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

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

Does “compassionate deception” have a place in palliative care?

by: Olivia Gamboa (@Liv_g_g)

There is broad consensus in the medical community that lying to patients is unethical.  However, in the care of patients with dementia, the moral clarity of this approach blurs.  In her recent New Yorker article, “The Memory House,”  Larissa MacFarquhar provides an excellent portrait of the common devices of artifice, omission and outright deception that are frequently deployed in the care of patients with dementia.  She furthermore explores the historical and ethical underpinnings of the various approaches used in disclosing (or not) information to patients living with dementia.

Ms. MacFarquhar introduces the idea of “compassionate deception,” or the concept that withholding truths, or even promoting outright falsehoods, is a reasonable and even ethical choice for those caring for patients with dementia.  To the extent that it helps a person with dementia feel happier and calmer, allowing them to believe in a gentler reality (one in which, say, their spo…