Official websites use .gov

A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS

A lock ( 🔒 ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Need Help

Physician Subspecialization and the Health and Health Care of Older Americans

Award Number: R01AG076580
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 07/01/2025
PERIOD OF PERFORMANCE END DATE: 05/31/2027

Group Awards By:

View Award Description

Physician Subspecialization and the Health and Health Care of Older Americans - PROJECT SUMMARY Over the past 40 years, specialist physicians have supplanted primary care as the most frequently seen clinicians for older adults in the US. This shift towards specialty care is driven by advancing medical technology and increased “subspecialization,” whereby specialist physicians focus on narrower and narrower clinical areas. Subspecialization has grown markedly: in 1980, the American Board of Medical Specialties had 28 specialty boards, with an additional 28 certified subspecialties. By 2020, 40 specialty boards encompassed 147 separate subspecialties. While subspecialists bring greater clinical expertise, too much subspecialization could lead to inequitable access, overtreatment, overdiagnosis or fragmentation of care. There is little empirical evidence on the implications of growing subspecialization for the health of older Americans. A major obstacle to filling these evidence gaps is the lack of meaningful measures of subspecialization at the physician level. Existing physician directories, like the one used by Medicare, contain in-depth specialty data, but are also highly inaccurate. For example, Medicare data identify only 17% of board-certified advanced heart failure specialists in the US. Other specialties have similar data gaps. To understand how access to subspecialists influences access to specific advanced treatments and clinical outcomes, it is necessary to better define the hundreds of types of subspecialty care being provided to patients. We propose to characterize subspecialization in the US and assess its implications for the health and health care of older adults. Using comprehensive data from Medicare, we will develop novel methods to classify physician subspecialists by their observed practice patterns, focusing on 3 key specialties in the care of older adults (cardiology, medical oncology and general surgery) as “tracer” disciplines to fill evidence gaps in subspecialty care that can inform policy. Specifically, we will: 1) Use community detection algorithms, a common tool in network science, to identify subspecialists based on their practice patterns (as measured by services provided, drug treatments, and patient diagnoses). 2) Identify patient, health system and geographic factors associated with subspecialty supply and access. 3) Using quasi-experimental methods, measure the impact of access to subspecialist care on health outcomes and utilization in the three key specialties. These Aims will provide novel evidence to guide health policy, including improved methods to accurately measure subspecialist supply, guide health insurers and policymakers for applications such as determining adequacy of specialist coverage in insurance design (e.g., Medicare Advantage), identify populations with shortages in subspecialist access, and guide telemedicine development. Without this evidence, clinical advances may not reach older adults who could benefit the most.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $0 )
2026	2025	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Aging Research	003	4	6/15/2026	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$0
2026	2025	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Aging Research	000	4	2/11/2026	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$0
2026	2025	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Aging Research	002	4	4/21/2026	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$0
2026	2024	PRESIDENT AND FELLOWS OF HARVARD COLLEGE	1033 MASSACHUSETTS AVE STE 3	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Aging Research	001	3	2/11/2026	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2025 ( Subtotal = $467,559 )
2025	2025	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Aging Research	001	4	8/1/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$467,559
2025	2024	PRESIDENT AND FELLOWS OF HARVARD COLLEGE	1033 MASSACHUSETTS AVE STE 3	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Aging Research	000	3	8/1/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $467,559

Issue Date FY: 2024 ( Subtotal = $637,331 )
2024	2024	HARVARD COLLEGE PRESIDENT & FELLOWS OF	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	3	5/30/2024	NON-COMPETING CONTINUATION	$637,331
														Subtotal = $637,331

Issue Date FY: 2023 ( Subtotal = $662,840 )
2023	2023	HARVARD COLLEGE PRESIDENT & FELLOWS OF	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	002	2	6/13/2023	NON-COMPETING CONTINUATION	$662,840
2023	2022	HARVARD COLLEGE PRESIDENT & FELLOWS OF	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	001	1	5/31/2023	NEW	$0
2023	2022	HARVARD COLLEGE PRESIDENT & FELLOWS OF	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	1	2/24/2023	NEW	$0
														Subtotal = $662,840

Issue Date FY: 2022 ( Subtotal = $671,795 )
2022	2022	HARVARD COLLEGE PRESIDENT & FELLOWS OF	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	1	9/21/2022	NEW	$671,795
														Subtotal = $671,795

Grand Total All Awards = $2,439,525

Top

All Categories

About

Search

Reports

Data Submission

Award Information

Physician Subspecialization and the Health and Health Care of Older Americans

Award Number: R01AG076580

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 07/01/2025

PERIOD OF PERFORMANCE END DATE: 05/31/2027

Federal Websites

Department of Health & Human Services

HHS Operating Divisions

HHS Staff Divisions

Download A Document Viewer