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

Table 6.15 Fellowship-Trained Geriatricians (1990-1998 Cohort), Current Academic
Credentials and Professional Activities
Respondents
Category Credentials/Activities (n=490) 1 Percent 2
Academic Appointment 332 69
Rank Instructor 64 20
Assistant Professor 237 72
Associate Professor 25 8
Professor 1 0.3
Higher Level Degree/Training 127 26
Degree Master of Public Health (MPH) 71 14
Other Master’s Degree 48 10
Doctoral Degree (PhD) 11 2
Teaching Commitment 378 78
Disciplines Medical Students 240 64
Residents 294 78
Geriatric Fellows 215 57
Nurses 105 28
Other Health Professionals 95 25
Continuing Medical Education 67 18
Principal or Co-Investigator 187 39
Focus of Clinical 120 65
Research Epidemiology 46 25
Health Services 45 24
Education 27 15
Basic Science 16 9
Publications 214 44
Types Abstract 142 29
Research Article 131 27
Non-research Article 93 19
Book 5 1
Book Chapter 96 20
Book Review 20 4
Professional Society Member
Organizations American Geriatrics Society (AGS) 410 84
American Medical Directors
Association (AMDA) 138 28
Gerontological Society of
America (GSA) 122 25
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
of two or more year fellows with the same amount of post-fellowship
time (Table 6.16). Seventy-three respondents had completed one year
of training; 145 had completed two or more years of training during
this time.
While clinical activity during training and in their current careers
were similar between the two groups, there were significant
differences regarding career development. Respondents with two or
more years of fellowship training were more likely to have made their
career decisions based on their positive medical school experience
and their attraction to the multidisciplinary nature of the field.
Regarding overall professional activities, fellows with more than
one year of training were more likely
to have conducted research,
published research articles, and
submitted abstracts for presentation
at scientific meetings during or since
their fellowship training. They were
also more likely to currently participate
in national professional geriatric
societies and be involved in teaching.
Their practice focus was “essentially
all geriatrics” and they were more
likely to work as multidisciplinary
team members and have a greater
number of geriatrician colleagues.
Additionally, fellows with two or more
years of training were more likely to
have completed formal coursework.
Implications
Graduates of these fellowship
programs will be the next generation
of geriatrics clinical and academic
leaders. One hundred nineteen
geriatric medicine programs and 62
geriatric psychiatry programs are now
accredited by the ACGME and 7
programs are accredited by the AOA.
Only 73% of first-year positions in
geriatric medicine and 63% in geriatric
psychiatry allopathic fellowship
programs were filled for AY 2001-
2002. Several factors may account
for the relatively small number of
applicants to geriatrics fellowship
programs and the small number of
USMSGs. The percent of fellows who
are USMSGs is one measure of
trainee pool quality. During 1997-
1998 USMSGs filled 75% of residency
and fellowship positions (Council of
Graduate Medical Education (COGME),
1999). Geriatric medicine and psychiatry
training programs fall below this
mean. As discussed in Chapter 7,
physician interest in primary care is
correlated with interest in geriatrics, and the increased interest in
primary care that began in the late 90s is now weakening. A
significant factor in career choice is medical student debt. Over 80%
of U.S. medical school graduates are indebted upon graduation; the
average debt is just shy of $100,000 (Cohen, 2001). As presented in
Chapter 4, salaries for both academic and non-academic primary care
physicians and geriatricians remain relatively low compared to
procedure-oriented disciplines.
Variation exists among fellowship programs. Most programs are
small, with only 15 medicine programs and 2 psychiatry programs
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