I worked in public relations at the Case Western Reserve University School of Medicine for several years.
The three most celebratory days of the academic year were the white coat ceremony at the beginning of the year, where new students would receive short jackets to welcome them as future doctors; graduation, where students would receive their medical degrees; and, in between, in March, Match Day, when fourth-year students would learn where they would be undertaking their residencies and internships.
On Match Day, local TV crews would show up to record students screaming for joy as they opened their envelopes to see where they’d be spending the next few years of their lives receiving more training before practicing medicine. Even later in my tenure at CWRU, when match results were posted online in addition to being available in person, most students would gather in the common space set aside for the observance so they could experience and share the excitement with friends, family and faculty.
There’s another, much more low-key event, known as Fellowship Matches, that occurs in February, and if anyone in senior living or long-term care is screaming in relation to this year’s results, they are screams of despair.
That’s because geriatric medicine was among the least competitive (read: least desirable) specialties among those seeking programs. Only 176 fellowship positions of 389 available — or 45% — were filled, according to the National Resident Matching Program. In fact, only 199 of 10,778 applicants even were interested in the geriatric medicine positions. And that trend has been consistent for several years, according to five-year trend data readily available from the NRMP.
Overall, across all specialties in the Fellowship Matches this year, 86.2% of positions were filled. Of the 63 medical subspecialties participating in the match, 33 filled 90% or more of the positions offered.
In a 2016 survey by the NRMP, geriatric medicine fellowship program directors identified the top potential challenge for their programs as “not enough applicants in the specialty,” rating it 4.8 on a 5-point scale. The main reason for the lack of interest in geriatric medicine can be found in the second-highest-ranked potential challenge cited: “undesirable income potential as a practicing physician,” which scored a 4.5 on the scale. We also know that the opportunity to successfully manage multiple chronic conditions simultaneously is a draw for too few.
Much like the recruiting and retention issues related to nursing aides, personal care aides and similar positions in senior living and long-term care, the shortage of geriatricians is nothing new and appears not to be going away any time soon. It’s not just a reason for despair; it’s frightening at a time when members of the large Baby Boom generation in this country are aged 53 to 72 and many of their older siblings and parents, aunts and uncles are in need of the specialized care that these doctors are trained to provide. These are the physicians who see your residents in their medical offices or are medical directors at your facilities.
AMDA–The Society for Post-Acute and Long-Term Care Medicine’s We Are PA/LTC campaign is one way that the industry is trying to educate the public about those who care for residents in senior living and long-term care facilities by sharing “the tales of joy, comfort and compassion that happen in this setting every day.” Let’s hope that some aspiring physicians are inspired by it.
In the meantime, while the federal government and states try to find solutions to the geriatrician shortage — in part by expanding the legal capabilities of nonphysician healthcare providers (physician assistants and nurse practitioners, for instance) — society at large needs to find more ways to make caring for the elderly at any level more appealing and rewarding.