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

Table 6.10 Program Directors Reported Sources of Funding for
Fellows’ Stipends for the First 12 Months of Geriatric Psychiatry
Fellowship Training (n=47)
Percent of
Programs
Funding Source
Reporting
Hospital (Part A, Graduate Medical
Education Funding or other sources) 61.7
Veterans Health Administration 48.9
Other institutional support (medical school,
department money, clinical revenue) 40.4
Other external support (Foundations, gifts, etc.) 19.2
Bureau of Health Professions 4.3
State Agencies 6.4
Source: IHPHSR ADGAP Database Project, 2001
Table 6.11 Program Directors Reported Sources of Funding for Fellows’
Stipends for Training Beyond Year One of Geriatric Psychiatry
Fellowship Training (n=8)
Percent of
Programs
Funding Source
Reporting
Veterans Health Administration 62.5
Other institutional support (medical school,
department money, clinical revenue) 50.0
National Institute on Mental Health 37.5
Hospital (Part A, Graduate Medical
Education Funding or other sources) 25.0
Foundations, AFAR/AGS awards 25.0
Bureau of Health Professions 12.5
State Agencies 12.5
Source: IHPHSR ADGAP Database Project, 2001
researchers, with fewer programs offering clinical research or
administrative/physician executive training. The PDs reported that
fellows extending their training beyond the required 12 months
spent a median of 20% of their effort providing clinical care (range,
10% to 80%).
Trends in Application Rates for Geriatric
Psychiatry Fellowship Programs
Program Directors reported a steady rate of applications during the
academic years 1999 to 2002. In AY 2001-2002, the median number
of applications for each first-year position was 8 (range, 0 to 30
applications). Programs conducted a median of 4 interviews for each
of these first-year positions (range, 0 to 15 interviews). Geriatric
psychiatry fellowship programs do not participate in the resident/
fellow matching system. The majority of PDs reported they begin to
make offers to accept fellows into their programs within 12 months
of the matriculation date, and 37% of PDs were still offering positions
within six-months of the start date.
In AY 2000-2001, data from the AMA reports a fill rate for
first-year geriatric psychiatry fellowship positions of 63% (79 firstyear
fellows/125 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 6 programs reported
that fulfilling clinical demands was somewhat difficult without a full
complement of fellows.
First-Year Geriatric Psychiatry Fellows
The size of geriatric psychiatry fellowship programs is varied. In AY
2001-2002, the PDs in our study reported a median of 2 available
first-year positions (range, 0 to 7 positions). The median number
of filled first-year positions in AY 2001-2002 was 2 (range, 0 to 7
fellows). The distribution of first-year geriatric psychiatry fellows
for AY 2001-2002 is shown in Figure 6.5. Seventy percent of the
programs reported having 2 or less first-year fellows, and 15% had
no first year fellows. Table 6.9 shows how the number of USMSGs
in their first year of training varied between programs. Forty-six
percent of the programs reported they had no USMSGs as firstyear
fellows.
Sources of Support for Geriatric Psychiatry Fellows
During First Year of Training
Sources of reported support for geriatric psychiatric fellows are
diverse. Table 6.10 describes the sources of support for first-year
fellows as reported by the PDs. Sixty-two percent of the PDs
reported utilizing Medicare Part A or other hospital funding and
nearly one-half of the programs received VHA funding for their
first-year fellows. These findings are consistent with VHA data. The
VHA reports that it supported 27 first-year fellows at 22 fellowship
programs for AY 2000-2001.
Geriatric Psychiatry Fellows
Continuing Beyond Year One
The ten responding programs with second-year fellowship training
opportunities reported for AY 2001-2002 a median of one available
second year position (range, 1 to 3 available positions). The total
number of reported second-year fellows in training during 1999-2000
was 5, during 2000-2001 it was 3, and during 2001-2002 it was 2.
Only one program reported having third- or fourth-year fellows.
The data on fellows in training from our survey was compared to
existing summary data from the AMA. For AY 2000-2001, programs
reported 7 fellows in training beyond year one. This is consistent with
the second-year fellows reported for the same year in our survey.
Program directors with training opportunities beyond one year
were asked to report if they had been unable to retain international
medical graduates (IMGs) for further training because of J1 visa
limitations. Only two PDs reported that they had not been able to
retain at least one IMG fellow due to J1 visa limitations. Since 1998,
the PDs reported that this problem had affected a total of 4 IMGs. Only
10 programs offer training beyond the one year accredited by ACGME.
Sources of Support for Geriatric Psychiatry
Fellows Beyond Year One
The PDs reported utilizing diverse resources to support fellows in
training beyond year one (Table 6.11). The VHA was reported to be the
major source of funds for fellows in training beyond year one. Other
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