6

The 1993 Institute of Medicine Report

In December 1993, the Institute of Medicine published its report Strengthening Training in Geriatrics for Physicians. That report was the culmination of a 5-month study conducted in 1993. For that study, the Institute of Medicine convened an expert committee that met twice, commissioned a background paper, and listened to testimony at a 1-day invitational workshop. The committee's recommendations included needs in five general categories: (1) improved education in geriatrics, (2) leadership centers, (3) enhanced attractiveness of geriatrics, (4) revision in payment policies, and (5) research support.

The specific recommendations regarding the need for improved education in geriatrics included the following: the need for funding for development of models of undergraduate curriculum development, increased geriatrics medicine experience in internal medical and family practice residency programs (at least 6 months by 1996 and 9 months by 1999), combined (geriatric medicine and subspecialty) training programs, and the development of a high-quality, national-level clinical scholars-type program in geriatrics. In addition, the report supported an increase in expertise in geriatric medicine by those in non-primary care specialties through a variety of strategies. Finally, the report recognized the importance of developing effective midcareer retraining programs.

Under the heading leadership centers, the report recommended continued federal support for Centers of Excellence sponsored by the National Institute on Aging and the U.S. Department of Veterans Affairs. Moreover, it recommended additional support to allow for a more comprehensive focus on research, education, and clinical services.

The report recommended several strategies to enhance the attractiveness of



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Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions 6 The 1993 Institute of Medicine Report In December 1993, the Institute of Medicine published its report Strengthening Training in Geriatrics for Physicians. That report was the culmination of a 5-month study conducted in 1993. For that study, the Institute of Medicine convened an expert committee that met twice, commissioned a background paper, and listened to testimony at a 1-day invitational workshop. The committee's recommendations included needs in five general categories: (1) improved education in geriatrics, (2) leadership centers, (3) enhanced attractiveness of geriatrics, (4) revision in payment policies, and (5) research support. The specific recommendations regarding the need for improved education in geriatrics included the following: the need for funding for development of models of undergraduate curriculum development, increased geriatrics medicine experience in internal medical and family practice residency programs (at least 6 months by 1996 and 9 months by 1999), combined (geriatric medicine and subspecialty) training programs, and the development of a high-quality, national-level clinical scholars-type program in geriatrics. In addition, the report supported an increase in expertise in geriatric medicine by those in non-primary care specialties through a variety of strategies. Finally, the report recognized the importance of developing effective midcareer retraining programs. Under the heading leadership centers, the report recommended continued federal support for Centers of Excellence sponsored by the National Institute on Aging and the U.S. Department of Veterans Affairs. Moreover, it recommended additional support to allow for a more comprehensive focus on research, education, and clinical services. The report recommended several strategies to enhance the attractiveness of

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Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions geriatrics. Included among these were foundation support for medical student research programs in geriatrics and gerontology and financial stimuli, including low-interest loans for those starting academic careers in geriatric medicine and loan-forgiveness programs for physicians entering training programs in geriatric medicine. The report recognized the need for a marketing effort to create positive attitudes about the importance of geriatrics and the major opportunities that exist in this area; it noted that complementary efforts should be taken to increase the public's awareness of geriatrics as well. In addition, the report recommended that geriatric medicine faculty be protected from excessive clinical obligations. The report recommended several revisions in payment policies, including separate payment codes for planning and coordinating services for frail elderly patients, the provision of appropriate payment for all health professionals on geriatric teams, and inclusion of nonhospital settings as part of the payment formula used in calculating Medicare 's indirect medical education adjustment. Finally, the report recommended increased federal funding for academic and research activities in geriatric medicine. With that report, the Institute of Medicine outlined a framework and strategy for strengthening training in geriatrics for physicians that may guide health policy decisions in federal and state governments. It may also help foundations to determine priority areas for funding programs in geriatrics. Finally, it helps to provide an inventory for the academic geriatrics community to take stock of its current strengths and weaknesses and plan for the future.