While the financing of health care is likely to be a hotly debated issue in the upcoming president, too little attention is likely to be paid to one of the greatest challenges we face related to an aging, still growing America: a shortage of trained medical personnel.

Two months ago, the Institute of Medicine released a report (“Retooling for an Aging America: Building the Health Care Workforce”) that raised alarm about a growing shortage of doctors and nurses certified in geriatrics. At present, there are only 7,100 geriatricians (physicians) in the United States - one per every 2,500 older Americans - and less than 1 percent of registered nurses are certified in geriatrics.  The study, which was conducted by IOM’s ad hoc Committee on the Future Health Care Workforce for Older Americans, looked at the health care needs of Americans over 65 years of age. 

The IOM report notes that:

The number of older adults in the United States will almost double between 2005 and 2030, and the nation is not prepared to meet their social and health care needs. The baby boomer generation starts to turn 65 in 2011, which will create multiple challenges for the health care system. For one, the majority of older adults suffer from at least one chronic condition and rely on health care services far more than other segments of the population. Additionally, this generation of older adults will be the most diverse the nation has ever seen….. Another problem is the dramatic shortage of all types of health care workers, especially those in long-term care settings. Finally, the overall health care workforce is inadequately trained to care for older adults.

The report's conclusion warns that:

The impending crisis, which has been foreseen for decades, is now upon us.  The nation needs to act now to prepare the health care workforce to meet the care needs of older adults.  If current reimbursement policies and workforce trends continue, the nation will continue to fail to ensure that every older American is able to receive high-quality care.  The dramatically rising number of older Americans, along with changes in their demographic characteristics, health needs, and settings of care will necessitate transformations related to the education, training, recruitment, and retention of the health care workforce serving older adults.

But it’s not just the lack of geriatricians and nurses certified in geriatrics that should concern policymakers.  Many of the states that are ‘aging’ rapidly are also growing rapidly.  For example, the population of the country’s most populous state, California, is projected to grow from 33.9 million in 2000 to 46.4 million by 2030.  During that same time period, the percentage of Californians aged 65 and over is expected to increase from 10 percent to 17.5 percent.  That means that the number of Californians between 2000 and 2030 will increase by just over one-third and the number of Californians over the age of 65 will jump by nearly two-thirds.

States that are aging and growing face a double challenge. Arizona, the second fastest growing state in 2007, is another one of those ‘aging and growing’ states.  A study just completed by the Arizona Healthcare Workforce Data Center concluded that Arizona will need an additional 49,000 registered nurses over the next nine years to keep pace with Arizona's projected population growth.  And Arizona, the report indicates, already has a shortage of registered nurses, just 681 registered nurses per 100,000 people compared with the national average of 825 registered nurses per 100,000.

The problem in Arizona is not necessarily a lack of people interested in nursing; it’s a lack of teachers and classroom space according to a story that appear in the Arizona Republic.  And Arizona is not alone in this challenge.

The new IOM report indicates that by 2030 America will need an additional 3.5 million health care providers just to “maintain the current ratio of providers to the total poplation.”  That number is a very conservative estimate. As the IOM report stresses, that number does not take into account that older Americans require more health care services and that, as America ages, the ratio of providers to the total population should rise and so should the ratio of geriatricians to other health care specialties.

As important as it is to provide health care coverage to the more than 40 million Americans who lack health insurance coverage, let’s hope that policymakers at all levels will also give more attention to the future of America’s healthcare workforce.