The Reply

Abstract

We appreciate the comments of Cumbler et al. We wholeheartedly agree that a student loan forgiveness program will not alleviate the tremendous shortfall of needed geriatricians in the United States; consequently, we titled it, “A Step Toward Solving the Geriatrician Shortage.” Loan forgiveness is one aspect that may address recruitment but will not do much to address retention of qualified individuals. As mentioned, the Institute of Medicine Report, “Retooling for an Aging America: Building the Health Care Workforce,” outlines a number of measures that will help address both recruitment and retention of an appropriately trained workforce. Specifically, recommendations 4.3 (a-c) include that “Public and Private Payers should provide financial incentives to increase the number of geriatric specialists in all health professions.” We are hopeful that meaningful measures will be taken to address the financial disincentives to providing geriatric care.Clearly, hospitalists represent a rapidly growing field of physicians who are already providing a substantial amount of care to hospitalized older adults. We agree that they represent a considerable workforce who may be able to affect the shortage of geriatricians, but probably only in the venue of the hospital. We feel particularly strongly that hospitalists who are specifically trained in caring for older inpatients will improve the care and safety of older patients who are hospitalized. This would still, however, leave all of the outpatient services, including rehabilitation, nursing homes, medical home programs, home services, and others, with ongoing shortages.No single solution will address the current and worsening shortage of appropriately trained workers to care for our rapidly growing older adult population. However, with a multifaceted approach to the workforce shortage, combined with coordinated efforts by health care providers, societies, congress, and, most important, our older adults to whom we are providing care, we are optimistic that meaningful changes to reverse and correct these shortages can be accomplished over time. We appreciate the comments of Cumbler et al. We wholeheartedly agree that a student loan forgiveness program will not alleviate the tremendous shortfall of needed geriatricians in the United States; consequently, we titled it, “A Step Toward Solving the Geriatrician Shortage.” Loan forgiveness is one aspect that may address recruitment but will not do much to address retention of qualified individuals. As mentioned, the Institute of Medicine Report, “Retooling for an Aging America: Building the Health Care Workforce,” outlines a number of measures that will help address both recruitment and retention of an appropriately trained workforce. Specifically, recommendations 4.3 (a-c) include that “Public and Private Payers should provide financial incentives to increase the number of geriatric specialists in all health professions.” We are hopeful that meaningful measures will be taken to address the financial disincentives to providing geriatric care. Clearly, hospitalists represent a rapidly growing field of physicians who are already providing a substantial amount of care to hospitalized older adults. We agree that they represent a considerable workforce who may be able to affect the shortage of geriatricians, but probably only in the venue of the hospital. We feel particularly strongly that hospitalists who are specifically trained in caring for older inpatients will improve the care and safety of older patients who are hospitalized. This would still, however, leave all of the outpatient services, including rehabilitation, nursing homes, medical home programs, home services, and others, with ongoing shortages. No single solution will address the current and worsening shortage of appropriately trained workers to care for our rapidly growing older adult population. However, with a multifaceted approach to the workforce shortage, combined with coordinated efforts by health care providers, societies, congress, and, most important, our older adults to whom we are providing care, we are optimistic that meaningful changes to reverse and correct these shortages can be accomplished over time.