pharmacy, which are referred to as PGY-1, for Post Graduate Year 1. Pharmacists may pursue a second year of residency training (PGY-2) in a focused area, including geriatric pharmacy. The ASHP currently accredits (or pre-accredits) 351 PGY-2 programs (ASHP, 2007). There are eight accredited programs in geriatric pharmacy, and two other programs are pre-candidates for accreditation. The American College of Clinical Pharmacy offers one fellowship position in geriatrics to prepare pharmacists for academia and independent research; this 2-year fellowship focuses on Alzheimer’s Disease (ACCP, 2007). Viability of these programs has been hindered by inconsistent funding; with the exception of GECs, there are few federal or private-foundation-funded programs or initiatives that support pharmacist education and research training in geriatrics.

Pharmacist licensure, which is performed by individual states and jurisdictions, depends on passing a national examination, and 46 jurisdictions require an additional examination on federal law and state-specific regulations (CCP, 2006). Some states also require laboratory and oral examinations. Re-licensure requires a minimum of continuing education credits. Currently, neither continuing education in geriatrics nor demonstrated geriatric competency is required for pharmacist re-licensure in any state. However, a 2005 survey of state pharmacy laws found that one state requires all pharmacists to participate in 2 hours of continuing education in end-of-life care every 2 years, and two states require all pharmacists working as long-term care consultants to have at least a portion of their continuing education activities focused on the care of older adults (Linnebur et al., 2005).

Physician Assistants

Physician assistants (PAs) represent an important part of the workforce for the elderly population (Olshansky et al., 2005). PAs work under the supervision of a physician, but they can often work apart from the physician’s direct presence and can prescribe medications and bill for health care services. Unlike some of the other professions described above, the PA workforce tends to be younger and is growing rapidly. About half of PAs work in family medicine or general medicine (Brugna et al., 2007; Hooker and Berlin, 2002). The 65-and-older population accounts for about 32 percent of office visits to PAs (Hachmuth and Hootman, 2001), and 78 percent of PAs report treating at least some patients over the age of 85 (Center for Health Workforce Studies, 2005).

PAs are an especially important source of care in underserved areas, where they often act as the principal care provider in clinics, with physicians attending on an intermittent basis. In this vein, they are a potential source of care to meet the increased need that is projected for long-term



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