Updated Inventory and Projected Requirements for Specialist Physicians in Geriatrics

Abstract

Background 
 The predicted growth of Canadians aged 65+ and the resultant rise in the demand for specialized geriatric services (SGS) requires physician resource planning. We updated the 2011 Canadian Geriatrics Society physician resource inventory and created projections for 2025 and 2030.
 Methods 
 The number and full-time equivalents (FTEs) of geriatri­cians and Care of the Elderly (COE) physicians working in SGS were determined. FTE counts for 2025 and 2030 were estimated by accounting for retirements and trainees. A ratio of 1.25/10,000 population 65+ was used to predict physician resource requirements.
 Results 
 Between 2011 and 2019 the number of geriatricians and COE physicians increased from 276 (235.8 FTEs) and 128 (89.9 FTEs), respectively, to 376 (319.6 FTEs) and 354 (115.5 FTEs). This increase did not keep pace with the 65+ population growth. The current gap between supply and need is expected to increase.
 Discussion 
 The physician supply gap is projected to widen in 2025 and 2030. Increased recruitment and interdisciplinary team-based care, supported by enhanced funding models, and full integra­tion of COE physicians in SGS could reduce this increasing gap. In contrast to pediatrician supply in Canada, the specialist physician resources available to the population 65+ reflect a disparity.

Identifying the areas of low self-reported confidence of internal medicine residents in geriatrics: a descriptive study of findings from a structured geriatrics skills assessment survey

“…Older patients often present with unique healthcare considerations that include interacting comorbidities [4], increased vulnerability to the adverse effects of polypharmacy [5,6], frailty [7] and a poorer prognosis for different conditions in comparison with younger patients [8][9][10]. While it would be ideal if the number of geriatricians corresponded with specialist-to-aging-population requirements, the current and future predicted number of geriatricians does not align with existing and future needs [11,12]. As such, there has been growing recognition of the need to ensure that all physicians working with older persons are confident and capable of delivering appropriate geriatric care [13][14][15][16].…”

Not enough geriatricians or not where they are needed?

“…In Canada, geriatricians are internists with subspecialty training in an accredited geriatric medicine residency program. They are consultants, who practice primarily in hospitals while less than 20% practice in the community 6 . A small percentage of family physicians complete 6–12 months of additional training in an accredited enhanced skills program, Care of the Elderly (COE), and provide primary care to older adults 6 .…”

“…They are consultants, who practice primarily in hospitals while less than 20% practice in the community 6 . A small percentage of family physicians complete 6–12 months of additional training in an accredited enhanced skills program, Care of the Elderly (COE), and provide primary care to older adults 6 . In the US, most geriatricians practice primary care as either family physicians or internists 7 .…”

“…Geriatricians in both countries are experts in quality improvement and patient safety, comprehensive geriatric assessment (CGA), and interdisciplinary team‐based (IDT) care. Although the number of trained geriatricians and COE‐certified family physicians has increased in Canada over the past decade, the increases are insufficient to meet the projected demand resulting from population growth 6 . As of 2019 there were an estimated 354 COE‐physicians and only 376 geriatricians in Canada, including 168 geriatricians in Ontario 6 .…”

“…Although the number of trained geriatricians and COE‐certified family physicians has increased in Canada over the past decade, the increases are insufficient to meet the projected demand resulting from population growth 6 . As of 2019 there were an estimated 354 COE‐physicians and only 376 geriatricians in Canada, including 168 geriatricians in Ontario 6 . In the US there are approximately 7,000 certified geriatricians, and the number of physicians entering geriatrics fellowship programs fails to meet the current and projected needs of older adults 8,9…”