A Word From the President

Preparing Our Students to Care for an Aging Population

One thing we know for sure - America is getting older. Demographers predict with confidence that some 15 percent of the U.S. population will be at least 65 years of age by 2015; fully 20 percent-an astounding 78 million people-will fall into that category by 2050. Coupled with the obvious fact that older people require more medical care, this profound demographic change poses a difficult challenge for academic medicine. How are we going to prepare the future physician workforce for the prodigious task of providing appropriate care for this burgeoning population of older people?

Part of the answer, of course, is to do what we can to increase the number of students choosing geriatrics as a career. Not because geriatricians alone, no matter how many we might turn out, could possibly provide all the medical care needed by this population. Far from it. But having many more geriatricians in the future physician workforce would help meet medicine's challenge in at least two very important and related ways.

First, geriatricians are uniquely qualified to provide the consultative services other practitioners require to ensure that the special needs of the elderly are dealt with appropriately. Optimally, meeting the predictable future demand for those consultative services will require a sizable contingent of practicing geriatricians. Second, the availability of more geriatricians would be a boon to medical school faculties. Indeed, the need for more geriatrics faculty is especially acute; fewer than 1 percent of current medical school faculty are geriatricians. Having more geriatric expertise to call upon would undoubtedly assist medical educators greatly in their efforts to properly educate the majority of their students who, with some exceptions (e.g., future pediatricians), are destined to care for more and more elderly patients as the coming demographic shift takes hold.

Despite the advantages, the prospects are dim for an appreciable increase in geriatricians in the foreseeable future. At present, our students are not, to say the least, flocking to this discipline. In the past academic year, 716 positions were offered in ACGME-accredited geriatrics programs, but only 496 were filled. Even if all the available spots were being filled, the output of current residency programs would, by most estimates, fall far short of meeting the anticipated need. The reasons for the dearth of interest in this discipline are many and, for the most part, beyond the reach of medical schools. Perhaps chief among them are the inadequate reimbursements available for geriatric services and the concern on the part of medical students that a geriatrics practice may not yield the same professional gratification or manageable lifestyle as other career choices are thought to provide.

Clearly, we can't wait for a flood of new geriatricians to come along before taking concerted action to prepare for the aging boom. And, indeed, we're not. Medical schools have recognized for years that decisive efforts were needed to better prepare all students to care for the growing elderly population. Over 20 years ago, the AAMC called attention to this demographic change and strongly encouraged medical schools to a) increase the attention given to the aging process in their educational programs; b) expand their efforts in aging research to improve the clinical care of the elderly; and c) incorporate a variety of clinical settings in which students could gain experience with elderly patients.

Over the past 20 years the number of U.S. medical schools with identifiable administrative units (e.g., departments, divisions) devoted to geriatrics or gerontology has risen from 15 to 57. In addition, according to LCME data, geriatrics is now taught as part of a required course in nearly every medical school.

To further assist our schools in these efforts, four years ago the AAMC partnered with the John A. Hartford Foundation to establish a grants program to stimulate medical educators to develop innovative gerontology and geriatrics curricula, with special attention to integrating appropriate experiences across all four years. Forty medical schools were awarded competitive grants totaling $4.8 million, and all agreed to share with other schools the educational materials produced by their efforts in order to facilitate rapid dissemination of the lessons learned. An encouraging early result of this grants program was evident in the responses to the 2002 GQ; students at grantee schools expressed more confidence in their knowledge of geriatrics than did students from other schools.

The efforts of medical schools in this regard, as important as they are, can go only so far. After all, students acquire the bulk of the education required to become independent practitioners during residency. Family medicine and internal medicine have, for some time, included at least some geriatrics training in their GME curricula, which has offered them the opportunity to look at new and innovative sites of training-such as assisted-living facilities-and given them the opportunity to model the "team care" approach to patients. I am concerned, however, that the preparation of primary care physicians, let alone of those seeking more specialized training, still falls short of what our older patients truly need.

As we continue to adapt our educational programs to the public's rapidly evolving expectations of future physicians, few tasks are more challenging than equipping our students and residents with the knowledge and skills required to meet the escalating needs of our rapidly aging population.

Jordan J. Cohen, M.D.
AAMC President

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