Last week I discussed public policy progress since the IOM’s Retooling for an Aging America report came out on April 14, 2008. I wish I could say that medical education has been revamped in response to the report, but that is wishful thinking. Given that the bulk of the Foundation’s giving has been in academic health professions training, the weak uptake of the issues into the internal policymaking of the health professions is quite galling. The IOM report calls the US health care workforce “woefully unprepared” both in its numbers and their competence. Stakeholders outside academe are beginning to look at the report. In its June 2009 report, MedPAC, the commission that advises Congress on issues affecting Medicare, uses the IOM’s Recommendation 4.1 to support a call for increased training of resident physicians outside the hospital so that they can see the broader array of patient needs in primary, long-term, and home care settings.
However, the IOM report’s recommendation 4.2 calls for demonstration of required geriatric care competence in all health professions training, certification, licensure, and recertification. This is a major challenge to the status quo of health professions education and training with far-reaching implications.
So far, there have been a few positive signs from professional groups. In May the American Geriatrics Society and leaders of the Geriatrics for Specialists Initiative sponsored a series of meetings to discuss recommendation 4.2 with the leaders of specialty societies of medicine, followed by a separate meeting of representatives of boards, residency review committees, and other leaders within academic medicine. The American Board of Internal Medicine has similarly called a meeting to consider the implications of the IOM report for September 2009. I hope that there are similar moves afoot in other health professions and at the level of individual schools and courses.
Outside of these few glimmers, however, deans, provosts, and professional boards have not yet responded to the recommendations of the IOM to increase their emphasis on geriatric care in professional standards, program certification, training requirements, and licensure. In its effort to support primary care, MedPAC is suggesting that the federal government use its power over payments for graduate medical education to enforce some of its primary care–related recommendations. Part of what defines professions is the right to some level of self-regulation. I hope that serious people in the health professions will act to implement recommendation 4.2 without needing that kind of outside regulation.