Geriatric psychiatrist shortage threatens care: medical school exposure proposed.
Despite this outlook, the officials see cause for optimism.
"We've gone from a handful of geriatric psychiatry programs to something like 60, and that's almost a doubling in the last 5 years," said Dr. Gary J. Kennedy, immediate past president of the AAGP "What this means is that we have the programs ready; we just need to sustain the growth of the fellows coming into the programs, and then get a little bit of help legislatively. Then I think we'll make the target."
Right now, there are about 2,590 board-certified geriatric psychiatrists in the United States, said Dr. Joel E. Streim, president of AAGP. Current estimates are that about 54000 are needed. The 60 geriatric psychiatry fellowship programs now produce about 80 board-certified geriatric psychiatrists annually. In addition, 50 fellowship slots go unfilled, Dr. Kennedy said.
The shortage of 2,500 geriatric psychiatrists might seem insurmountable, but Dr. Kennedy said he thinks a realistic goal would be a 20% annual increase in the number of fellows graduating each year for the next 5 years. Such an increase would result in about 200 graduates per year.
A recent study by Dr. Susan Lieff of the University- of Toronto and her colleagues provided some hints on strategies aimed at increasing the number of psychiatrists interested in the subspecialty. In a survey of 184 residents and fellows who attended geriatric psychiatry recruitment and mentorship programs, three factors appeared to have special influence on the choice of geriatric psychiatry (Am. J. Geriatr. Psychiatry, 11:300-308, 2003).
First, the respondents reported being heavily influenced by encounters with teachers who work in the field. Second, they appreciated the uniquely complex nature of geriatric psychiatry, which requires knowledge of neuropsychiatry and medicine because of the multifaceted nature of patient problems. Third, they reported positive personal relationships with seniors.
Dr. Streim and Dr. Kennedy said they think that encounters with geriatric psychiatry early in medical training could also help turn the tide. "We aren't introducing geriatrics and geriatric psychiatry to medical students early in their career," said Dr. Streim in an interview, "so we don't have the opportunities to let them know that this is a challenging field, it's an exciting field, you actually can make' a living doing this, there's tremendous demand out there as well as tremendous satisfaction. But because we're not represented in the curricula of medical schools, we have little opportunity to let medical students know that this is even a career option."
Dr. Kennedy said much hinges on current faculty members. "The faculty needs to get down into the first years of training and give lectures, give case conferences, take people on house calls, take the trainees to the nursing homes so they can see what real satisfaction there is in this practice," he said.
And the AAGP thinks Congress should provide economic incentives as well. The association has been supporting legislation that would provide partial loan forgiveness to physicians who choose either geriatrics or geriatric psychiatry as a profession.
Dr. Streim said he thinks another factor limiting the number of geriatric psychiatrists is the Medicare policy of reimbursing only 50% of psychiatric services. "That discriminatory coverage policy has a chilling effect on psychiatrists' interest and willingness to practice geriatrics," he said.
And ageism may be yet another factor. "Ageism is something that operates at all levels, and really has infected not only public perception but the perception of professionals, including physicians," Dr. Streim said. "Many doctors have the notion that old people just have chronic degenerative diseases; they're never going to get better; and that we put too many resources into their medical care, anyway." Because of these perceptions, "it becomes a less appealing subspecialty to choose."
Even without legislation and other new initiatives, recent changes in residency requirements will mean that more residents will be exposed to geriatric psychiatry.
For the last 2 years, a 1-month geriatric psychiatry rotation has been required for all psychiatry residents. Dr. Kennedy says time will tell whether the new requirement helps fill those fellowship slots.
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|Title Annotation:||Geriatric Psychiatric|
|Publication:||Clinical Psychiatry News|
|Date:||Sep 1, 2003|
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