There’s a scourge in our midst about to kill off any hope that geriatric medicine will grow any larger than it already is. (Oh, right, it’s already shrinking.) I’m not talking about H1N1, but a hard-to-kill and pervasive parochialism about how geriatrics fellowship programs go about recruiting. I’ll call it the "fallacy of geriatric exceptionalism.”
Rather than compete nationally for fellows through the National Resident Matching Program (NRMP), geriatric fellowship programs tend to recruit from within their own institutions. The field seems to hold a perception that geriatric medicine fellowship recruitment is so unique, extraordinary, or “exceptional,” that recruitment can only be done by hand, one by one. Unfortunately, there is another way to look at exceptionalism. Some program directors will admit that they fear geriatric medicine is such an unattractive sell as a medical specialty that to get any takers at all they must hover over and wall off their own internal prospects as early as possible, quietly ushering them into their own programs.
Because fellowship training is the gateway into specialty careers in geriatric medicine, finding local residents early and getting them hooked and interested in geriatrics isn’t bad by itself. I myself have counseled the Foundation’s Centers of Excellence in Geriatric Medicine to adopt a “grow your own” strategy (see http://www.geriatricsrecruitment.org/). However, this isn’t sufficient. We need to bring new blood into the fold by opening the fellowship programs to fence-sitting shoppers through the Specialty Matching Service (SMS), run by NRMP. Click here for a list of advanced specialty resident or fellowship matches. You’ll notice that geriatric medicine is not among them.
Why is geriatric medicine not participating in the SMS match? On one level, I know the answer. Besieged academic geriatricians, trying to keep their fellowship programs filled, don’t want to compete nationally for fellows because they think they might lose the few they might have in their internal pipelines already--strictly bird-in-hand thinking. That might make sense if it was working. But we have fewer geriatrics fellows now than we did 10 years ago. What do we have to lose?
I’d like to see the nation’s 145 geriatric medicine training programs all join the match right now. It could happen fast. The Association of Directors of Geriatric Academic Programs (ADGAP) could exercise muscular leadership, maybe making it an opt-out style petition for program endorsements, and have it in to NRMP by December 31st. Actually, NRMP only requires 75% of a specialty’s programs to join the fellowship match, so they’d only need 109 or so to agree to YES. YES works for me. YES works for the 50% of programs who have already pushed to join the match. Does YES work for the remaining few holdouts? I hope so, or geriatrics as a specialty will continue down the exceptionalist primrose path toward extinction.