Tuesday, April 26, 2011

Geriatrician workforce: Rural-Urban


So the Baby Boom is here, and the US population over 65 is going to rise to 20% of the population by 2030, and we lack adequate geriatric workforce. And in the rural areas of the country, things may be even more challenging! The increase in percent of population over 65 is expected to be even greater in rural areas. Furthermore, elder rural residents have higher rates of chronic disease, have lower self-rated health, and are more likely to live in poverty that their urban counterparts.

Meanwhile, natural decrease (the phenomenon where deaths in a county exceed births) is impacting rural areas especially in the hot spot areas of Great Plains, Upper Great Lakes, Appalachians, Ozarks, and extreme southern Illinois, western Kentucky, and Tennessee. With smaller numbers of births and with young workers' outmigration, health care agencies such as home health and hospice may find it harder to find health care workers as the need increases.

This month's Journal of the American Geriatrics Society
details the distribution of geriatricians across rural vs. urban United States. Physician specialty was determined from the AMA Physician Masterfile from 2000, 2004, 2008 and this was merged with US census data to provide a county level analysis. Nearly 90% of the geriatricians were located in urban settings. There were 1.48 Geriatricians/10,000 older adults in the most-urban area, compared to only 0.80 Geriatricians/10,000 older adults in the most rural area. Large geographic areas had no geriatrician. General Internal medicine practitioners had a similar distribution to geriatricians with greater presence in urban areas, while family physicians were more evenly distributed across the rural-urban continuum.

So what do we do to help the rural elder?

Telemedicine based face-to-face visits for complex elders with a geriatric center may be one answer.
But for Geriatrics programs in urban settings, one way forward may be to partner with community-based training programs and provide geriatric training to future rural practitioners.

How do you impact the rural elder? What works in your area?


by: Paul Tatum

4 comments:

ken covinsky said...

I believe you are raising a very important issue that needs a lot more thought from the Geriatics community and policy experts. We don't have nearly enough Geriatricians to meet the needs of the urban population. The statistics presented in this article are quite striking and show that this situation is much worse in rural areas.

Telemedicine is an interesting option, but will it really work? The geriatric intervention literature suggests that one time consultations are not very effective. Most successful interventions seem to require a multidisciplinary team---suggesting that the problem in rural areas is probably much more than lack of Geriatricians---but also lack of Geriatric trained nurses, social workers, and physical therapists.

Maybe we need to think of ways of helping rural health professionals get this training. But it also illustrates the urgency of better training in Geriatrics throughout the educational experience of all health professionals--regardless of where they end up practicing.

Eric Widera said...

Academic institutions joining forces with community partners sounds like a great idea, especially with a goal of education. Are there any good working models for this?

Eric Widera said...

Academic institutions joining forces with community partners sounds like a great idea, especially with a goal of education. Are there any good working models for this?

Wen Dombrowski, MD said...

Health Affairs today published a case study about New Mexico's ECHO telemedicine model of education & specialty consulting for Hep C treatment.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2011.0278


I've also heard Dr. Michael Malone of Wisconsin speak about how they use academic geriatricians to help support the rural geriatric care www.healthaffairs.org/issue_briefings/2010_12_16_innovations_across_the_nation_in_health_care_delivery/IHC_Malone.ppt


Wen
www.linkedin.com/in/WenDombrowski