Geriatric Medicine Training and Practice in the United States at the ...

Table 5.4 Women and Minority Faculty in Academic Geriatric Programs
(Full-Time Equivalents)
Allopathic Osteopathic All
Schools Schools Schools
(n=94) (n=17) (n=111)
Faculty Rank Mean Range Mean Range Mean Range
Women Asst. Professor 2.4 0-15 0.9 0-7 2.2 0-15
Assoc. Professor 0.9 0-6 0.6 0-3 0.8 0-6
Professor 0.3 0-3 0.1 0-1 0.2 0-3
Other 0.2 0-4 0.2 0-2 0.2 0-4
Minorities 1 Asst. Professor 0.7 0-7 0.2 0-2 0.6 0-7
Assoc. Professor 0.3 0-5 0.1 0-1 0.2 0-5
Professor 0.1 0-2 0.1 0-2 0.1 0-2
Other 0.1 0-2 0.0 0 0.1 0-2
1 Minorities include African Americans, American Indians or Alaskan Natives, Native Hawaiians or other
Pacific Islanders, Hispanics or Latinos. Mean and range are in (FTEs).
Source: IHPHSR ADGAP Database Project, 2001
Table 5.5 Medical School Faculty Total Compensation 2000-2001 (thousands of dollars) 1
Departments Instructor Assistant Associate Professor Chair
Professor Professor or Chief
Median Median Median Median Median
Geriatrics - IM 100 122 145 180 188
Family Practice 125 128 145 156 219
Internal Medicine 75 105 129 163 271
General
Internal Medicine 110 120 142 169 220
Psychiatry 110 116 134 166 259
Nephrology 119 127 158 175 272
Rheumatology 80 111 128 167 195
Endocrinology 83 110 132 172 260
Gastroenterology 95 144 174 195 219
Neurology 70 109 134 165 260
PM & R 125 132 141 185 236
Urology 58 184 229 280 333
1 Fringe benefits not included
Source: AAMC Report on Medical School Faculty Salaries, All Schools, MD Degree, Clinical Science
Departments, January 2002
(Mt. Sinai School of Medicine, University of Arkansas, University of
Oklahoma, Philadelphia College of Osteopathic Medicine, Western
University of Health Science, and Ohio University College of
Osteopathic Medicine), one-third of the academic leaders reported
directly to their dean. This typically created access to new resources
and continued interdepartmental influence. The integration of DGAPs
into the medical schools’ leadership was further confirmed by their
significant participation in important medical school curriculum and
leadership committees.
The relatively low number of fellowship-trained DGAPs (42% of
the leaders surveyed) reflected the youth of the discipline. Leadership
has been drawn from senior faculty who completed their formal
training before the availability of fellowship programs, since geriatric
fellowships became more common after 1980. Many senior faculty
are nearing the end of their careers, and the demand for new leaders
will be high in the coming decade.
In a 1993 report, it was argued that a
significant shortage of geriatric medicine
faculty existed in U.S. medical schools and
residency programs (Reuben, Zwanziger,
Bradley et al., 1993). An IOM national
advisory panel recommended that each
medical school have nine geriatric physician
faculty to sustain their programs. Twentythree
allopathic schools reported less than
2.5 FTE physician faculty, and 66 (two-thirds
of the respondents) had less than the IOM
target of 9 FTE faculty.
The DGAPs unexpectedly reported
openings for only 112 physicians. If the
number of current vacancies is
proportionally extrapolated to include the
non-responding schools, this results in open
positions for 133 geriatric physician faculty
at U.S. medical schools. This number seems
small when compared to estimates of the
number of physician faculty required to
sustain programs. (However, it is relatively
large when compared to the number of
geriatric medicine fellowship graduates
pursuing careers in academic geriatric
medicine.) A possible explanation for the
small number of faculty openings is that
some programs lack the financial resources
to recruit additional faculty. This seems
especially relevant for clinician-educators. In
fact, the DGAPs reported a greater need to
fill open and funded vacancies for research
faculty (at 61% of schools) than clinicianeducator
faculty (at 28% of schools).
The wide variability among medical
school spending on geriatric medicine is not
surprising. In the United States, medical
schools are diverse, and the size and scope
of their overall programs vary considerably
(see Tables 5.1 and 5.2). In addition, since the 1987 IOM report on
geriatric medicine was published, an explicit “centers of excellence”
(CoE) strategy has been developed. This strategy emphasizes the
concentration of resources at a limited number of medical schools to
yield maximum training of the next generation of academic leaders.
When the medical schools responding to our survey were ranked by
annual budget, 71% of those with the largest annual budgets (top
third) also had one or more of the following designations: Hartford
Foundation Centers, association with a GRECC, Alzheimer’s Disease
Center, Pepper Center Award, and/or department status. This finding
suggests that the CoE strategy has been effective.
The limited investment in research/scholarship at 86% of the
allopathic schools was consistent with the above discussion regarding
financial and faculty resources and the wide range of overall medical
school missions. The DGAPs reported that the primary obstacle to the
development of their academic programs was the lack of research
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