Happy Boxing Day! This holiday season we got an unexpected gift in geriatric medicine.
One of the most easily counted indicators of the success of geriatrics in medical education is the number of graduating resident physicians choosing additional training in geriatric fellowship programs. Each year, the Journal of the American Medical Association compiles the number of trainees in residency and fellowship programs, and the past two years, I’ve graphed the trends and stirred the tea leaves to try to divine the future of the field. (Read Decline in geriatric fellows defies pay boost: +10% = -10% from 2012 and Falling Leaves, Falling Numbers from 2011.)
Last year, I was concerned and puzzled by what looked like continuing and consistent declines in first-year geriatric fellows in Internal Medicine (IM) and Family Medicine (FM) based programs, despite improving financial incentives. This year, there is an abrupt improvement, with first-year fellows in IM and FM rising by almost 20 percent.
Geriatric Psychiatry, meanwhile, is now on a two-year winning streak, yielding another 30 percent increase in the number of trainees. Congratulations!
These are excellent results and if they were to extend another year, the pipeline of geriatricians would return to the size it was in 2006-07.
Just as I’ve struggled to explain prior declines, I can’t explain this turnaround either. It could be that the increasing presence of geriatrics in medical school and residency training programs is finally translating into more interest in the field. It could be that some of the new payment incentives and impending realignment of health care away from fee for services is having an impact.
It could be that the demographic shift is finally becoming clear and that the news that older adults are the core business of health care has filtered out. It could be that the participation of geriatrics in the “match” process for trainees looking for fellowship programs is finally working. Or it could just be a fluke.
Still, this is one Christmas gift I won’t be returning.