Geriatric Health Care Team (Click on the position titles listed below to read a full description) Geriatrician Nurse Practitioner Pharm acist Physical Therapist Physician Assistant Registered Dietitian / Nutritionist Registered Nurse Social Worker Speech-Language Pathologist 1 Geriatrician What Is Geriatrics? Geriatrics is a branch of medicine that focuses on health promotion and the prevention and treatment of disease and disability in later life. Description: A geriatrician is a medical doctor who is specially trained to prevent and manage the unique and, oftentimes, multiple health concerns of older adults. Older people may react to illness and disease differently than younger adults. Geriatricians are able to treat older patients, manage multiple disease symptoms, and develop care plans that address the special healthcare needs of older adults. Educational background:  A minimum of 90 semester hours of Undergraduate Study. Completion of a college major or baccalaureate degree is strongly recommended.  Primary Degree: M.D. or D.O. (4 yrs.)  Residency: Internal Medicine or Family Medicine (3 yrs.)  Fellowship: fellowship in geriatrics (1-2 yrs.). Certifications: Primary Boards-Internal Medicine or Family Medicine Specialty Boards-Geriatrics ( through American Board of Internal Medicine [ABIM] or American Board of Family Medicine [ABFM]) Tuition: Tuition at the University of Nebraska Medical Center for a resident of the state of Nebraska is approximately $111, 970 for an MD degree based on rates for 2012-2013. This does not include living expenses and miscellaneous student fees. Salary: According to the Bureau of Labor Statistics, the 2010 median pay for physicians and surgeons was $166,400. What types of work do they do?  Primary care providers in outpatient clinics  Geriatric Assessment Clinic Consultants  Medical directors of Nursing Homes and/or Hospices  Hospitalists  Medical Directors of Quality Improvement Organizations, Hospitals, Healthcare Organizations,  Insurance Companies  Researchers  Home Care Provider (independent, PACE)  Academics 2 Back to page 1 What types of patients need to see a geriatrician? While primary care physicians—general internists and family physicians—care for most older people, geriatricians frequently provide the primary care for older adults who have the most complicated medical and social problems. Also, because of their unique qualifications and training, geriatricians are often sought to provide consultations for the frailest of older persons. A geriatrician should be consulted when:  An older person's condition causes considerable impairment and frailty. These patients tend to be over the age of 75 and coping with a number of diseases and disabilities, including cognitive (mental) problems.  Family members and friends are feeling considerable stress as caregivers. For more on this go to http://www.healthinaging.org/aging-and-health-a-to-z/topic:geriatrics/ References American Board of Family Medicine. (2012). “Initial Certification/Residency.” Retrieved from https://www.theabfm.org/cert/index.aspx American Board of Internal Medicine. (2004-2012). “Geriatric Medicine.” Retrieved from http://www.abim.org/specialty/geriatric-medicine.aspx Medicaid.gov. (2012). “Program of All-Inclusive Care for the Elderly (PACE).” Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and- Support/Integrating-Care/Program-of-All-Inclusive-Care-for-the-Elderly-PACE/Program-of-All-Inclusive-Care-for-the- Elderly-PACE.html University of Nebraska Medical Center. (2012). “Admissions.” Retrieved from http://www.unmc.edu/com/admissions.htm United States Department of Labor. (2012). Occupational Outlook Handbook. Retrieved from http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm 3 Back to page 1 Nurse Practitioner Description: A nurse practitioner (NP) is an advanced practice registered nurse who provides health care services similar to those of a physician. NPs may choose to specialize in family, pediatric or geriatric nursing. Common duties include diagnosing and treating illnesses and injuries, prescribing medications and educating patients. Educational background: There are two educational routes one can take to become a nurse practitioner. First, one can become a registered nurse by obtaining a bachelor’s degree in nursing (BSN) and then continue on to achieve a master’s degree as a nurse practitioner. The second route one can take to become a nurse practitioner is to obtain an associate’s degree in nursing (ADN), then a BSN and then a master’s degree. 1). Bachelor’s Degree in Nursing (BSN): program lengths vary from 18 months to 4 years. 2). Master’s degree as a nurse practitioner (MSN): 2-5 years graduate study Certification and Licensure: Most states require additional licensure to work as an advanced practice nurse. Advanced practice nurses operate in one of four roles: nurse practitioner, nurse anesthetist, nurse midwife or clinical nurse specialist. Licensing is regulated by individual states, and requirements vary; however, all NPs must first be licensed RNs with a master's degree in one of the four advanced practice specialties. Some states mandate extra exams and professional experience. Many states require continuing education classes or maintenance of a national certification to renew a license. The American Academy of Nurse Practitioners (AANP) and the American Nurses Credentialing Center (ANCC) are two organizations that offer national certification commonly recognized by state nursing boards. Certification usually requires passing an examination, and most organizations mandate continuing education to maintain the credentials. Available specialty examinations nurse practitioners may choose from include acute care, diabetes management, family care, school nursing, mental health, gerontology and pediatrics. Tuition: 1). Bachelor’s Degree in Nursing (BSN): The 2012-2013 tuition for a resident of Nebraska at the University of Nebraska Medical Center is approximately $32,820 for the traditional BSN. This amount does not include living expenses and miscellaneous student fees. 2). Master of Science Degree in Nursing (MSN) Specialty Track at the University of Nebraska Medical Center: At the University of Nebraska Medical Center, to work toward the Nurse Practitioner (NP) designation, the student may choose an MSN specialty track. Graduates from these specialty tracks are eligible to take the Nurse Practitioner Certification Exam Required credit hours vary by specialty track. Required credits range, for example, from 39 for Women's Health NP to 66 for the dual/integrated Family NP/Psychiatric Mental Health NP. The 2012-1013 estimated tuition range for Nebraska residents at the University of Nebraska Medical Center for these examples would be from approximately $17,140- $29,007. This does not include living expenses, miscellaneous student fees, or undergraduate tuition. 4 Back to page 1 Salary: In early 2011, the American Academy of Nurse Practitioners (AANP) conducted the 2011 AANP National Nurse Practitioner Compensation Survey. Based on this survey, the average base salary for a full-time NP (those who practiced clinically 35 hours or more per week) was $91,310. What types of work do they do?  Obtain medical histories and perform physical examinations  Provide immunizations and other preventative care  Diagnose and treat illness  Identify, treat, and manage chronic diseases such as diabetes and arthritis  Order and interpret diagnostic tests such as x-rays, blood work, and EKGs  Prescribe Medications  Prescribe physical therapy, massage therapy, and other rehabilitation therapy  Perform procedures such as sutures, casting, cryotherapy, and skin biopsy References American Academy of Nurse Practitioners. (2012). Starting Your Career. Retrieved from http://www.aanp.org/education/student-resource-center/starting-your-career Education-Portal.com. (2003-2012). How to Become a Nurse Practitioner. Retrieved from http://education-portal.com/how_to_become_a_nurse_practitioner.html NP Central. (1994-2005). About NPs. Retrieved from http://www.npcentral.net/consumer/about.nps.shtml Nurse Practitioner Zone. (2012). Becoming a NP. Retrieved from http://www.nursepractitionerzone.com/ 5 Back to page 1 Pharmacist Description: Pharmacists provide information to patients about medications and their use and distribute drugs prescribed by physicians and other health practitioners. They advise physicians and other health practitioners on the selection, dosages, interactions, and side effects of medications. Pharmacists also monitor the health and progress of patients in response to drug therapy to ensure the safe and effective use of medication. Pharmacists must understand the use, clinical effects, and composition of drugs, including their chemical, biological, and physical properties. Educational background:  Pre-pharmacy requirements: A minimum of 90 semester hours including coursework in chemical, physical, and biological sciences.  The Doctor of Pharmacy (PharmD) degree: 4 years  Pharmacy Residency or Fellowship Programs: (1-2 years)  MS or PhD degree: many colleges of pharmacy offer these degrees after completion of a PharmD degree. (2-5 years) Licensure: A license to practice pharmacy is required in all states, the District of Columbia, and all US territories. To obtain a license, the prospective pharmacist must graduate from a college of pharmacy accredited by the Accreditation Council for Pharmacy Education (ACPE) and pass a clinical examination as well as a state specific law exam. Some states also require a third exam on patient counseling or compounding. Practicing pharmacists can also obtain specialty board certification through exam after graduation and residency training. Tuition: Tuition for Nebraska Residents at the University of Nebraska Medical Center for 2012-2013 is approximately $73, 310.00 for a PharmD degree. This does not include living expenses and miscellaneous student fees. Salary: According to the Bureau of Labor Statistics, the median annual wage for pharmacists was $111,570 in May 2010. 6 Back to page 1 What types of work do they do?  Fill prescriptions, verifying instructions from physicians on the proper amounts of medication to give to patients  Check whether the prescription will interact negatively with other drugs that a patient is taking or conditions the patient has  Instruct patients on how and when to take a prescribed medicine  Advise patients on potential side effects they may experience from taking the medicine  Advise patients about general health topics, such as diet, exercise, and managing stress, and on other issues, such as what equipment or supplies would be best for a health problem  Complete insurance forms and work with insurance companies to be sure that patients get the medicines they need  Oversee the work of pharmacy technicians and pharmacists in training (interns)  Keep records and do other administrative tasks  Teach other healthcare practitioners about proper medication therapies for patients  Some pharmacists who own their store or manage a chain pharmacy spend more time on business activities, such as inventory management. Pharmacists also take continuing education throughout their career to keep up with the latest advances in pharmacological science.  Pharmacists who work in universities or for pharmaceutical manufacturers are involved in researching and testing new medications.  Clinical pharmacists work in hospitals and other healthcare settings. They spend little time dispensing prescriptions. Instead, they are involved in direct patient care. For example, they may go on rounds with a doctor and recommend medications to give to patients. They also counsel patients on how and when to take medications and monitor patients’ health.  Consultant pharmacists advise healthcare facilities or insurance providers on how to make pharmacy services more efficient. They also may give advice directly to patients, such as helping seniors manage their prescriptions.  Some pharmacists work full time or part time as college professors. References American Medical Association. (1995-2012). “Careers in Health Care.” Retrieved from http://www.ama-assn.org/resources/doc/med-ed-products/pharm01-pharmacist.pdf United States Department of Labor. (2012). Occupational Outlook Handbook. Retrieved from http://www.bls.gov/ooh/Healthcare/Pharmacists.htm University of Nebraska Medical Center College of Pharmacy. (2012). “Programs”. Retrieved from http://www.unmc.edu/pharmacy/programs.htm 7 Back to page 1 Physical Therapist Description: Physical therapists (PTs) are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility - in many cases without expensive surgery and often reducing the need for long-term use of prescription medications and their side effects. Physical therapists can teach patients how to prevent or manage their condition so that they will achieve long-term health benefits. PTs examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. Educational Background:  Physical Therapy Program requirements: Most require a Bachelor’s Degree (4 years)  Other programs offer a 3+3 curricular format in which 3 years of specific pre-professional (undergraduate/pre-PT) courses must be taken before the student can advance into a 3-year professional PT program.  Freshman Entry: A few programs recruit all or a portion of students directly from high school into guaranteed admission programs. High school students accepted into these programs are guaranteed entry into the professional phase of the PT program pending the completion of specific undergraduate courses and any other stated contingencies (eg, minimum GPA).  Doctor of Physical Therapy (DPT) Degree (3 years for most programs)  Master of Physical Therapy (MPT) or Master of Science in Physical Therapy (MSPT) Degree (2 yrs)  *The Commission on Accreditation in Physical Therapy Education (CAPTE) will require all programs to offer the DPT degree effective December 31, 2015.  Clinical Residency and Clinical Fellowships:  Licensed physical therapists may choose to pursue a residency or fellowship program to enhance their knowledge and practice.  Specialty Certification: Physical therapists have the opportunity to become board-certified clinical specialists through the American Board of Physical Therapy Specialties (ABPTS). Licensure: After graduation, candidates must pass a state-administered national exam. Other requirements for physical therapy practice vary from state to state according to physical therapy practice acts or state regulations governing physical therapy. PTs are licensed in all 50 states and the District of Columbia, Puerto Rico, and the Virgin Islands. Licensure is required in each state in which a physical therapist practices and must be renewed on a regular basis, with a majority of states requiring continuing education as a requirement for renewal. PTs 8 Back to page 1 Tuition: The 2012-2013 tuition for a resident of Nebraska for a DPT degree at the University of Nebraska Medical Center is approximately $43,800. This does not include living expenses or miscellaneous student fees. Salary: According to the Bureau of Labor Statistics, the median annual wage of physical therapists was $76, 310 in May 2010. Where do physical therapists practice? Although many physical therapists practice in hospitals, more than 80 percent practice in:  Outpatient clinics or offices  Inpatient rehabilitation facilities  Skilled nursing homes, extended care, or sub-acute facilities  Education or research centers  Schools  Hospices  Industrial, workplace, or other occupational environments  Fitness centers and sports training facilities References American Physical Therapy Association. (2012). “Physical Therapist (PT) Education.” “Role of A Physical Therapist.” Retrieved from http://www.apta.org/ United States Department of Labor. (2012). Occupational Outlook Handbook. Retrieved from http://www.bls.gov/ooh/healthcare/physical-therapists.htm University of Nebraska Medical Center School of Allied Health Professions. (2012). “Physical Therapy.” Retrieved from http://www.unmc.edu/alliedhealth/pt.htm 9 Back to page 1 Physician Assistant Description: A physician assistant (PA) is a medical professional who works as part of a team with a doctor. A PA is a graduate of an accredited PA educational program who is nationally certified and state-licensed to practice medicine with the supervision of a physician. PAs perform physical examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling and make rounds in hospitals and nursing homes. All 50 states and the District of Columbia allow PAs to practice and prescribe medications. Educational Background: Pre-PA Program requirements: At least two years of college courses in basic science and behavioral sciences. Graduation from a PA program: Approximately 27 semester hours (this typically leads to a Master of Physician Assistant Studies (MPAS) degree). Licensure: Upon graduation from an accredited program, PAs are eligible to take the national certifying examination administered by the National Commission on Certification of Physician Assistant (NCCPA).Only those passing the examination can use the title of “Physician Assistant-Certified (PA-C).” In order to maintain national certification, PAs must complete 100 hours of Continuing Medical Education (CME) every two years and take a recertification exam every six years. Tuition: The tuition to obtain a Master of Physician Assistant Studies at the University of Nebraska Medical Center for a resident of the state of Nebraska is approximately $35,055 (based on 2012- 2013 tuition rates). This amount does not include living expenses and miscellaneous student fees. Salary: According to the Bureau of Labor Statistics, The median annual wage of physician assistants was $86,410 in May 2010. What types of work do Physician Assistants do? A hallmark of physician assistant practice is that PAs provide a broad range of medical and surgical services as part of a team with their supervising physicians. As part of the physician/PA team:  PAs diagnose and treat illness and injuries  Perform physical examinations  Order and interpret diagnostic tests  Prescribe medications  Provide patient education and preventive health care counseling  Perform therapeutic procedures such as suturing lacerations and applying casts 10 Back to page 1