The provision of and need for services for elderly patients are underestimated by Frank Denton and associates1 in their analysis of the effect of population aging on future physician requirements. In their Fig. 1, pediatrics is identified as a separate physician category, but geriatrics is not, even though the roles of geriatricians and the Regional Geriatric Programs (RGPs) of Ontario were recognized by the province's ministry of health in 1988.2
In addition, many of the medical services provided to frail elderly patients are not captured by OHIP. Comprehensive geriatric assessments performed by geriatricians (or by team members with case conferences involving geriatricians) in the 5 RGPs are funded by alternative payment plans, not OHIP.
Of patients 75 years of age or older, 14% to 27% are frail and could benefit from a comprehensive geriatric assessment.3 However, the RGPs of Ontario saw only about 1% of this group in 2001/02. By 2030, the proportion of the population in this age group will have grown by more than 94%.4,5
Unfortunately, the supply of physicians with geriatric training is not keeping up with this projected demand. For example, in Canada in 2000/01, only 7 people entered a training program in geriatric medicine,6 and only rarely do family physicians train in care of the elderly.
Planning by medical schools alone will not address the low numbers of physicians with geriatric training. Governments need to establish and implement policies to correct the existing and increasing shortfall of health care professionals able to assess and treat frail elderly patients.
Michael J. Borrie William Dalziel Rory Fisher William Molloy John Puxty Program Directors Regional Geriatric Programs of Ontario
References
- 1.Denton FT, Gafni A, Spencer BG. Requirements for physicians in 2030: Why population aging matters less than you may think [editorial]. CMAJ 2003;168(12):1545-7. [PMC free article] [PubMed]
- 2.Guidelines for the establishment of regional geriatric programs in teaching hospitals. Toronto: Ontario Ministry of Health; 1988.
- 3.Rockwood K, Fox RA, Stolee P, Robertson D, Beattie BL. Frailty in elderly people: an evolving concept. CMAJ 1994;150(4):489-95. [PMC free article] [PubMed]
- 4.Age groups (12) and sex (3) for population, for Canada, provinces and territories, 1921 to 2001 censuses — 100% data. Ottawa: Statistics Canada; modified 2003 Jul 3. Available: www12.statcan.ca/english/census01/products/standard/themes/ListProducts.cfm?Temporal=2001&APATH=3&THEME=37&FREE=05.
- 5.Population projections for 2001, 2006, 2011, 2016, 2021 and 2026, July 1 [CANSIM table 052-001 online]. Ottawa: Statistics Canada; modified 2003 Jul 9. Available: www.statcan.ca/english/Pgdb/demo23c.htm (accessed 2003 Aug 30).
- 6.Hogan D, Beattie B, Bergman H, Dalziel WB, Goldlist B, MacKnight C, et al. Submission of the Canadian Geriatrics Society to the Commission on the Future of Health Care in Canada. Geriatr Today 2002;5(1):7-12.