Geriatric medicine in the United States: new roles for physician assistants

The problem of adequate medical care for the nation's elderly is mounting as this population grows in numbers. While the overall U.S. population has tripled since 1900, the segment over 65 has increased eightfold. Because of the high incidence of chronic illness in persons over 65, they consume a disproportionate amount of health care. Contributing to the problem are pervasive attitudes of ageism in the U.S. culture (including those of physicians), with the result that old people in the U.S. receive fragmented and often substandard medical care, particularly in nursing homes. Although some stirrings of activity in geriatric medicine are apparent in medical schools, not nearly enough faculty are available to teach courses and the interest of medical students is low. Several trends indicate that physician assistants are prepared to help fill the gaps in health care of the elderly. First, as physician extenders, these allied health professionals have demonstrated that they can perform approximately 80% of primary care tasks carried out by physicians at no sacrifice of quality. Second, a large proportion of the current caseload of physician assistants is patients over the age of 65. Third, physician assistant training programs have incorporated a fivefold increase in geriatric courses into their curricula since 1980, and both students and graduates show a high interest in this field. Finally, reimbursement policies of third party payers indicate a trend toward underwriting more physician assistant services. For example, Medicare Part B recently included payment of physician assistants in nursing homes and hospitals.