care settings. Their use may be a particularly attractive strategy since, as with NPs, the use of PAs has been shown to be cost-effective (Ackermann and Kemle, 1998; Brugna et al., 2007). On the other hand, according to a survey of more than 23,000 PAs, only 5 percent of respondents reported spending any time in a nursing home or other long-term care facility, and less than 1 percent identified their primary practice as geriatrics (AAPA, 2007). Of those respondents who specialize in geriatrics, 67 percent reported working primarily in a nursing home or long-term care facility, and 75 percent reported spending at least some time in those settings. Almost 18 percent of PAs who specialize in geriatrics spend some time caring for patients at home, compared to 1.3 percent of all other types of PAs. And almost 22 percent of PAs specializing in geriatrics are employed by the government, primarily by the VA, while only 9 percent of all other types of PAs work for the government.

The overwhelming majority of the 136 accredited PA programs are located within universities and colleges, but a few exist within hospitals, community colleges, and military institutions (BLS, 2007c). Most of these programs offer a master’s level degree, while others offer bachelor’s and associate-level degrees. Virtually all students in these programs—99 percent—pursue primary-care tracks. Most programs follow traditional curricula of medical schools (Hooker and Berlin, 2002), and while some PAs receive advanced training, the bulk of the advanced programs focus on surgical and emergency care (APPAP, 2008). Accreditation standards require training in geriatrics but do not specify a minimum workload (BLS, 2007c). As is the case with other professions, there have been many calls for increased education and training of PAs in geriatrics (Brugna et al., 2007; Olson et al., 2003; Segal-Gidan, 2002; Woolsey, 2005). Unfortunately, very little has been done to examine the quality and quantity of current geriatric education and training among PA programs. In one survey, PA program administrators who were asked which areas of the curricula needed increased emphasis said that geriatric issues related to pharmacology and mental health deserved the highest priority (Olson et al., 2003).

Social Workers

The need for geriatric social workers has been recognized for decades (NIA, 1987; Saltz, 1997). In 1987 the NIA estimated that there would be a need for 70,000 social workers prepared in geriatrics by 2020, or a 43 percent increase over the needs at that point in time. In spite of this urgency, the number of social workers trained in geriatrics has not kept pace with the need. While 73 percent of social workers report that they work with adults aged 55 and over, and between 7.6 and 9.4 percent of social work-



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