The University of Maryland has already launched its adult/gero NP program, and Galik has seen improvements as a result. “I used to teach in the standalone GNP program, and our cohort of students every year was usually four to six,” she reports. “This fall, I am finding geriatric placements for 36 students in our adult/gero program. Many of them would not have specifically picked gerontology, but now they’re getting exposure to it because they’re in a combined program.”
Many students have been surprised to discover how much they enjoy working with older adults. “By having this opportunity, I think ultimately we’ll see more people enter the field than we did when we had specific programs,” Galik says.
For those who want to become true experts in gerontology, GAPNA and other stakeholders are currently in discussion about development of a specialty certification. Bednash notes that this would “provide another opportunity for enhanced capacity in geriatrics. But it won’t be for licensure or for entry into the role of an APN; it will be a personal choice that someone will make to go on and get additional education.”
In the meantime, Galik says, the expertise of GNPs and geriatricians will be needed to facilitate the changes. “Just as we need our students entering these combined programs to keep an open mind about different populations that they’ll care for and in different settings,” she says, “we need our GNPs and our gero experts to help educate and to provide precepting experiences.”
THE FUTURE IS NOW
While the rationale for transforming NP education is solid, there are still those who worry that a combined adult/gero education program will be “gero-lite.” Added to those voices—and moving outside nursing—are others expressing concern that very few clinicians are adequately trained to care for older adults.
“I do worry about whether we, as a health care provider community, will be well trained to deal with this population,” Baker says. “Gerontology NPs and physician geriatricians are very well trained. But there’s not a lot of them, so I understand the move toward trying to make every generalist a specialist in this as well.”
Clinician Reviews Editorial Board member Freddi I. Segal-Gidan, PA, PhD, Co-Director of the Alzheimer’s Research Center of California at Rancho Los Amigos National Rehabilitation Center in Downey and Assistant Clinical Professor in the Departments of Neurology and Family Medicine at the University of Southern California’s Keck School of Medicine, compares caring for an older adult to understanding a foreign language. If you know the English alphabet, you can technically read French or Spanish, which use the same letters; however, you won’t know what the words mean.
“It’s still medicine; they’re just presenting differently,” she says. “That’s the piece that I think has to be taught…. If the NPs can train people to do that, and do it well, from my perspective, kudos to them. That’s what I would like to see us doing in PA education.”
PAs, obviously, are educated as generalists. The proportion identifying themselves as specializing in geriatrics is small: The 2010 American Academy of Physician Assistants Census indicated that 671 PAs were clinically practicing in this area. Recruitment is just as difficult as it is among nurses; Kathy Kemle, PA-C, MS, Assistant Director of the Geriatrics Fellowship/Geriatrics Division, Department of Family Medicine, Mercer University School of Medicine, Medical Center of Central Georgia, offers an elective in geriatrics for any PA student. “I don’t get many takers,” she says. “I haven’t had a student [for that course] in probably two years.”
Geriatrics as a career path isn’t “sexy.” Some view it as depressing. It doesn’t pay well, because the best reimbursement goes to procedures or to aspects of care that can be easily quantified. There aren’t any flashy tech toys.
“We don’t have a little instrument that we can plug the patient into and download the data,” Kemle says. “Clinicians don’t get paid to listen and think, and that’s what we do in geriatrics.”
The nursing community formulated its response to the difficulty of enticing students into gerontology. But what about current practitioners?
“The consensus provides a framework for the clinicians of the future, the new graduates who are going to provide primary and acute care services to older adults,” Bednash says. “All of the providers in this country have to be concerned about making sure that they are maintaining their capacity to care for the patients they see in their everyday work.”
How? The obvious, easiest answer is through CE/CME (or, as the PAs will switch to, MOC). But as in other contexts, gerontology and geriatrics lectures and modules don’t attract sell-out crowds. Requirements, therefore, may be needed. Bakerjian, for example, suggests license renewal or certification maintenance could be tied to a minimum number of hours devoted to education in geriatric specialty care. (Segal-Gidan, for that matter, thinks a similar carrot could be used at the primary education level: If 20% of the questions on the boards had a geriatric/gerontology focus, she says, then people would have to learn about this patient population in order to pass.)