Seven Reasons Why I Am Bullish on the Future of Geriatrics in America: Urgency and Opportunity Converge in a Perfect Storm

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As an academic gerontologist and geriatrician privileged to develop programs in aging at three academic health centers (AHCs) over the past 40 years, with the 2015 American Geriatrics Society (AGS) meetings at National Harbor and especially a year of fellowship immersed in healthcare reform in Centers for Medicare and Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI) still fresh in my mind, I am pleased to report that I am enthusiastically bullish on the future of geriatrics in America. Let me summarize seven reasons for my ascending optimism. First: Research on the aging process has matured and gained the respect and support it has long deserved. Especially defining have been epidemiological studies of genuinely old persons with their complex array of multiple morbidities, geriatric syndromes, functional difficulties, and iatrogenic complications. Thus, the defining academic anchor of a respected scientific profession has been secured. Second: These research achievements will sustain the ongoing professional development of geriatricians in clinical and academic domains, maximally leveraging the contributions of the limited number of geriatricians clustered at those sites as academic researchers, teachers, and clinicians. Investments in research training will yield rich dividends as new trainees become the engine for innovation in the field and form the core educators for the training of future geriatricians. Third: Progress and recognition in recent decades validate the initial strategy to concentrate development at AHCs as homes in which to nurture and develop our discipline and the professionals who populate it. These institutions foster excellence in all dimensions of our mission—research, education and training, and superior clinical care in support of these domains. Strong institutional commitment to geriatrics is required for its sustained success at those AHCs—especially in a relative value unit–driven climate of financial health still widely prevalent across the U.S. medical services landscape. Fourth: Our longtime extramural partners in geriatric program development remain solidly committed to excellence and continuing innovation in the care of elderly adults. The Department of Veterans Affairs continues as an exemplar of comprehensive, continuing primary and specialty care of eligible aging veterans and provides extensive national support for the training and professional development of geriatricians. The National Institute on Aging (NIA) has also progressively refined and solidified its intramural and extramural research and training and career development programs in the field while also mounting an intramural campaign to disseminate research on aging into programs offered by all National Institutes of Health institutes. Perhaps most gratifying is the NIA's assumption of financial responsibility for sustaining the renowned Paul B. Beeson Scholars in Aging in advanced career development through its new R-76 Independence Awards. Fifth: As Bob Dylan long ago alerted us, the times they are a-changing. Although unsettling to many (and the subject of many corridor and late-night bar conversations at the AGS meetings), there is increasing urgency regarding the need for important changes in our programs and strategies to assure that our agenda is aligned with those changes and that our momentum is sustained. The John A. Hartford Foundation is shifting its focus from the education of geriatricians toward interdisciplinary education supporting team-based care. CMS and especially its developmental arm (CMMI) and other federal programs under the Affordable Care Act are developing and evaluating new models of care across the spectrum of age, sites, and systems of care. The large, recently initiated Transforming Clinical Practice Initiative from CMMI seeks to shift the center of gravity of U.S. primary and specialty care to patient-centered medical homes featuring multidisciplinary staffs and supported by strong electronic medical record systems. These changes will allow us to continuously track and evaluate data and outcomes, facilitate communication and transitions across sites and over time, prevent unnecessary hospital admissions and readmissions, and enhance primary and specialty care collaboration and communication. Such practice innovations will enhance value-based, patient-centered care, with creative reimbursement schemes providing incentives that will especially benefit those who care for our most vulnerable clients—complex, frail, elderly adults. Sixth: These innovations will create more opportunities to accelerate progress in forging partnerships with multiple specialties, service lines, community sites, and programs to insinuate geriatric principles and services throughout complex health systems. The emerging demand for the services we provide will be enormous, and newer healthcare payment methods will be favorable to the rapid expansion of our field. Seventh: This “perfect storm” of urgent realignment of priorities and resources represents an unprecedented opportunity for all members of geriatric healthcare professions, regardless of role, to contribute to meeting the needs of the onrushing aging tsunami. At the AGS meeting, I witnessed practitioners from many disciplines gathered to discuss the added value of geriatric professionals in multidisciplinary, team-based care. At one session, the energy in the room was electric as geriatric physicians, geriatric nurse practitioners, geriatric physician assistants, geriatric nurses, geriatric clinical pharmacists, and geriatric mental health professionals discussed the possibilities for interdisciplinary collaboration. Indeed, the tent of geriatrics is very big, and there is room for many. Together, these translate into a single optimistic prediction: this is a fabulous opportunity for every member of our geriatric care teams to enjoy long and fulfilling careers in taking care of elderly adults. So have I made my case? Is there a perfect storm of opportunity and urgency here? Are you, too, bullish about the future of geriatrics in America? Conflict of Interest: The author has no competing interests to declare. Wake Forest School of Medicine provided funding. Author Contributions: WH is the sole author this paper. Sponsor's Role: None.

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