Pushing for Geriatrics as a Primary Care Discipline
The American Geriatrics Society (AGS) has long advocated for greater investment in geriatrics education and training and we’re now seeing more movement in this important area. Among the recommendations in the Council on Graduate Medical Education's (COGME) recent report, Improving Value in Graduate Medical Education, are two proposals that would enhance geriatrics training and, as a result, the quality of care for older patients.1
One of the proposals calls for directing increases in graduate medical education (GME) funding to six high-priority specialties—geriatrics, general internal medicine, general surgery, family medicine, psychiatry, and priority pediatric subspecialties. The other calls for directing increases in GME funding to training programs that have a higher proportion of trainees continuing in these six specialties and that are located in areas with relatively low per capita supplies of physicians. Though the recommendations have yet to be finalized, they are a significant accomplishment. Among other things, they will be influential as Congress continues to discuss reforms in the GME system.
In letters to COGME, the AGS and its leadership have repeatedly suggested that geriatrics be eligible for increased GME funding, and that the field be explicitly recognized as a primary care discipline.
“We are very pleased with COGME’s recommendations," said AGS Board Chair Jim Pacala, MD, in response to the report. “We believe that geriatrics should be recognized as a primary care discipline and that Medicare GME funding to hospitals and other training sites should be directly linked to the nation's healthcare workforce needs. Ensuring that GME funding is aligned with the nation's need for a workforce that is competent to care for our rapidly growing older adult population continues to be a core policy priority for AGS.”
While GME programs focus on physicians, the interdisciplinary team approach that is central to geriatrics care—with geriatricians playing not only roles as primary care physicians, but also as consultants and geriatrics team leaders—helps disseminate their knowledge among the rest of the team. And at the same time, physicians learn from other team members who have their own areas of expertise, enabling the team to work optimally. As a result, the benefits of GME funding for geriatrics go far.
Not only geriatrics healthcare providers, but health professionals in virtually all fields need to be familiar with the unique healthcare needs of older patients, given the rapidly growing number of older Americans. They need to recognize both age-related (physiologic) and disease-related changes; important shifts in cognitive functioning, mental illness, functional status and their impact on quality of life; problems with medication management; and how to recognize and treat other common conditions seen in the older adult population.
And this is why GME funding is so important, as are other programs supporting geriatrics training. Efforts such as these need to be expanded into yet other disciplines and good geriatrics care needs to be fostered in all healthcare settings. The current focus on Accountable Care Organizations, medical homes, and other innovative care delivery structures opens the door for enhanced appreciation of the unique needs of older adults, especially with regard to care coordination and across care transitions.
Those of us in geriatrics have much to teach others about optimizing care value; identifying needed resources; clarifying the goals of care; and using available care, including community and other resources, more wisely. Geriatrics healthcare professionals are trained to coordinate and promote high quality care and can serve as valuable local and national resources in healthcare delivery and quality and safety initiatives. COGME’s recognition of geriatrics as a high priority field and its recommendations should stimulate further dissemination of the science and skills of our profession and should provide much needed support—not only to improve the quality of care for older adults, but also to raise the professional standing and recognition of our field. This recognition will also improve our ability to promote and deliver higher value and better informed care as health reform initiatives begin to take effect over the next few years.
- Council on Graduate Medical Education. Improving value in graduate medical education. www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/twentyfirstreport.pdf. Published August 2013. Accessed September 9, 2013.