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Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions Contents 1 INTRODUCTION 1 Health Care Reform, 1 Medical Education, 2 2 GERIATRIC MEDICINE AND GERIATRICIANS 3 Historical Development and Current Trends in Health Care Delivery to Older People, 3 Utilizing and Financing Health Services, 5 Roles of Physicians: Generalists and Specialists, 7 Certification of Geriatricians, 8 Review of Last Decade of Initiatives and Programs in Education and Training in Geriatric Medicine, 9 Profiles and Inventory of Geriatricians, 11 3 ANALYSIS OF EFFECTIVENESS OF PAST EFFORTS TO BUILD GERIATRICS 14 Increase in Number of Geriatricians, 14 Increase in Number of Geriatrics Faculty, 17 Outcomes of Midcareer Training Programs, 18 Increase in Number of Geriatrics Fellowship Programs, 18 Number of Unfilled Fellowship Slots, 19 Geriatrics in Residency Training, 21 Number of Medical Schools with Required Courses in Geriatrics or Gerontology: Change Over Time, 22 Student Research or Other Participation in Geriatrics, 23
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Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions Continuing Medical Education, 23 Other Measures of Growth in Geriatrics, 24 Obstacles and Constraints to the Development of Academic Geriatrics, 25 4 ASSESSMENT OF LEVEL OF NEED FOR GERIATRICIANS AND FACULTY 30 Faculty for Teaching Needs, 30 Faculty for Research Needs, 31 Physicians for Clinical Needs, 32 5 STRATEGIES TO STRENGTHEN GERIATRICS TRAINING FOR PHYSICIANS 35 Revision in Reimbursement Policies, 36 Alliance for Aging Research Efforts, 36 ADGAP Plan, 36 Geriatrics Curriculum and Implementation Grants, 37 Increasing Expertise in Non-Primary-Care Specialties, 37 Centers of Excellence, 37 Replicating the USPHS and NIH Model, 39 Joint Geriatric or Other Subspecialty Training Programs, 40 Solving the Academic Leadership Crisis in Geriatrics by Retraining Specialists for Leadership in Aging, 41 Strengthening Faculty Development and Retention Programs to Reduce Attrition from Faculty Leadership Roles, 42 Recruitment and Marketing Strategy, 43 Increasing the Geriatric Medicine Content in National Examinations, 43 Visibility of Geriatrics on the National and State Legislative Scene, 43 6 THE 1993 INSTITUTE OF MEDICINE REPORT 44 REFERENCES 46 ACRONYMS 51