Predictors for Matriculation into Geriatric Psychiatry Fellowship: Data from a 2019–2020 National Survey of U.S. Program Directors

Abstract

Objective With the number of geriatric psychiatry fellows declining from a peak of 106 during 2002–2003 to 48 during 2020–2021, this study aims to investigate characteristics of the geriatric psychiatry training requirement across U.S. psychiatry residency programs and to identify specific factors which may influence residents to pursue geriatric psychiatry subspecialty training. Methods The authors queried the American Medical Association’s Fellowship and Residency Electronic Interactive Database Access system to compile a list of program directors from the Accreditation Council for Graduate Medical Education sponsored general adult psychiatry residency programs. Program directors were emailed an anonymous multiple-choice survey to ascertain specific characteristics of their program’s geriatric psychiatry training experiences. This study’s primary outcome was the percentage of residents entering geriatric psychiatry fellowship after completion of general psychiatry training. Linear regression analysis determined which variables may be associated with this primary outcome. Results Of 248 surveyed, 60 programs (24%) responded to the survey. Only one of the independent variables revealed a statistically significant association with the percent of residents that became geriatric psychiatry fellows: the number of geriatric psychiatrists at the residents’ home institution ( p =0.002). Conclusions Consistent with previous data, the presence of geriatric psychiatry faculty members is strongly associated with the decision to pursue subspecialty training in geriatric psychiatry.

Why Does the US Overly Rely on International Medical Graduates in Its Geriatric Psychiatric Workforce?

“…22 Other reasons may include lack of exposure to geriatric psychiatry or geriatric psychiatrists during medical school and the early part of residency. 16 As the number of IMGs matched into US psychiatry residencies continues to decline, the number of these trainees choosing a career in geriatric psychiatry will also decline. The result will be a substantial shrinkage in the pool of practicing IMG geriatric psychiatrists in the United States, which will worsen the burden of care of older adults with psychiatric disorders and reduce the diversity of the geriatric psychiatry workforce.…”

“…23 To increase the number of trainees going into geriatric psychiatry fellowships, efforts would need to be made by residency programs to recruit and retain geriatric psychiatric faculty to help develop geriatric psychiatry curricula, provide early exposure to geriatric psychiatry, and provide mentorship in the field to medical students and residents. 16,18,21 Other strategies to enhance recruitment could include desensitizing trainees to ageist biases, identifying those trainees with favorable attitudes and experiences, and educating them about geriatric psychiatric practice and opportunities. The potential barrier of student debt to subspecialty training for general and academic career tracks also needs to be addressed.…”

“…15 Moreover, geriatric psychiatry fellowships with more geriatric psychiatry faculty can provide role models and mentors. 16 Furthermore, access to a robust pipeline scholarship program that provides greater understanding of the field of geriatric psychiatry in addition to offering excellent mentorship during psychiatry residency (eg, the AAGP Scholars Program) possibly attracts IMGs to geriatric psychiatry. 16,17 In addition, non-US IMGs often come from countries and cultures where older adults are an important part of the extended and multigenerational family structure and therefore may experience greater comfort and confidence in working with older adults, even those with psychiatric disorders.…”

Spotlight on the Challenges of Depression following Retirement and Opportunities for Interventions

“…Historically, geriatric psychiatry is one of the least popular specialties chosen by medical residents, with less than half of available fellowship positions filled each year. 19 , 135 According to the Accreditation Council for Graduate Medical Education, in the academic year 2020/21, there were 64 accredited programs in geriatric psychiatry and 44 on-duty residents, a 58% drop compared to 2002/03, which saw a peak of 106 residents. For comparison, the number of addiction psychiatry residents increased 65% (from 57 to 94 residents), child and adolescent psychiatry increased 43% (from 681 to 975 residents), and forensic psychiatry increased 38% (from 66 to 91 residents) during this same time period.…”

Geriatric Psychiatrists’ Perspectives on Palliative Care: Results From A National Survey

“…[27][28][29] These deficits are expected to expound given recruitment challenges to geriatric psychiatry and the growth of the older adult population. 30 Such workforce challenges have significant implications on the role of geriatric psychiatrists as primary palliative care experts. First, the growing deficit in geriatric psychiatrists will necessitate that subspecialty trained geriatric psychiatrists provide care to the sickest and most complex older adults-likely the population with the highest palliative care needs.…”