Frequently Asked Questions

The following answers to questions about geriatricians and the shortage of geriatrics healthcare providers is based on data from the Association of Directors of Geriatric Academic Programs (ADGAP) and the American Geriatric Society’s (AGS) Geriatrics Workforce Policy Studies (GWPS) Center.


What is a Geriatrician?

A geriatrician is a medical doctor who is specially trained to meet the unique healthcare needs of older adults. Illnesses, diseases and medications may affect older people differently than younger adults and older patients often have multiple health problems and take multiple medications. Geriatricians prevent, manage and develop care plans that address the special health problems of the elderly.

Generally, geriatricians are primary care physicians who are board-certified in either family medicine or internal medicine and have completed the additional training necessary to become board certified in Geriatric Medicine.

Geriatricians often work as part of a team with other healthcare providers, including nurses, pharmacists and physical therapists — who may also have advanced training and hold special certifications in geriatrics. A geropsychiatrist is a psychiatrist trained to meet older adults' mental health needs and address specific syndromes seen in the elderly.

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How many board certified geriatricians and geropsychiatrists are there in the US?

As of March 2011, there were 7,162 board certified geriatricians (6,756 in allopathic medicine and 406 in osteopathic medicine) and 1,751 (1,746 allopathic and 5 osteopathic) board certified geriatric psychiatrists in the US.

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What special training do geriatricians receive?

After earning their medical degrees, geriatricians complete a three-year residency program in either internal medicine or family medicine before entering a geriatric medicine fellowship program.

Through this training, geriatricians develop clinical competence in: the physiology of aging; illnesses common among older persons; atypical presentations of illnesses in older adults; the functional assessment of older people; the treatment and management of older adults in acute care, long-term care, community-based, and home-care settings; and the assessment of cognitive status and mood in the elderly. Geriatricians also have clinical training and experience providing care for persons who are generally healthy and require primarily preventive healthcare. In addition, their training highlights behavioral aspects of illness, socioeconomic factors, health literacy issues and ethical and legal considerations that may affect the medical management of older patients.

Geropsychiatrists complete a four-year residency program in psychiatry before entering a fellowship program in geriatric psychiatry.

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How many geriatrics training slots are there? How many are filled?

For academic year 2009-2010 in allopathic programs, there were 489 geriatric medicine first-year fellowship training slots, and 273, or 56%, were filled. For the same year, there were 120 geriatric psychiatry fellowship first-year training slots, and 54, or 45%, were filled.

Osteopathic geriatric medicine fellowship programs had 46 slots and two first year fellows, and the one osteopathic geriatric psychiatry fellowship program had three positions but no residents.

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How many students are going into geriatrics training this year? How does this compare with previous years?

In 2009, 86 residents (0.9%) in internal medicine or family medicine who graduated from US medical schools (USMDs) entered geriatric medicine fellowship programs. The number of USMDs entering geriatric medicine fellowship programs decreased from 112 in 2005 to 86 in 2009.

In 2009, 17 residents (2.3%) in general psychiatry who graduated from US medical schools (USMDs) entered a geriatric psychiatry fellowship programs. The number of USMDs entering geriatric psychiatry fellowship programs decreased from 30 in 2005 to 17 in 2009.

The majority of physicians who enter geriatric fellowship programs attended medical school outside of the United States. Of the 296 physicians who entered allopathic geriatric medicine fellowship programs in 2009, 196 were international medical school graduates (IMGs). The same trend held for geriatric psychiatry fellowship programs — with 31 of the 55 fellows being IMGs.

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What are the current and projected future doctor to patient ratios in geriatrics?

There are currently 7,162 allopathic and osteopathic certified geriatricians in the US — one geriatrician for every 2,620 Americans 75 or older. Due to the projected increase in the number of older Americans, this ratio is expected to drop to one geriatrician for every 3,798 older Americans in 2030.

There are far fewer geriatric psychiatrists. Currently there are 1,751 - one for every 10,865 older Americans. That ratio is projected to decrease by 2030 to one geropsychiatrist for every 12,557 Americans 75 and older.

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What's the average salary for a geriatrician?

The median salary for a geriatrician in private practice in 2010 was $183,523. This was $5,879 less than the average family physician's salary, and $21,856 less than the average general internist's. Geriatricians train at least one year longer than their primary care colleagues, and yet they are compensated at a lower level. Overall, geriatricians' compensation is significantly lower than that of most other medical and surgical specialists.

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What factors are contributing to - or are expected to contribute to - the shortage of geriatricians?

Over the last 5 years, a declining number of US medical school graduates have been choosing careers in internal medicine and family medicine — the two fields that are the source of applicants for geriatric fellowship programs. Physicians in internal medicine, family medicine — and geriatrics — earn significantly less and have less predictable work schedules than those in other medical and surgical specialties, especially popular disciplines such as dermatology, plastic surgery, otolaryngology, radiation oncology, and emergency medicine.

A career focused on caring for older adults can be particularly financially unattractive for physicians with increasingly large medical school loan debts. Physicians graduating from U.S. medical schools in 2010 owed an average of $158,996 for their education. Thirty-nine percent of these graduates said that salary expectations were a moderate or strong influence in determining their specialty.

In many parts of the U.S., Medicare payment rates for physicians are lower than commercial insurance rates. Medicare reimbursement rates for mental health services are discounted even further than rates for geriatric medical services. Medicare reimbursement is the major source of income for most geriatricians and, as a result, community-based geriatricians have lower incomes than most other physician specialists.

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Are there any sub-specialties within geriatrics that are able to recruit more candidates than others?

Geriatricians providing hospital-based care for older adults and hospital-based palliative care for older people have been in increasing demand and are earning more competitive salaries. These important career paths are benefiting from a new trend — increasingly, U.S. hospitals are recruiting and subsidizing the practices of physicians caring for the hospitalized elderly.

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Where can I find more information about the Geriatric Workforce Policy Study (GWPS) Center?

The ADGAP/AGS Geriatric Workforce Policy Study (GWPS) Center tracks trends in geriatrics faculty development, medical school-based academic programs, and teaching programs for medical students, residents, and fellows, as well as the practice of geriatrics. The ADGAP/AGS study is currently funded by a grant from the John A. Hartford Foundation of New York City. Additional data and slides are available on the Center’s web page www.ADGAPstudy.uc.edu.

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