, 2004 & 2008 Surveys of FM Residency Program Directors • 2002, 2005 & 2008 Surveys of IM Residency Program Directors • 2001 & 2007 Surveys of GM and GP Fellowship Program Directors • 2006 Survey of Psychiatry Residency Program Directors

  3. Methods Secondary Data Sources • AAMC • AMA • ABIM, ABFM, & ABPN • ABMS • VHA • National Ambulatory Medical Care Survey (NAMCS) • Medical Group Management Association (MGMA)

  4. Results • Practice of Geriatrics • Academic Geriatric Medicine • Fellowship Programs • Graduate Medical Education • Medical Student Education

  5. Practice of Geriatric Medicine

  6. Source: Lou Grosso, ABIM & Gary Jackson ABFM. Compiled by AGS/ADGAP Geriatrics Workforce Policy Studies Center April 2012 To maintain their certification in geriatric medicine, family medicine physicians must also maintain their primary certification in Family Medicine. Since July 2006 Internal Medicine recognized geriatric medicine as a subspecialty of Internal Medicine.

  7. Certification and Re-certification in Geriatric Medicine by Year of Original Certification as of 4/12 Source: Lou Grosso, ABIM, 2012 and Gary Jackson, ABFM, 2012. Recertification examinations are given twice a year, in the spring and fall. Certificates are valid for 10 years. Compiled by GWPS Center. Notes: Starting in 1996, fellowship training was required for certification. Starting in 1998 only one year of training was required for certification.

  8. Comparison of Percent of Filled First Year Positions, Percent of USMDs, and Private Practice Salaries for Selected Specialties 2011 Sources: 1AMA and AAMC data from the National Survey of GME programs, JAMA, September 2011. 2Medical Group Management Association. Physician Compensation and Production Survey 2011 report based on 2010 data. Data compiled by Geriatrics Workforce Policy Studies Center. *Hospice and palliative medicine is a subspecialty of anesthesiology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, physical medicine and rehabilitation, psychiatry, radiology, or surgery. USMD = Graduates of US medical schools

  9. Current Geriatricians • 4.3 Geriatricians/10,000 75+ • Range 0.9 to 7.1 • 1.1 Geriatric Psychiatrist/10,000 75+ • Range 0.1 to 2.3

  10. Academic Geriatric Medicine

  11. Academic Staff in U.S. Medical Schools (FTEs, Mean) Geriatrics Workforce Policy Studies Center Survey of Geriatric Medicine Program Directors 2001, 2005, 2007, 2008 & 2010

  12. Geriatrics Workforce Policy Studies Center Surveys of Academic Leaders in Geriatrics at US Medical Schools 2001, 2005, 2007, 2008, & 2010

  13. Medical School Faculty Compensation median salary AAMC Report on Medical School Faculty Salaries, 2009-2010, April 2011

  14. U.S. Medical School Geriatric Medicine Faculty and Staff Time Allocated by Program Mission(% effort, mean ) Geriatrics Workforce Policy Studies Center Survey of Academic Geriatric Medicine Program Directors 2001, 2005, 2007, 2008 & 2010

  15. Source of Programs RevenuesMean Percent Geriatrics Workforce Policy Studies Center Survey of Academic Leaders in Geriatrics at US Medical Schools 2001, 2005, 2007, 2008, & 2010

  16. Annual Budgets In 2001, 26% had budgets < $250,000 By 2010 this ↓ to 14% In 2001, 42% had budgets > $1,000,000 By 2010 this ↑ to 65% Source: Geriatrics Workforce Policy Studies Center Surveys of Geriatric Academic Leaders in US Medical Schools in 2001 & 2008

  17. Geriatrics Workforce Policy Studies Center Survey of Academic Leaders in Geriatrics at US Medical Schools 2001, 2005 , 2008, & 2010

  18. Fellowship Programs

  19. Geriatric Medicine Fellowship Programs(Family Medicine and Internal Medicine) Source: AMA and AAMC data from the National Survey of GME Programs compiled by Geriatrics Workforce Policy Studies Center

  20. Geriatric Psychiatry Fellowship Programs Source: AMA and AAMC data from the National Survey of GME Programs compiled by Geriatrics Workforce Policy Studies Center

  21. Source: AMA and AAMC data from the National Survey of GME Programs compiled by Geriatrics Workforce Policy Studies Center. Does not include osteopathic programs.

  22. IMGs in U.S. GME Programs • Overall 27% of all Residents and Fellows are IMGs • Endocrinology -- 47% • Cardiology -- 37% • Ophthalmology -- 7% • Emergency medicine -- 7% • Geriatric Medicine fellows – 69% • Geriatric Psychiatry fellows –51% Source: AMA and AAMC data from the National Survey of GME Programs, 2010-2011. Note: IMGs= International Medical Graduates. IMGs do not include Canadians but do include U.S. citizen IMGs GME = Graduate Medical Education

  23. Graduate Medical Education Primary Care Specialties

  24. Geriatric Physician WorkforcePipeline • 9,732 MDs graduated from FM & GIM residency programs in AY 2009/2010 • 3% entered a GM fellowship in Fall 2010 • 985 MDs graduated from Psychiatry residency programs in 2009/2010 • 4% entered a GP fellowship in Fall 2010 Source: AMA and AAMC data from the National Survey of GME Programs 2008/2009 & 2009/2010.

  25. Required Time devoted to clinical instruction in Geriatric Medicine • During 3 year Internal Medicine and Family Medicine Residency program • 20 days (Median) Internal Medicine • 12 days (Median) Family Medicine • During 4 year Psychiatry Residency Program • 23 days (Median) Geriatrics Workforce Policy Studies Center. Surveys of Program Directors in Internal Medicine (2008), Family Medicine Residency Programs (2008) , and Psychiatry Residency Program(2006). Updated 10/10

  26. Geriatric Medicine Training in FM, IM & Psychiatry Residency Programsas rated by Program Directors • Curriculum conflicts #1 obstacle to implementing GM curriculum • Geriatrics rated second most important curriculum area by IM and FM, third by psychiatry • ICU/CCU first for IM • Ambulatory Adult Medicine first for FM • Emergency Psychiatry first by Psychiatry Geriatrics Workforce Policy Studies Center. Surveys of Program Directors in Internal Medicine (2008), Family Medicine Residency Programs (2008), and Psychiatry Residency Program (2006).

  27. MD Faculty Available to Teach Geriatric Medicine Mean and ± sd Full Time Equivalents Geriatrics Workforce Policy Studies Center Surveys of Program Directors in Family Medicine Residency Programs in 2001, 2004, 2008; Surveys of Program Directors in Internal Medicine Residency Programs in 2002, 2005, 2008; and Survey of Program Directors in Psychiatry Residency Programs

  28. Ambulatory Care Visits to Primary Care Generalist and Specialist Physicians, United States Patients Age 65 and over Note: This table presents data on visits to physician offices and excludes visits to other sites, such as hospital outpatient and emergency departments. Primary care generalists excludes geriatrics. Source: CDC, NCHS, National Ambulatory Medical Care Survey . Health 2010. Table 92: Visits to primary care generalist and specialist physicians, by selected characteristics and type of physician

  29. Percent of U.S. Medical Schools at which GM and GP Faculty Teach Geriatrics to Residents in Other Specialties Geriatrics Workforce Policy Studies Center Surveys of US Academic Medical Schools. 2007 response rate = 75%, 2005 response rate = 68%

  30. Percent of Geriatric Medicine and Geriatric Psychiatry Programs that Teach Principles of Geriatric Care to other Selected Specialties 2007 Specialties taught/medical school: median 5.0 (range 1-14) Geriatrics Workforce Policy Studies Center 2007 Survey of Academic Medical Schools

  31. Percent of Medical Schools Where Faculty from Other Selected Specialties Teach Principles of Geriatric Care to their Own Residents 2007 Specialties teaching their own residents/medical school: median 4.0 (range 1-11) Geriatrics Workforce Policy Studies Center 2007 Survey of Academic Medical Schools

  32. Medical Student Education

  33. Medical student geriatrics curriculum • 23% of medical schools require a geriatric clerkship in 2005 and in 2008 • 48% integrated geriatrics into a required clinical rotation in 2005 and this ↑ to 56% by 2008 Schools could report more than one type of experience Geriatrics Workforce Policy Studies Center Surveys of Geriatric Academic Leaders in US Medical Schools 2005 & 2008.

  34. Medical student geriatrics curriculum • 34% said curriculum experience depended on faculty interest in geriatrics in 2005 and this ↑ to 37% by 2008 • 17% had some exposure, but no objectives in 2005, but this ↓ to 12% by 2008 Schools could report more than one type of experience Geriatrics Workforce Policy Studies Center Survey of Geriatric Academic Leaders in US Medical Schools 2005 & 2008.

  35. Percent of graduating medical students who thought adequate time was devoted to instruction in Long Term Care Source: AAMC, Medical School Graduation Questionnaire, All Schools Report

  36. Percent of graduating medical students who thought adequate time was devoted to instruction in End of Life Care Source: AAMC, Medical School Graduation Questionnaire, All Schools Report

  37. Percent of graduating medical students who believed that the time devoted to their instruction in Geriatrics was appropriate, inadequate, or excessive: 1990-2005 and 2010-2012 Source: AAMC, Medical School Graduation Questionnaire, All Schools Report

  38. Percent of graduating medical students who agreed or strongly agreed with the following statements. Source: AAMC, Medical School Graduation Questionnaire, All Schools Report

  39. Percent of graduating medical students who agreed or strongly agreed with the following statements. ADL = Activities of daily living; IADL = Instrumental activities of daily living Source: AAMC, Medical School Graduation Questionnaire, All Schools Report

  40. Contact Information http://www.americangeriatrics.org/advocacy_public_policy/gwps Libbie Bragg, PhD, RN The University of Cincinnati Elizabeth.Bragg@uc.edu 513-558-5241

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