Geriatric and Primary Care Workforce Development

Reviewing the historical development of physician specialties within the context of market needs, the author explores the possible reasons for the shortage of physicians and other healthcare professionals trained to care for the growing older population. The formation and development of pediatrics provides an interesting backdrop to the development of geriatric medicine. The public funding of Graduate Medical Education (GME), which was meant to assure an adequate workforce, may have been responsible for the opposite result. The GME funding structure has discouraged primary care physicians in relation to more procedure oriented specialties. Geriatricians recognize that older individuals may require a different approach to care than younger patients. There are numerous clinical examples in the treatment of atrial fibrillation, prostate cancer, subclinical hypothyroidism, osteoporosis, hypertension and diabetes mellitus. The number of board certified geriatricians is declining annually, compounded by an increasing income gap between primary care physicians and procedurally based specialists. This discrepancy has been growing since the Omnibus Reconciliation Act (OBRA) of 1989 with the process for determining physician reimbursement put under the direct purview of the American Medical Association (AMA). There are a variety of possible solutions, all of which include the need for more geriatrician leaders and educators. One possible solution is for GME funds to be focused on developing more primary care geriatricians. No matter what is done from a educational perspective, the financial incentives for physicians must be aligned with the needs of the aging population.