As a way to keep in touch with developments in health care for older adults and feed the raging “Jhartfound” social media beast (joke), I have a series of Google searches running that send me an e-mail digest every night of new online content that uses terms like geriatric, long-term care, gerontology, etc. (You wouldn't believe how much material is online about "geriatric" pets.)
Recently I got a hit about a presentation (see below) that Helen Kao, a UCSF geriatric medicine faculty member (and GeriPal blogger), made to a group called Primary Care Progress. Curious, I followed the link. Helen's presentation on GeriTraCCC, (Geriatrics Transitions, Consultation, and Comprehensive Care — descended I think from a Foundation grant) was part of TOM Talks: Transforming Outpatient Medicine.
Helen’s talk was great, but I was also fascinated by this new-to-me group, Primary Care Progress. This is a "grassroots" advocacy movement by physicians to grow primary care. This is how they describe themselves:
PCP is Primary Care Progress.
We’re a 501 (c)(3) national nonprofit--a growing network of medical providers, health professional trainees, policy pundits, advocates, and educators. We are a home to everyone under the primary care umbrella--and anyone else--who cares about the future of primary care in this country. Our members are united by a new vision for revitalizing the primary care workforce pipeline through strategic local advocacy that promotes primary care and transforms care delivery and training in academic settings.
We are a primary care community.
We are a platform for spreading a reinvigorated vision of primary care.
We are a grassroots approach to primary care transformation.
We are the future of primary care.
Its leaders and founders are medical students and physicians who have community organizing and campaign experience and are applying those skills to improving primary care. Just looking at the website, I was really impressed and quite envious of the obvious passion that they bring to the issue and are eliciting from others. Their website/online community already lists 1,407 members.
Now, while Primary Care Progress includes general pediatrics, outside of that demographic the overlapping interests with geriatric medicine are clear. Family Medicine and Internal Medicine residencies followed by the one year of clinical geriatrics fellowship is the pathway towards being a "card carrying" geriatrician as a physician. I think for most geriatricians, the choice is not between geriatrics and a specialty like gastroenterology. People entering residency (and sometimes medical school) with their hearts set on a career as a specialist are not the raw material for geriatrics. Rather, geriatricians are those for whom there is a commitment to the principles of primary care combined with a desire and an interest to gain additional skills in the clinical care of this complex population. And we know that there is a vibrant cross-connection between academic geriatrics and the Society of General Internal Medicine in the persons of long-time friends like Seth Landefeld of the University of California, San Francisco, and Chris Callahan of Indiana University, among others.
The right relationship between geriatrics and its primary care cousins has been controversial within geriatrics. But for the last 20 years, the Foundation has favored an expert consultant model, wherein geriatricians are what we sometimes call "yeast." This view recognizes that the number of geriatricians is extremely small compared to the needs of the population of older adults. Therefore, the best use of their expertise is not in direct clinical care (in most cases), but rather in both clinical and system level consultation—the research, education, and clinical systems design that will put scarce expertise to work by helping the generalist provider community to do better by older Americans.
So geriatrics and primary care share a common fate and are often allies, as in the American Academy of Family Physicians’ (AAFP) support for a geriatrics seat on the Medicare payment advisory committee, the RUC. Together, will we be able to keep primary care accessible to the American public? Will we be able to help primary care providers, including nurse practitioners, physician assistants, and others, meet the daunting challenges of patients with complex chronic needs – mostly older adults? Will we be able to keep recruiting the workforce we need? Please let us know if you have ideas for how geriatrics and primary care can work together to improve care for older adults.
Next week, I will report on an exciting meeting on the future of primary care where I cross paths with Primary Care Progress: this time not in cyberspace, but in Philadelphia!