1. Geriatrics Fellowship Networks: A Model to Increase the Geriatrician Workforce Geriatrics Fellowship Networks: A Model to Increase the Geriatrician Workforce Kevin Foley, MD 1, Francis Komara, DO 2, Linda Keilman, 3, Robert Riekse, MD 4, Myriam Edwards-Miller, MD 5 Kevin Foley, MD 1, Francis Komara, DO 2, Linda Keilman, DNP, GNP 3, Robert Riekse, MD 4, Myriam Edwards-Miller, MD 5 1. College of Human Medicine 2. College of Osteopathic Medicine 3. College of Nursing, Michigan State University, East Lansing, MI 4. Mercy Health Saint Mary’s, Grand Rapids MI 5. Flint Medical Center, Flint MI 1. College of Human Medicine 2. College of Osteopathic Medicine 3. College of Nursing, Michigan State University, East Lansing, MI 4. Mercy Health Saint Mary’s, Grand Rapids MI 5. Flint Medical Center, Flint MI The research support on this poster was supported by the Health Resources and Services Administration. The investigators retained full independence in the conduct of this research The research support on this poster was supported by the Health Resources and Services Administration. The investigators retained full independence in the conduct of this research Methods Conclusions Background: Declining numbers and a mal-distribution of geriatricians between urban and rural areas poses a serious threat to the future of geriatric medicine. Geriatrics fellowship (GF) programs that supply the workforce have faced challenges competing for a small number of applicants to fill first-year fellow positions. Relocating to urban areas for GF training may not be appealing to the graduates of community-based residencies interested in geriatrics when they have ties to their smaller communities. Creation of new GF programs in less populated cities where family medicine or internal medicine residencies are located may be a means to increase the supply of geriatricians. Methods: The Colleges of Human and Osteopathic Medicine at Michigan State University (MSU) developed a collaborative network model of GF programs aligned with their respective family medicine residency (FMR) networks. GF network directors were appointed, readiness surveys were conducted, educational resources were developed, and new program accreditation applications were submitted for proposed sites. Results: The model facilitated accreditation of two new allopathic GF programs that accepted and graduated fellows. Cooperative efforts within the allopathic network resulted in writing of a GF curriculum, organization of a joint Observed Structured Clinical Examination, and monthly information-sharing teleconferences with program directors. Cooperative efforts with the osteopathic network led to the development of one new osteopathic GF program, shared journal club and didactic sessions using distance learning technology, and a curriculum meeting American Osteopathic Association requirements. Two additional allopathic and osteopathic MSU-FMR sites have committed to establish GF programs within the next five years, increasing the capacity of the networks to graduate twelve fellows per year. Conclusions: Early experience with a model of institutionally-aligned and mutually supportive allopathic and osteopathic GF networks indicates that new fellowship programs can be established in community-based residencies that attract fellows who prefer non-urban training opportunities in areas underserved by geriatricians. Formation of allopathic and osteopathic GF networks to create additional community- based GF programs offers a promising approach to stabilize and redistribute the geriatrician workforce. The U.S. faces unprecedented challenges in meeting the health care needs of older adults. Critical shortages exist in the national workforce for geriatricians, especially in rural areas. To improve access to geriatricians, the Michigan State University (MSU) Colleges of Human (CHM) and Osteopathic Medicine (COM) initiated a collaborative network model of geriatric medicine fellowships aligned with our affiliated family medicine residency (FMR) programs. Of the 218 geriatricians in Michigan with a certificate of added qualifications (CAQ), 64% (130) practice in 5 southeast counties that only account for only 40% of the state’s total population. 69 of the state’s 82 counties have populations of adults > 65 greater than the national average. 7 Approximately 40% of first-year GF training slots are unfilled annually. 8 Most GF programs in Michigan are clustered in the southeast region, a factor that may account for the inhomogeneous distribution of geriatricians in the state. FMR graduates trained in non-urban areas often have ties to their communities and build careers near their sites of training. 9 GF training in non-urban cities may be appealing to residents who are not inclined to relocate. GF program directors for the dually accredited Lansing based Sparrow/MSU program appointed as CHM and COM network directors. MSU internal medicine GF program (Flint-Hurley) joined CHM network. MSU internal medicine GF program (Botsford) joined COM network. Analysis of projected costs and required community resources completed for each proposed new fellowship site. Business plans developed including costs of fellow, faculty, and operational expenses to estimate financial support from sponsoring institutions. Readiness surveys conducted at core residency sites to assess unmet needs and plan for timing of accreditation applications. Adaptable fellowship training curricula meeting ACGME and AOA standards written by in-network geriatricians as a resource to new sites. Distance learning technology acquired to facilitate sharing of didactic lectures and journal club sessions with new GF sites. Biannual performance-based clinical skills and competencies evaluation (Objective Structured Clinical Examination) developed for all network fellows. Monthly information sharing and problem solving teleconferences with fellowship program directors instituted. Two new allopathic and one osteopathic fellowship program accredited since networks formed. Each new program accepted and graduated fellows. Graduates hired as geriatrics faculty members or chose to practice in areas underserved by geriatricians. Early experience with this model of GFN development in non-metropolitan areas of Michigan indicates that new fellowships can be established that competitively recruit and train fellows who are inclined to join the teaching faculty or practice in areas of greatest need. Once fully formed, the MSU CHM and COM GF networks will be capable of graduating 12 fellows annually. Creation of additional GF networks could provide a means to stabilize and redistribute the geriatrician workforce. Abstract Project Overview Background References Distribution of Geriatricians with CAQ in Michigan Current and Proposed CHM and COM Fellowship Sites Results March 2011- one certified geriatrician (6,756 allopathic and 406 osteopathic = 7,162) for every 2,620 adults > age 75. 1 36,000 geriatricians needed in the U.S. by 2030, 2 892 in Michigan (deficit of 672). 3 90% of geriatricians providing direct patient care are located in population-dense areas. 4 19% of older adults in the live in non-urban areas. 5 Non-urban dwelling older adults have more functional limitations and poorer self-reported health status compared to their urban dwelling counterpart. 6 1.American Geriatrics Society. The Geriatrics Workforce Policy Studies Center. http://www.americangeriatrics.org/advocacy_public_policy/gwps/. 2.Alliance for Aging Research. Medical never-never land: ten reasons why America is not ready for the coming age boom. Washington, DC: Alliance for Aging Research, 2002. 3.American Geriatrics Society. Projected future need for geriatricians, June 2012. http://www. americangeriatrics.org/files/documents/Adv_Resources/GeriShortageProjected2012.pdf. 4.Peterson LE, Bazemore A, Bragg EJ, et al. Rural-urban distribution of the US geriatrics physician workforce. J Am Geriatr Soc 2011;59:699-703. 5.Administration on Aging. A profile of older Americans: 2011. http://www.aoa.gov/AoARoot/Aging_Statistics/Profilr/2011/8.aspx. 6.Rogers CC. The older population in 21st century rural America. Rural America 2002;17:2-10. 7.Administration on Aging. Department of Health and Human Services. U.S. Population Estimates for States by Age: July 1, 2009. http://www.aoa.gov/AoARoot/Aging_Statistics/Census_Population/Population/2009/index.aspx. 8.Bragg EJ, Warshaw GA, Meganathan K, et al. National survey of geriatric medicine fellowship programs: comparing findings in 2006/07 and 2001/02 from the AGS and ADGAP, Geriatrics Workforce Policy Studies Center. J Am Geriatr Soc 2010;58:2166-72. 9.Ross R. Fifteen-year outcomes of rural residency: aligning policy with national needs. Fam Med 2013;45:122-7.