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

Fellowship Training
Activities for Geriatric
Medicine Fellows
The majority of respondents reported they
had received training that mirrors the
guidelines of the AGS and ACGME (Burton,
1994; Reuben, 1994; American Medical
Association, 2000). Regarding academic
fellowship training activities, 77% reported
participation as a principal or co-investigator
in a research project, the majority (71%) of
which were clinical. Basic science research
accounted for only 13%. Forty-eight percent
of respondents had published research
during their fellowships; 34% had presented
abstracts; 20% had published research
articles; 11% had published non-research
articles; and 11% had published book
chapters. Forty percent had completed
formal coursework in epidemiology, research
methods, management/administration or
public policy.
Current Practice
and Professional
Activities for Geriatric
Medicine Fellows
Table 6.14 lists the respondents’ current
professional focuses and clinical activities.
Forty-four percent identified “essentially all
geriatrics” as their focus, and 73% reported
that they work with multidisciplinary teams.
When asked to document involvement in
clinical activities during a typical week, at
least 60% reported that they participate in
outpatient geriatric assessment, outpatient
primary care, and long-term care.
Respondents reported having a wide
range (0 to 40) of geriatrician colleagues in their current places of
work, with 21% reporting zero colleagues and half reporting 1-5
colleagues.
Respondents were also asked to document the percentage of
time they devote to patient care, research, teaching and administration.
The majority of respondents’ time was spent in clinical work, with
66% spending more than 50% of their time in patient care and 39%
spending more than 75%. Two-thirds devote 5-25% effort to teaching
and administration. Only 11% spend greater than half of their time on
research, with a large majority conducting no research.
Table 6.14 Fellowship-Trained Geriatricians, Current Professional Focus and
Clinical Activities
Category Focus/Activities Respondents Percent 2
(n=490) 1
Focus of Essentially all Geriatrics 210 44
Current Position Primarily Geriatrics;
Secondarily Internal Medicine 93 19
Primarily Geriatrics;
Secondarily Family Medicine 28 6
Primarily Geriatrics;
Secondarily Specialty Practice 27 6
Primarily Internal Medicine;
Secondarily Geriatrics 60 13
Primarily Family Medicine;
Secondarily Geriatrics 37 8
Primarily Sub-Specialty;
Secondarily Geriatrics 22 5
Clinical Outpatient Assessment 278 60
Activities Outpatient Primary Care 297 64
During Acute Inpatient Geriatrics 165 35
Typical Week Acute Care for Elders Unit 34 7
Inpatient Consultation 136 29
Inpatient Assessment Unit 132 28
Rehabilitation Service 99 21
Long-Term Care 305 66
Home Visits 112 24
Hospice/Palliative Care 133 29
Day Care 30 6
Dementia Special Service 75 16
Liaison Consultation/
Other Specialties 39 8
Multidisciplinary Involvement 347 73
Team
1 Frequencies do not total 490 in every case due to missing data.
2 Percentages do not total 100% in every case due to rounding.
Source: Medina-Walpole, Barker, Katz, et al., 2002
Current Academic Credentials
and Activities for Geriatric
Medicine Fellows
Table 6.15 details respondents’ current academic credentials and
activities. Sixty-nine percent hold academic appointments; the majority
were junior faculty at the assistant professor level. Twenty-six percent
hold Master’s or PhD degrees, with Master of Public Health (MPH)
degrees the most common. Seventy-eight percent reported
involvement in teaching and 39% reported participation as principal
or co-investigator in research; the majority of research is clinical
projects.
1996-1998 Sub-Cohort Analysis
Since the majority of one-year fellows completed training between
1996 and 1998, further analysis of this time period was performed to
provide a comparison of academic career development of one to that
69