response, many state boards of pharmacy have allowed a broadening of pharmacy technician responsibilities.

As new or enhanced scopes of practice are developed, effort will be needed to avoid policies that impede the flexible and effective use of these personnel. While a detailed discussion of state scope-of-practice laws is beyond the scope of this report, the issue is central to improving the capacity of the health care workforce for older Americans.

RECRUITMENT AND RETENTION

Health care providers who care for older patients serve a complex, challenging population, and evidence shows that working with geriatric patients is highly satisfying. One study showed, for example, that geriatric medicine has the highest percentage of “very satisfied” specialists among physicians surveyed in the 1996-1997 Community Tracking Physician Survey (Leigh et al., 2002). Another study found that 79 percent of geriatricians surveyed felt their geriatric fellowship had a positive effect on their career satisfaction level, and almost 90 percent said they would recommend a geriatric fellowship to others (Shah et al., 2006). In spite of this, many geriatric fellowship positions remain unfilled. Among professionals who have a choice, most do not choose geriatric specialties or choose to work in long-term care settings. Among high school students considering a nursing career almost half have no interest in specializing in geriatrics, whereas 87 percent report having an interest in pediatric nursing (Evercare, 2007). In 2002, 15 percent of the RN positions and 13 percent of the LPN positions at nursing homes were vacant (National Commission on Nursing Workforce for Long-Term Care, 2005).

This section describes the barriers to recruitment and retention of professionals in geriatric fields, with a particular emphasis on the recruitment technique of offering financial support in exchange for service commitments. Many of these barriers are not unique to the health care professionals who care for older patients, but this section will focus specifically on these issues as they relate to the health care professionals who care for older patients or who work primarily in long-term care settings.

Barriers

The barriers to recruiting and retaining health care professionals in the geriatric field include negative stereotypes of working with older patients, the complexity of geriatric cases, a lack of mentors, the availability of more attractive opportunities in non-health care professions, and also various financial disincentives. It is particularly difficult to retain and recruit care providers into institutional long-term care because of the stressful



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