By John Reichard, CQ HealthBeat Editor

Low wages and poor training for health care workers responsible for treating the elderly — ranging from doctors to nursing home aides — are contributing to a looming crisis in medical care as 78 million baby boomers approach their retirement years, said a study released Monday by the Institute of Medicine.

Baby boomers “will face a health care work force that is too small and woefully unprepared to meet their specific health needs,” the institute said in a news release announcing the study. “More training is required for dog groomers and manicurists than direct-care workers in many parts of the country.”

Heading off the crisis is going to require “bold” initiatives right away to improve training and salaries, according to the report. Medicare, Medicaid, and private insurers should boost payments for care of the elderly to draw more health care workers into the field, the report recommended.

Health care lobbies issued statements Monday saying the report shows the need for Congress to act on legislation addressing physician payments and steering move caregivers into specialized care for the elderly.

Although shortages of health care workers loom in other fields of medicine, the study said the problem is worse in geriatric care because it attracts fewer specialists and is troubled by a high rate of turnover among so called direct-care workers — nurse aides and home health aides, for example. The study noted, for example, there are only about 7,100 physicians certified in geriatrics — the medical specialty covering diseases and problems of the elderly — or one for every 2,500 older Americans. Meanwhile 71 percent of nurses’s aides change their jobs each year and up to 90 percent of home health aides leave their jobs within two years.

A geriatrician — a primary care doctor who specializes in treating the elderly — earned $163,000 on average in 2005 compared with $175,000 for a general internist who receives less training. In contrast, dermatologists can earn more than $300,000 a year. Registered nurses who work in nursing homes also make less than their peers working elsewhere, despite working longer hours. Direct care workers made an average of $9.56 an hour in 2005 and were more likely to be uninsured and rely on food stamps than workers in other fields, according to the study.

The Medicare Payment Advisory Commission recommended last week that Congress boost Medicare payments for primary care physicians, which include geriatricians (See related story, CQ HealthBeat, April 9, 2008). Senate Finance Chairman Max Baucus , D-Mont., expressed support for such an increase in a meeting with doctors on April 11. But money for doctors is tight, which led the advisory panel to recommend that a payment boost for primary care be funded by cuts in payments to specialists. Some specialty groups told Baucus they opposed such a move.

Since virtually all providers treat the elderly to some extent in their careers, they need a minimal level of competence in geriatric care, according to the report. Health professional schools should expand coursework to foster that competence, which should be required to maintain licenses, the study recommended.

The study also addressed “informal caregivers” — up to 52 million family members, friends and others who provide care for the elderly in their homes. Not enough is done to assure they have the needed knowledge and skills for the job, the study said, recommending that local hospitals and community groups could provide such training. For example, the study noted that state attorneys general should recognize training programs for unpaid caregivers as a way for nonprofit hospitals to justify their tax-exempt status.

“It will be impossible to train the anticipated 36,000 geriatricians needed to care for seniors and aging baby boomers,” said Cecil B. Wilson, a board member of the American Medical Association, and all doctors “caring for aging patients need to become proficient in geriatric care to help meet the increasing health care needs of seniors.

“The AMA, in collaboration with other organizations,” he said, “is working to increase physician knowledge and skills for medical students and practicing physicians to meet their needs at all stages of their medical careers.”

Wilson also warned that lawmakers must head off steep scheduled cuts in Medicare payments to doctors to avoid exacerbating the situation. Baucus has said he hopes to bring Medicare physician payment legislation to the Senate floor by mid-May.

The senior lobby AARP, meanwhile, cited the Institute report in making a pitch for a measure (S 2708) cosponsored by Sens. Barbara Boxer , D-Calif., and Susan Collins , R-Maine, to boost training in geriatrics and long-term care. The bill also would create a “Health and Long-Term Care Workforce Advisory Panel” to track those fields and issue recommendations on improving health care in those areas.