Recommendation 6-2: Public, private, and community organizations should provide funding and ensure that adequate training opportunities are available in the community for informal caregivers.
Among most health care professions, the opportunities for advanced training in geriatrics are scarce or nonexistent and among the professionals who do have the opportunity to pursue advanced geriatric training, very few take advantage of these programs. Aside from their clinical expertise, specialists in geriatrics are needed because of their role in educating and training the rest of the workforce in geriatric issues. Resistance to entering geriatric fields may arise from significant financial issues.
Recommendation 4-3: Public and private payers should provide financial incentives to increase the number of geriatric specialists in all health professions.
The costs associated with extra years of geriatric training do not translate into additional income, and geriatric specialists tend to earn significantly less income than other specialists or even generalists in their own disciplines. In part, this income disparity is due to the fact that a larger proportion of a geriatric specialist’s income comes from Medicare and Medicaid, which have low rates of reimbursement for primary care activities in general. Moreover, reimbursements fail to fully account for the fact that the care of more frail older patients with complex needs is time consuming, leading to fewer patient encounters and fewer billings.
Recommendation 4-3a: All payers should include a specific enhancement of reimbursement for clinical services delivered to older adults by practitioners with a certification of special expertise in geriatrics.
Similar financial burdens affect the recruitment and retention of faculty in geriatrics. For example, in spite of their extra training, junior faculty in geriatric medicine have lower compensation than junior faculty in family medicine or internal medicine. The Geriatric Academic Career Awards (GACAs), awarded by the Bureau of Health Professions, have been instrumental in the development of academic geriatricians. Similar opportunities for geriatric faculty in other health professions are rare.