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

Geriatric Medicine Fellowship Program
Structure, Curriculum and Resources
Fellowship programs were established between 1975 and 2001 with
over 50% being established by 1989 (Figure 6.1). Accreditation of
these programs occurred between 1988 and 2000, 50% were
accredited by 1990. Forty-six percent of programs offered only oneyear
fellowship training experiences. The remaining 54 percent of
programs offered training beyond the accredited 12 months. Among
the 51 programs that offered training beyond 12 months, 22 programs
offered a third year and 5 programs offered a fourth year. For the
majority of reporting programs, this additional training was reported to
be optional, but six programs required fellows to spend more than
one-year in training.
The fellowship programs had developed interdisciplinary faculty
and staff. One-half of the PDs reported that they were actively
recruiting for additional geriatric medicine faculty for their programs.
Within the accredited 12 months of clinical training, many programs
Table 6.6 Distribution of United States Medical School
Graduates (USMSGs) in First Year Positions At Geriatric
Medicine Fellowship Programs for AY 2001-2002
Number of
Total Number of
USMSG, First-Year Number of USMSG,
Fellows/ Program Programs First-Year Fellows
0 33 --
1 25 25
2 15 30
3 8 24
4 6 24
5 1 5
6 1 6
7 -- --
8 1 8
9 1 9
Total 91 131
Source: IHPHSR ADGAP Database Project, 2001
Figure 6.2 Distribution of First Year Geriatric Medicine Fellows for
AY 2001-2002
Number of Programs
30
25
20
15
10
5
0
4
22
24
9
20
6
0 1 2 3 4 5 6 7 8 9 10 11
Source: IHPHSR ADGAP Database Project, 2002
3
2 2
First Year Geriatric Medicine Fellows/Program
0
1 1
included didactic and/or experiential training in research, teaching,
and/or administrative skills. Programs reported lecture hours in
research (n=70; median 12.0 hours), teaching skills (n=65; median 10
hours), administrative skills (n=60; median 10 hours) and experiential
training in half days for research (n= 38; median 27.5 half days)
teaching skills (n=72; median 12 half days) and administrative skills
(n=47; median 10 half days). The curriculum focus of the 51 training
programs extending beyond one year varied with a majority of the
programs offering training experiences to prepare fellows to become
clinical educators (37 programs) or clinical/health services researchers
(46 programs). Fewer programs offered basic research (28 programs)
or administrative/physician executive training (22 programs). The PDs
reported that fellows extending their training beyond the required
12-months spent a median of 25% of their effort providing clinical
care (range, 10% to 75%).
Trends in Application Rates for Geriatric
Medicine Fellowship Programs
Program Directors reported stable number of application rates
between AYs 1999 and 2002. In AY 2001-2002 the median number of
applications per program for first-year positions was 32.5 (range, 2 to
250 applications) and programs conducted a median of 6 interviews
for first-year positions (range, 1 to 45 interviews). The median number
of applications per available first-year position was 10 (range, 0.6 to
77) and the median number of interviews per position was 2.0 (range,
0.6 to 9). Geriatric fellowship programs do not participate in the
resident/fellow matching system. The majority of PDs begin to make
offers to accept fellows into their programs within 12 months of the
matriculation date, and 69% of PDs were still recruiting fellows within
six-months of their program’s start date.
In AY 2001-2002, data from the AMA reports a fill rate for firstyear
geriatric medicine fellowship positions of 73% (247 first-year
fellows/337 positions). The PDs were asked to report on their
program’s ability to meet committed clinical responsibilities when
fellowship positions were not all filled. Only 7 programs reported
that fulfilling clinical demands was difficult without a full
complement of fellows.
First-Year Geriatric Medicine Fellows
The size of geriatric medicine fellowship programs is varied.
In AY 2001-2002, the PDs in our study reported a median of 3
available first-year positions (range, 1 to 11 positions) and a
median number of 2 filled first-year positions (range, 0 to
11 fellows). The distribution of first-year geriatric medicine
fellows is shown in Figure 6.2 for AY 2001-2002. More than
one-half of the programs reported having 2 or less first-year
fellows and 31% of programs had 3 to 4 first-year fellows.
The distribution of USMSG-first-year geriatric medicine
fellows among the reporting programs in 2001-2002 in our
survey is shown in Table 6.6. Thirty-three (36%) programs
reported having no USMSGs among their first-year fellows
and another 25 (28%) reported having only one.
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