ADGAP National Survey of Geriatric Medicine FellowshipProgram DirectorsComparing 2001 to 2007

Updated September 2012 with National GME Census Data

Gregg A. Warshaw, MD

Elizabeth “Libbie” Bragg, PhD, RN

Methodology

• 2007 Survey 102/143 = 71% response rate– Survey available online only

• 2001 Survey 96/126 = 76% response rate– Survey available both online and paper

• Secondary data from AMA/AAMC GME Survey

Program Directors

2007 2001 P value

Years director* 6.6 5.6 P=0.02

Years since formal training*

17.3 15.6 NS

Hours/week administration*

12.1 9.6 P=0.004

*Means

Program Directors

Certification 2007 2001Without fellowship training 29% 37%

With fellowship training 68% 59%

Not certified 3% 4%

Faculty Academic Rank (2007)

Rank Men Women Total

Assistant Professor 200 276 476

Associate Professor 119 81 200

Professor 105 36 141

Other 28 50 78

Total 452 443 895

Data presented as number of faculty

Fellowship Program Faculty Certified in Geriatrics (2007)

Number Mean ± sdMedian (range)

Certified without fellowship training 245 2.5 ± 3.0 2.0 (0-19)

Certified with fellowship training 727 7.1 ± 5.9 6.0 (0-34)

Application Trends*

2004-07 1999-02 P value

Applications 60 138 P=<0.0001

Interviews 23 19 P=0.0556

*Means over three years

Geriatric Medicine Fellowships: 1st year Positions, 1st year Fellows, and Programs

Source: AMA and AAMC data from the National Survey of GME Programs compiled by Geriatrics Workforce Policy Studies Center. Updated 9/12

Total GM Fellows, IMGs, and USMDs

Source: AMA and AAMC data from the National Survey of GME Programs compiled by Geriatrics Workforce Policy Studies Center. Data presented on fellows for all years of training. Osteopathic and Canadian medical school graduates are included in the total number of fellows but are not included in IMGs or USMDs. Updated 9/12.

Distribution of First Year Geriatric Medicine Fellows

Funding Sources: First Year Fellows(Percent of Programs Utilizing Source)

Sources 2007 2001

Medicare GME 86% 79%

VA 41% 48%

Institutional support* 41% 46%

Foundations/gifts 23% 27%

BHPr 12% 10%

Other 8% --

*Includes clinical revenue

ADGAP Survey Question Regarding

Advanced Fellows (2007)

Does your program offer additional training for any of your fellows beyond the ACGME accredited 12-month training program as advanced fellows or junior faculty? (In some programs advanced fellows beyond the 12 month clinical program are given junior faculty appointments. If these junior faculty are functioning in a role similar to advanced fellows, you would answer “yes” to this question.)

51% of program directors responded: Yes

Number of Advanced Fellows2007 Survey Data Compared with

GME CensusData Source 2006-07 2005-06 2004-05

GME Census

34 55 36

ADGAP Survey

65 73 72

Sources: GME Census: AMA and AAMC data from the National Survey of GME Programs compiled by ADGAP Status of Geriatrics Workforce Study; ADGAPstudy: 2007 Survey of Geriatric Medicine Fellowship Directors

Distribution of Second Year Geriatric Medicine Fellows

Funding Sources: Advanced Fellows (Percent of Programs Utilizing Source) Sources 2007 2001

Institutional support* 56% 56%

Foundations 46% 58%

Medicare GME 46% 46%

NIA Grants 35% 16%

VA SFPAG 28% --

VA Other 23% 43%

BHPr 21% 16%

*Includes clinical revenue

Selected Specialties

Percent USMDsPercent Filled 1st Year Positions Median Private Practice Salaries

Specialty% of First Year

Filled Positions1 % USMDs1 Private Practice Salary2

Hematology/Oncology 102.3% 53.6% 381,992Physical Medicine & Rehabilitation 102.2% 55.0% 241,182

Gastroenterology 100.2% 64.7% 463,955Emergency Medicine 99.4% 81.0% 277,297

Psychiatry 98.9% 57.2% 199,996Family Medicine 98.3% 44.2% 189,402

General Internal Medicine 97.9% 48.9% 205,379Dermatology 97.6% 94.9% 392,885

Pediatrics 97.2% 66.5% 192,423Neurology 96.3% 55.3% 249,867

Rheumatology 96.1% 50.6% 225,521Nephrology 92.9% 36.3% 306,046

Infectious Disease 91.6% 51.9% 219,556Endocrinology 91.5% 48.5% 211,400

Urology 84.2% 95.2% 372,455Hospice/Palliative Care* 62.1% 58.3% 196,262

Geriatrics (FM+IM) 57.2% 24.4% 183,523Geriatric Psychiatry 30.0% 36.6% 211,071

Sources: 1AMA and AAMC data from the National Survey of GME programs, JAMA, September 2011. 2Medical Group Management Association. Physician Compensation and Production Survey 2011 report based on 2010 data. Data compiled by Geriatrics Workforce Policy Studies Center.*Hospice and palliative medicine is a subspecialty of anesthesiology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, physical medicine and rehabilitation, psychiatry, radiology, or surgery.USMD = Graduates of US medical schools

Comparison of Percent of Filled First Year Positions, Percent of USMDs, and Private Practice Salaries for Selected Specialties 2011

Source: AMA and AAMC data from the National Survey of GME Programs compiled by Geriatrics Workforce Policy Studies Center. Does not include osteopathic programs.

Certification and Re-certification in Geriatric Medicine by Year of Original Certification as of 4/12

Year

Family Medicine Internal Medicine

CertifiedFirst

Recertification Second

Recertification Certified

First Recertification

Second Recertification

1988 752 481 (64%) 274 (36%) 1,659 817 (49%) 280 (17%)

1990 473 317 (67%) 190(40%) 1,204 550 (46%) 227 (19%)

1992 597 372 (62%) 1,254 636 (51%)

1994 771 411 (53%) 1,568 764 (49%)

1996 254 123 (48%) 291 168 (58%)

1998 103 49 (48%) 337 223 (66%)

1999 28 16 (57%) 183 112 (61%)

2000 27 21 (78%) 200 129 (65%)

2001 21 17 (81%) 193 109 (56%)

Source: Lou Grosso, ABIM, 2012 and Gary Jackson, ABFM, 2012. Recertification examinations are given twice a year, in the spring and fall. Certificates are valid for 10 years. Compiled by GWPS Center. Notes: Starting in 1996, fellowship training was required for certification. Starting in 1998 only one year of training was required for certification.

Actual and Projected Ratio of Geriatricians/10,000 Population

Updated 9/09

Source: The Geriatrics Workforce Policy Studies Center staff projected the number of geriatricians/10,000 population using population data from the  Administration on Aging and data on geriatricians from the ABFM and ABIM and the GME National Census

Note: The 2000 data is from the 2000 Census. The figures for 2010 to 2050 are from Census Bureau International Data Base.

Summary (I)

• Program directors – now 2/3 with fellowship training

• Number of applications per program declining• Number of available 1st year positions more than

doubled over last decade

Summary (II)

• USMDs filling 1st year positions peaked at 167 in 2002-2003 and declined to 75 in 2010-2011

• The majority of programs have 2-4 first-year fellows

• AMA/AAMC GME data under-estimates the number of advanced fellows

• In the coming decades, based on current trends, the rapidly growing older population will overwhelm the supply of geriatricians.

Contact Information

Elizabeth Bragg, PhD, RN

Email: Elizabeth.Bragg@uc.edu

Contact Informationhttp://

www.americangeriatrics.org/advocacy_public_policy/gwps

Libbie Bragg, PhD, RNThe University of CincinnatiElizabeth.Bragg@uc.edu513-558-5241

Gregg Warshaw, MD

Email: Gregg.Warshaw@uc.edu