Geriatrics Recruitment Resources

Environmental Challenges
Programmatic Challenges
Common Themes

Environmental Challenges
Fewer physicians are being recruited into academic medicine in general and geriatrics in particular. The 2008 Institute of Medicine report, Retooling for an Aging America: Building the HealthCare Workforce, leaves no doubt about this challenge: "As of 2007, there were 7,128 physicians certified in geriatric medicine and 1,596 certified in geriatric psychiatry. According to one estimate, by 2030 these numbers will have increased by less than 10 percent; others predict a net loss of these physicians because of a decreased interest in geriatric fellowships and the decreasing number of physicians who choose to recertify in geriatrics. According to the Alliance for Aging Research, by 2030 the United States will need about 36,000 geriatricians."

Contributing factors are many. Low physician reimbursement by Medicare (on average 8 percent less than managed care reimbursement), and the additional time needed to provide care for frail elderly patients have resulted in low salaries and other factors that discourage physicians-in-training from pursuing careers in geriatric medicine.

For those hardy individuals who make it through to academic geriatrics, challenges related to variable funding streams from the National Institutes of Health (NIH) and other federal, local, and private sources mean that CoE directors must piece together funding for geriatrics fellowships and other activities from a variety of sources.

Programmatic Challenges
Leaders of CoEs are challenged to build the capacity of junior faculty to become the teachers and researchers of tomorrow, to address the shortage of senior faculty, and increasingly, to expand geriatrics expertise beyond academic geriatrics programs. As champions of geriatrics training and research, program directors are looking closely at how they can optimize resources and embed sound management practices. Many are working to develop internal marketing strategies, and some have increasingly explored fundraising strategies for local support and beyond.

Common Themes
A few common themes, or key points, emerged from interviews with CoE directors around the country:

CoEs are innovative. Leaders have incorporated a range of novel approaches that successfully address challenges related to expanding academic geriatrics programs, managing training and research activities, and training subspecialties physicians in geriatrics.

Leadership and management skills are not taught in medical school. Most CoE directors have had to learn management skills and business-oriented strategies primarily on the job. Many of those interviewed credited leadership training received after completing their medical training for strengthening their management skills and stimulating them to think in new ways. That additional training, advice from peers, plus experience, have taught them to think strategically, a critical component of smart growth for their programs.

Geriatrics is Collaborative. In order to address the complexities of caring for older patients, clinical geriatrics is by necessity collaborative and multidisciplinary. Academic geriatrics is also collaboratively oriented with regard to aging-related research and expanding geriatrics training into other subspecialties and disciplines. Long before the NIH formally recognized a new roadmap for collaboration and cross-specialty and cross-disciplinary engagement, geriatrics “got it.” Leaders interviewed in this report include some who have found ways to simultaneously strengthen geriatrics and build bridges with other disciplines to expand resources and develop new approaches.

The personal connection is powerful. CoE directors frequently emphasized the importance of the mentoring they received as they were forging their careers, the support and role modeling they received for building their programs via on-site consultations with senior leaders, and their own satisfaction in mentoring others. Many advocated for broader programs for mentoring and consultation. For programs to thrive, leaders stressed building strong relationships with senior management, including keeping deans and other administrators up-to-date about successes and goals, but also asking how geriatrics could be helpful to them and the institution.

Build a diversified portfolio. CoEs are expanding the number and type of funding sources to ensure longer-term stability and growth.

With CoEs, one size does not fit all. In terms of the management strategies described in this report, not all "best practices" are easily transferable from one setting to another. This is due to differences in the programmatic focus; maturity of the program; size and interests of faculty; sources, kinds, and depth of resources for geriatrics; and a variety of institutional characteristics. Nevertheless, it is hoped that the views and information shared here can stimulate discussions and opportunities.