Geriatric medicine is advancing, not declining: A proposal for new metrics to assess the health of the profession

Much has been written over the past 40 years about workforce challenges in aging-related disciplines. Geriatric medicine has more recently been at the forefront of the debate, and the field has been characterized as waning.^{1, 2} But is it?

Such bleak perspectives regarding the geriatrics workforce typically cite the number of practicing geriatricians, which remains stubbornly around 7000 board-certified geriatricians, yielding roughly 0.96 geriatricians for every 10,000 older adults. Reasons commonly cited for the inadequate number of geriatricians include low prestige, low compensation compared with other specialties, and low match rates into geriatric medicine fellowship programs.¹ Many argue that the number of geriatricians must increase to meet the projected need of 28,000 geriatricians by 2025.³ The fact that only three residency programs—family medicine, internal medicine, and medicine/pediatrics—require geriatrics-focused training may contribute to the inadequate supply of geriatricians.³ Geriatric medicine fellowship fill rates remain among the lowest of all medicine subspecialties, although the overall fill rate is higher than the 43% reported by Gurwitz, with a geriatric medicine fellowship fill rate of 70% for the 2022–23 match.⁴ A metric that incorporates attention to both those who are exiting geriatric medicine and those who are embarking on careers as geriatricians is the American Board of Medical Specialties (ABMS) tracking of active geriatric medicine certificates. See Figure 1 below, which was developed by the American Geriatrics Society (AGS) based on a review of the last 18 years of data from ABMS.⁵ This figure demonstrates that the number of board-certified geriatricians has remained stable at approximately 7000 each year. This number is probably a slight underestimate because ABMS does not include osteopathic physicians who receive geriatrics certification through the American Osteopathic Association. However, the ABMS does include osteopathic physicians who receive geriatrics board certification through the ABIM and ABFM.

What can be done to increase the supply of geriatricians? Simply placing health professions trainees where older adults are present and expecting them to develop adequate competency in geriatrics does not work.⁶ However, immersion when accompanied by structured geriatrics educational experiences improves competence in caring for older adults.⁷ Negative attitudes related to aging can be improved with various exposures to older adults.⁸ Geriatrics care is best delivered by interprofessional teams, but interprofessional team training presents logistical barriers and is infrequently provided by academic health centers.⁹ The Geriatrics Workforce Enhancement Program and the Geriatric Academic Career Award, both funded by the Health Services and Research Administration, are vital in developing this expertise in the primary care workforce. Flexibly implemented geriatric medicine fellowship training slots for mid-career internal medicine and family medicine physicians, the pilot of a Medicine-Geriatrics Integrated Residency and Fellowship Pathway (also known as the Med-Geri Pathway), and a combined Geriatrics & Palliative Medicine (Geri-Pal) Fellowship are additional innovative approaches to increase this workforce.

Geriatrics workforce statistics such as the supply of geriatricians do not account for the robust geriatrics care models responsible for advances in the science and care of older adults.¹⁰ As such, we contend that an accurate assessment of the capacity and vitality of geriatric medicine requires more than simply counting the number of geriatricians.

We pointed out the limitations of relying solely on the number of board-certified geriatricians to assess the profession's health. The question remains: What are the best metrics to report on the health of geriatric medicine? In Table 1 below, we propose metrics that should be considered for inclusion in future workforce reports to answer this question, organized by the domains of clinical care, workforce, education, and organized medicine.

Evidence-based, safe, and reliable care of older adults is a minimum standard that we all need to incorporate into our practice. The workforce development of geriatrics care specialists and models of care that all clinicians can implement continue to be the partnership that will ensure this minimum standard for quality and safety now and in the future. Creative strategies that integrate best practices for older adults within every discipline and specialty will help ensure that the growing number of older adults in our country and worldwide receive the care they need and deserve. New metrics to assess the health of geriatric medicine over a 5-year period will permit a more nuanced and accurate assessment of progress in this regard.

Concept and design: Timothy W. Farrell and Terry Fulmer. Preparation of manuscript: Timothy W. Farrell, Amalia Korniyenko, Grace Hu, Terry Fulmer.

The authors declare no conflicts of interest.

None.