Building the Physical Therapy Workforce for an Aging America

Abstract

BACKGROUND AND PURPOSEA landmark Institute of Medicine (IOM) Report in 2008, Retooling for an Aging America: Building the Healthcare Workforce,1 provided a discouraging assessment of the readiness of the health care workforce to meet the needs of the rapidly growing older adult population and stressed the critical need to enhance educational preparation in geriatrics. The IOM report examined workforce data and educational preparation across the spectrum of health disciplines, concluding that (1) the health care workforce in general is inadequately prepared to deliver effective and efficient health care services to older adults, and (2) the numbers of health care practitioners choosing to specialize in geriatrics is critically insufficient to meet the needs of the population.This is not the first call for greater emphasis on geriatrics in health professional education. This need was widely discussed in the late 1970s and early 1980s.2,3 The IOM's 1978 report 'Aging and Medical Education4 focused on the changing demographics and the need to better prepare clinicians for these changes. The implementation of geriatric education centers (GECs)5 by the US Public Health service in 1983 was spurred by the recognition of this growing and unmet need for better preparation of health care practitioners in geriatrics.In 1990, the APTA's Department of Accreditation, recognizing the critical need for enhanced geriatric content, received an Administration on Aging grant to support a project aimed at enhancing the aging-related content and learning experiences in physical therapist (PT) and physical therapist assistant (PTA) education programs. A survey was conducted, resource manual produced, and a cadre of physical therapy professionals with advanced knowledge in geriatrics were trained as onsite reviewers for the accreditation of PT and PTA academic programs.Despite the effort of many over the years, the gap between the need for and the existence of a well-prepared workforce remains large. A crisis is now upon us. Older adults are currently the predominant group using the health care system. Older adults access the health care system at 3 times the rate of other age groups, have longer hospital stays, have more office visits, and spend more money on health care than other age groups.6 Given our population demographics, this growth will continue for at least the next several decades. A workforce well prepared to deliver quality health services in a resource-efficient and clinically effective manner is essential to meet the health care needs of the population. Quality health care for older adults will not be achieved through the services of specialists alone. All health professionals must have a solid preparation in the management of older adults, and students seeking entry to health professions programs should recognize that the majority of them will regularly work with older adults.The patient demographics within physical therapy mirror other health professions. In the 2011 Analysis of Practice for the Physical Therapy Profession: Entry-Level Physical Therapists7 commissioned by the Federation of State Boards of Physical Therapy, a large and representative sample of PTs reported the percentage of their typical caseload by age bracket (18 or younger, 19-65, 66 or older). The summary data indicated that, on average, 47% of patients managed by PTs are 66 years of age or older. This compares to 37% of patients between 19-65 and 13% of patients 18 years or younger. The parallel document for the PTA, the Analysis of Practice for the Physical Therapy Profession: Entry-Level Physical Therapist Assistants,8 reports that, on average, 63.6% of the patients treated by PTAs are 66 years of age or older, 28.8% are between the ages of 19-65, and 5.5% are 18 years of age or younger. Thus, the older adult constitutes an even higher percentage of the PTAs caseload.Bardach and Rowles9 reported on the contemporary status of geriatric education across 7 health care disciplines, including physical therapy. …