Skip to main content

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

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?
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

Popular posts from this blog

Caring, and the Family Caregivers We Don’t See

Over lunch at a restaurant in Manhattan, my father and I talked about long-term care insurance and the emergence of senior centers and nursing homes across the U.S. that offer a variety of ethnic cuisines and cultural events, catering not only to a growing population of adults over 65, but also, to an increasingly diverse population of adults who call the U.S. their home. This conversation was different from many similar ones before it – we weren’t talking about my research; we were talking about our own lives.
My parents immigrated to the U.S. in the late ‘70s and early ‘80s, following their parents’ advice on professional opportunities that seemed unimaginable in India at the time. Although they considered moving back soon after to care for their aging parents and to raise children, they ultimately decided to stay in the U.S. As I chronicled earlier, my paternal grandparents lived with us until I completed middle school, at which point they returned to India and lived with my mater…

Practical Advice for the End of Life: A Podcast with BJ Miller

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End."

As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care.  His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times.  As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement.

The book he and Berger wrote is filled to the brim with practical advice.  I mean, nuts and bolts practical advice.  Things like:
How to clean out not only your emotional house but your physical house (turns out there are services for that!)Posting about your illness on social media (should you post to Facebook)What is the difference between a funeral home and mortuaryCan I afford to die?  …

Top 25 Studies in Hospice and Palliative Care (#HPMtop25)

by: Kara Bishoff (@kara_bischoff )

Back in 2015 we wrote a post asking for input on what articles should belong on a list of the top 25 articles in hospice and palliative care.   We decided to focus on hospice palliative care studies and trials - as opposed to review articles, consensus statements and opinion pieces.

Here’s what we came up with. It was hard to pick just 25! We highly prioritized clinical utility and tried to achieve diversity & balance. Many others are worthy of inclusion. Take a look and let us know if you have suggested changes for next year.

Module 1: Symptom Management
Randomized, Double-Blind, Placebo-Controlled Trial of Oral Docusate in the Management of Constipation in Hospice Patients. Tarumi Y et al. JPSM, 2013.Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study. Currow DC et al. JPSM, 2011.Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomise…