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Developing the Faculty to Teach Doctors about
Older Persons’ Health Needs

Centers of Excellence in Geriatric Medicine and Training

Together, three statistics illustrate an overwhelming shortfall beginning to face American medicine. First, the number of older Americans is expected to rise sharply from 12 to 20 percent in the next two decades. Second, patients aged 65 and older consume the largest share—by far—of health care services. And finally, only one percent of all physicians in the U.S. are geriatricians. The question is whether the massive health care needs of the growing population of adults over age 65 will be met in the coming years, or if many older people with multiple chronic conditions will be left to manage their own care, shuttling between different doctors treating different problems independently.

Unfortunately, as the need to place greater emphasis on the acquisition of skills and knowledge to treat older adults grows, medical schools are not graduating the numbers of needed doctors who specialize in the care of older patients. By the year 2030, demographers predict a shortfall of 26,000 geriatricians. To avoid this scenario, and the inefficiencies and expense of fragmented care that would result, our country must produce geriatric-trained faculty skilled in research and education to teach future doctors how to treat older patients. But faculty skilled in geriatrics—the crucial lever needed to train tomorrow’s doctors—are not available in adequate numbers any more than geriatricians are for treating older patients. In 2001, there were only 900 full time academic geriatricians working in about 120 U.S. medical schools—or less than eight professors per school to teach future doctors about the group of patients who use the most health care services. Observers suggest that at least 2,400 geriatric academicians are needed to train new geriatric fellows, integrate geriatrics into other specialties, and conduct research.

But there is a weak infrastructure to support the careers of junior faculty and fellows in geriatrics. A quick look at the process of becoming an academic physician specializing in geriatrics illustrates a number of barriers. After four years of medical school, followed by three years of residency, a one-year fellowship to learn the clinical practice of geriatrics is completed, finishing with the attainment  of a certificate in geriatric medicine that allows a doctor to practice as a specialist in the care of older patients. To continue in academia, however, one or more additional years of training are required.

For most medical specialties, several years of specialized training are required, and salary support is available through graduate medical education funds. However in geriatrics, federal dollars only support fellowships for one year, resulting in financial pressures that often force potential faculty into careers in clinical practice which provide them a reliable source of income. The critical multi-year period of junior faculty and fellows’ career development—when they learn the skills to become successful researchers or teachers—has few regular sources of support. As a result, the demand for faculty with training in geriatrics—the physicians who teach students, residents, and fellows; who conduct research to advance knowledge about aging, health services and systems; and who pioneer new models of care for the elderly—consistently outstrips supply.

Our society needs to maintain and expand the pipeline for the development of faculty skilled in geriatric research in order to produce sufficient capacity to care for the burgeoning numbers of older adults.

The gap in funding in the critical early years following the first (government-funded) year of fellowship and before obtaining career development funding derails many promising academic careers before they can even get started. This is where the John A. Hartford Foundation has stepped in. Recognizing the necessity to actively recruit and train the next generation of academic geriatricians to ensure that tomorrow’s care of older patients will be better than today, since 1988, the Foundation has supported advanced fellowship training in geriatrics to prepare future medical school faculty.

The strategy of the Centers of Excellence initiative is to identify medical schools with the necessary components for training academic geriatricians—such as research infrastructure, advanced training opportunities, and academic mentoring—then add resources to these institutions to train larger numbers of future faculty more rapidly than would otherwise be possible. Centers of Excellence funds are used as salary support to allow for protected time to conduct research, train to become clinician educators, and pioneer new models of care. Having received the highest quality mentorship and support, these young scholars acquire the skills to build a solid foundation on which to launch successful careers and to become tomorrow’s leaders and innovators in the field of geriatric medicine.

Since the inception of this program, the Hartford-designated Centers of Excellence have produced hundreds of geriatric-expert leaders in medical research, education and practice. Centers of Excellence have also helped to create a higher level of recognition and appreciation of the discipline throughout their respective medical centers, universities and affiliated clinical service settings.