Male doctor talking with senior man in exam room
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Twenty-five years ago, there were about 35 million Americans age 65 or older and about 10,000 board certified specialists in geriatric medicine to care for them. Today, there about 60 million older adults in the US. And the number of geriatricians has fallen to about 7,300.
Perhaps more troubling, it appears that physicians are going into other specialties, such as oncology or cardiology, with less training in geriatric care than in past years.
Another result: Not only is there a nationwide shortage of primary care doctors, who are in the front lines of medicine for most older adults, but the relative handful of physicians choosing that field know far less about treating older patients than they should.
To take just one example: Are primary care physicians properly trained in how to respond to a patient who visits with a complaint of a cough but also shows signs of cognitive impairment?
Declining Geriatrics Education
Emily Harris, a journalist studying at the Harvard Medical School, described these challenges in a recent article in the Journal of the American Medical Association.
The troubling situation she identifies echoes my own recent experiences. Last year, I spoke to about 35 medical residents at a large teaching hospital. Only one planned to go into geriatrics, while two were considering palliative care. All the rest were interested in other specialties.
Harris reports that only about 39% of available geriatric fellowship positions were filled in 2025. That compares to 80% of all internal medicine fellowships and 100% of cardiovascular and 98% of gastroenterology programs.
The dean of a well-respected medical school bragged to me about his geriatrics program, including sessions on how to effectively communicate with older patients. Except it was an elective. Most likely, the students choosing the program were those least likely to need it.
And given that 70% of patients admitted to hospitals through emergency department visits are age 65 or older and 40% of all hospitalizations are older adults, it is deeply troubling that every med student does not get at least some geriatrics training before their residencies. Learning only on the job is a disservices to their patients.
What’s The Problem?
Why is geriatrics so unpopular? The pay is among the lowest of all specialties (pediatrics is similarly low). Other physicians consider the work low-status: Just ask doctors what they think about colleagues who work in nursing homes.
The third reason may be just as important. The late Dr. David Greer, former dean of the Brown University School of Medicine and a geriatrician himself, explained it to me this way many years ago: “Doctors don’t like patients who don’t get better.”
What did he mean? The self-image of many physicians is based on their ability to cure disease or repair an injury. But for older patients, many conditions are manageable but not curable. For them, the best outcome often is maintaining a stable quality of life, not a cure.
Geriatrics is a relatively new specialty. Back in the day, family medicine doctors learned how to care for older patients as part of their routine training. Given the lack of interest in geriatrics as a specialty, perhaps it makes sense to simply include care of older adults in basic medical education.
Yet, despite the rapid increase in the population of seniors, Harris reports this training is also declining. In 2021, only 10% of medical schools required geriatrics courses, down from 23% in 2005, and only about 38 percent included the training as part of, say, their internal medicine programs. The share of med schools offering geriatrics even as an elective fell from 89% to 71%.
A similar trend is occurring in medical residency programs, where geriatrics training is becoming less important and less rigorous.
Some Good News
Harris notes there are some outliers, including medical schools at the universities of Michigan and Wisconsin. George Washington University Hospital in Washington, D.C. has a highly regarded geriatrics fellowship and includes a geriatrics rotation in its residency program.
Medical care for older adults is very different than for 30- or 40-somethings. They communicate differently. They respond differently to medications. They have different medical conditions. Their goals often are quite different.
Increasingly, young physicians are expected to provide quality care to their older patients without the necessary training. No physician would be allowed to perform surgery on a patient without first receiving careful coaching. Yet, there seems to be no problem letting them diagnose and treat older adults without proper education.
Our medical system is largely ignoring this critical and growing need. By doing so, it is shortchanging both young doctors and their patients. And it inevitably will have serious health consequences.
