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Hartford Medicine Program

The John A. Hartford FoundationFourth Quarter Board Meeting

December 7, 2007

Gavin W. Hougham, PhD

© 2007 The John A. Hartford Foundation

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JAHF Medicine CommitmentJAHF Medicine Commitment

• Foundation goal is to increase the Foundation goal is to increase the nation’s capacity to provide effective nation’s capacity to provide effective and affordable care to its rapidly and affordable care to its rapidly increasing older adult population. increasing older adult population.

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Why Medicine?Why Medicine?

• As physicians have traditionally been As physicians have traditionally been central to the health care needs of central to the health care needs of older adults…older adults…

• JAHF strategy has focused on JAHF strategy has focused on preparing physicians.preparing physicians.

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U.S. Physician WorkforceU.S. Physician Workforce

• Physicians are centralPhysicians are central• Diagnose and treatDiagnose and treat• Prescribe medicationPrescribe medication• Drive medical researchDrive medical research• Train/supervise other professionals Train/supervise other professionals • Most services physician-orderedMost services physician-ordered• Central to team careCentral to team care• 780,000 physicians in U.S. 780,000 physicians in U.S.

Source: Impact of the Aging Population on the Health Workforce in the U.S., 2005.

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JAHF Medicine StrategyJAHF Medicine Strategy

1) All fields of medicine1) All fields of medicine Primary to specialty carePrimary to specialty care Surgical and related specialties Surgical and related specialties Internal medicine specialtiesInternal medicine specialties

2) Geriatric medicine2) Geriatric medicine

Ensure adequate pipelineEnsure adequate pipelineTrain future faculty and leadersTrain future faculty and leadersSupport of field-wide growthSupport of field-wide growth

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Context and BarriersContext and Barriers

• Getting attention is a challengeGetting attention is a challenge• Diversification/specializationDiversification/specialization• Competition, politics, turfCompetition, politics, turf• Academic medicine is hardAcademic medicine is hard• Geriatrics remote to young MDsGeriatrics remote to young MDs• Ageism is everywhereAgeism is everywhere

Source: Impact of the Aging Population on the Health Workforce in the U.S., 2005.

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JAHF Medicine TacticsJAHF Medicine Tactics

• Capitalize on Hartford brand Capitalize on Hartford brand • Manage existing programsManage existing programs• Create networksCreate networks• Develop new programsDevelop new programs• Broker resources & knowledgeBroker resources & knowledge• Convene stakeholdersConvene stakeholders• Partner with other foundationsPartner with other foundations

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JAHF Medicine CommitmentsJAHF Medicine Commitments

• 1983-2007 (229 grants): $161m 1983-2007 (229 grants): $161m

• Current (56 grants): $59.8mCurrent (56 grants): $59.8m

• Leverage, 2002-2006: $178mLeverage, 2002-2006: $178m

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Number of Certified GeriatriciansNumber of Certified Geriatricians

Source: ADGAP Status of Geriatrics Workforce Study, 2007

8,143 8,3547,762 7,976

7,4207,735

6,8757,138 7,128

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

1998 1999 2000 2001 2002 2003 2004 2005 2006

Active CAQs, yearly totals

(n)

1010

Academic staffAcademic staff 20012001 20072007

MDsMDs 7.57.5 9.69.6

MD fellowsMD fellows 3.33.3 4.04.0

Total academic staffTotal academic staff 1818 2424

Growth in Geriatrics Programs Growth in Geriatrics Programs


Size of programsSize of programs 20012001 20072007

% programs with % programs with budgets over $1Mbudgets over $1M 4242 5959

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Percent of U.S. Medical Schools at Percent of U.S. Medical Schools at which Geriatrics Faculty Teach which Geriatrics Faculty Teach Geriatrics in Other SpecialtiesGeriatrics in Other Specialties


20052005 20072007

75%75% 87%87%

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Medical Students Better PreparedMedical Students Better Prepared

Source: AAMC, Medical School Graduation Questionnaire

20032003 20042004 20052005 20062006 20072007

% medical students % medical students who feel prepared who feel prepared to care for older to care for older adultsadults

65%65% 69%69% 70%70% 72%72% 75%75%

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Strategy One: All PhysiciansStrategy One: All Physicians

Medical Students

Interns,Residents

Fellows,Junior Faculty

Senior Faculty,Practicing MDs

Source: Adapted from JAHF Strategic Plan 2006

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Medical Students

Interns,Residents


Senior Faculty, Practicing MDs


Curriculum,Summer students,Interest groups

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Medical Students:Medical Students:

• Curriculum Education Dissemination (40+ schools)Curriculum Education Dissemination (40+ schools)• (AAMC national consensus conference held 2007)(AAMC national consensus conference held 2007)

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Interns,Residents



Specialties,Chief Residents,Pilot grants


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Interns/Residents:Interns/Residents:

• Geriatrics for Specialty Geriatrics for Specialty Residents (64 schools so far)Residents (64 schools so far)• (spread geriatrics to (spread geriatrics to

trainees in surgical spec)trainees in surgical spec)

• Chief Resident Immersion Chief Resident Immersion Training (just starting)Training (just starting)• (spread geriatrics to all (spread geriatrics to all

specialties of medicine)specialties of medicine)

• Other pilots through CoEsOther pilots through CoEs

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Other SpecialtiesDevelopment awards,

Curriculum,Specialty societies,Pilot grants


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• Surgical Specialties (started 1992)Surgical Specialties (started 1992) AGS geriatrics for surgical specialties AGS geriatrics for surgical specialties (63 Jahnigens)(63 Jahnigens)

• Specialties of Internal Medicine (started 1994)Specialties of Internal Medicine (started 1994) American Association of Internal Medicine American Association of Internal Medicine (40 Williams)(40 Williams)

• Paul Beeson Scholars program Paul Beeson Scholars program (135)(135)

• Hospitalists: Society of Hospital MedicineHospitalists: Society of Hospital Medicine• Cardiology: American College of CardiologyCardiology: American College of Cardiology

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Medical Students

Interns,Residents


Senior Geriatrics Faculty


Other Specialties

Strategy Two: GeriatriciansStrategy Two: Geriatricians

Summer students,Interest groups

2121

Medical Students:Medical Students:

• Medical Student Training in Aging Research (1,086)Medical Student Training in Aging Research (1,086)


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Medical Students:Medical Students:• Medical Student Training in Aging Research Medical Student Training in Aging Research • NIA, other foundationsNIA, other foundations• Some early students now facultySome early students now faculty

Stacy T. Lindau, MD, MAStacy T. Lindau, MD, MA

NEJM 2007:Today (NBC), CBS NEJM 2007:Today (NBC), CBS News, USA Today, Washington News, USA Today, Washington Post, New York Times, Post, New York Times, Newsweek, NPR, BBC…Newsweek, NPR, BBC…


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CoEs,Junior FacultyDevelopment

Interns,Residents

Pilot grants

2424


Geriatrics Fellows/Junior Faculty:Geriatrics Fellows/Junior Faculty:

• JAHF CoE – Centers of Excellence (500 trained)JAHF CoE – Centers of Excellence (500 trained) Geriatric Medicine (22 + 3 pending)Geriatric Medicine (22 + 3 pending) Geriatric Psychiatry (2)Geriatric Psychiatry (2)

• Hartford Health Outcomes Research Scholars (27)Hartford Health Outcomes Research Scholars (27)• Paul Beeson Scholars (135)Paul Beeson Scholars (135)

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CoEs,Leadership,Institutions

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Geriatrics Senior Faculty:Geriatrics Senior Faculty:

• JAHF CoE – Centers of ExcellenceJAHF CoE – Centers of Excellence Geriatric Medicine (22 + 3 pending)Geriatric Medicine (22 + 3 pending) Geriatric Psychiatry (2)Geriatric Psychiatry (2)

• CoE Network Resource CenterCoE Network Resource Center

• Geriatrics Leadership Development (22)Geriatrics Leadership Development (22)

• New Division Chiefs Awards (Supiano at Utah)New Division Chiefs Awards (Supiano at Utah)

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Current JAHF Medicine GrantsCurrent JAHF Medicine Grants

Field-wide:Field-wide:

• Status of Geriatrics WorkforceStatus of Geriatrics Workforce• (gold standard data on field)(gold standard data on field)

• Institute of Medicine Healthcare Workforce StudyInstitute of Medicine Healthcare Workforce Study• (potential for new JAHF and field-wide ideas)(potential for new JAHF and field-wide ideas)

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TraineesTrainees

All of MedicineAll of Medicine

GeneralistsGeneralists

Faculty Faculty developmentdevelopment

InstitutionsInstitutions

Top downTop down

What worksWhat works

PracticingPracticing physicians physicians

GeriatricsGeriatrics

SpecialistsSpecialists

Curriculum Curriculum developmentdevelopment

IndividualsIndividuals

Bottom upBottom up

New areasNew areas

Balancing PrioritiesBalancing Priorities

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Future Medicine Programs?Future Medicine Programs?

Strategy One:Strategy One:

• American Association of Medical Colleges - CurriculumAmerican Association of Medical Colleges - Curriculum• American College of Surgeons - QualityAmerican College of Surgeons - Quality• National Board of Medical Examiners – EducationNational Board of Medical Examiners – Education

Strategy Two:Strategy Two:

• Pending 3 new CoEs in geriatric medicine - FacultyPending 3 new CoEs in geriatric medicine - Faculty• Possible new CoE in geriatric psychiatry – FacultyPossible new CoE in geriatric psychiatry – Faculty• American Association of Geriatric Psychiatry - FacultyAmerican Association of Geriatric Psychiatry - Faculty

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SummarySummary

• JAHF investment and payoffs in medicine significantJAHF investment and payoffs in medicine significant

• JAHF programs “gold standard” and field-changingJAHF programs “gold standard” and field-changing

• Academic geriatricians reaching senior leadershipAcademic geriatricians reaching senior leadership

• Visibility of geriatrics within medical schools risingVisibility of geriatrics within medical schools rising

• Geriatrics spreading to other specialties Geriatrics spreading to other specialties

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For further information on medicine areaFor further information on medicine areaprograms at the Foundation:programs at the Foundation:

Gavin W. Hougham, Ph.D.Gavin W. Hougham, Ph.D.Senior Program OfficerSenior Program OfficerThe John A. Hartford FoundationThe John A. Hartford Foundation

55 East 5955 East 59thth Street StreetNew York, NY 10022New York, NY 10022

[email protected]

Office: 212.832.7788Office: 212.832.7788Fax: 212.230.2957Fax: 212.230.2957

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