1. ADGAP National Survey of Geriatric Medicine Fellowship Program Directors Comparing 2001 to 2007 Updated September 2012 with National GME Census Data Gregg A. Warshaw, MD Elizabeth “Libbie” Bragg, PhD, RN

2. 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

3. Program Directors 20072001P value Years director*6.65.6 P=0.02 Years since formal training* 17.315.6 NS Hours/week administration* 12.19.6 P=0.004 *Means

4. Program Directors Certification20072001 Without fellowship training 29%37% With fellowship training 68%59% Not certified 3%4%

5. Faculty Academic Rank (2007) RankMenWomenTotal Assistant Professor 200276476 Associate Professor 11981200 Professor 10536141 Other 285078 Total 452443895 Data presented as number of faculty

6. Fellowship Program Faculty Certified in Geriatrics (2007) NumberMean ± sd Median (range) Certified without fellowship training 2452.5 ± 3.02.0 (0-19) Certified with fellowship training 7277.1 ± 5.96.0 (0-34)

7. Application Trends* 2004-071999-02P value Applications60138 P=<0.0001 Interviews2319 P=0.0556 *Means over three years

8. Geriatric Medicine Fellowships: 1 st year Positions, 1 st 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

9. 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.

10. Distribution of First Year Geriatric Medicine Fellows

11. Funding Sources: First Year Fellows (Percent of Programs Utilizing Source) Sources20072001 Medicare GME86%79% VA41%48% Institutional support*41%46% Foundations/gifts23%27% BHPr12%10% Other8%-- *Includes clinical revenue

12. 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

13. Number of Advanced Fellows 2007 Survey Data Compared with GME Census Data Source2006-072005-062004-05 GME Census 345536 ADGAP Survey 657372 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

14. Distribution of Second Year Geriatric Medicine Fellows

15. Funding Sources: Advanced Fellows (Percent of Programs Utilizing Source) Sources20072001 Institutional support*56% Foundations46%58% Medicare GME46% NIA Grants35%16% VA SFPAG28%-- VA Other23%43% BHPr21%16% *Includes clinical revenue

16. Selected Specialties Percent USMDs Percent Filled 1 st Year Positions Median Private Practice Salaries

17. Specialty % of First Year Filled Positions 1 % USMDs 1 Private Practice Salary 2 Hematology/Oncology102.3%53.6%381,992 Physical Medicine & Rehabilitation102.2%55.0%241,182 Gastroenterology100.2%64.7%463,955 Emergency Medicine99.4%81.0%277,297 Psychiatry98.9%57.2%199,996 Family Medicine98.3%44.2%189,402 General Internal Medicine97.9%48.9%205,379 Dermatology97.6%94.9%392,885 Pediatrics97.2%66.5%192,423 Neurology96.3%55.3%249,867 Rheumatology96.1%50.6%225,521 Nephrology92.9%36.3%306,046 Infectious Disease91.6%51.9%219,556 Endocrinology91.5%48.5%211,400 Urology84.2%95.2%372,455 Hospice/Palliative Care*62.1%58.3%196,262 Geriatrics (FM+IM)57.2%24.4%183,523 Geriatric Psychiatry30.0%36.6%211,071 Sources: 1 AMA and AAMC data from the National Survey of GME programs, JAMA, September 2011. 2 Medical 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

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

19. Certification and Re-certification in Geriatric Medicine by Year of Original Certification as of 4/12 Year Family MedicineInternal Medicine Certified First Recertification Second Recertification Certified First Recertification Second Recertification 1988752481 (64%)274 (36%)1,659817 (49%)280 (17%) 1990473317 (67%)190(40%)1,204550 (46%)227 (19%) 1992597372 (62%)1,254636 (51%) 1994771411 (53%)1,568764 (49%) 1996254123 (48%)291168 (58%) 199810349 (48%)337223 (66%) 19992816 (57%)183112 (61%) 20002721 (78%)200129 (65%) 20012117 (81%)193109 (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.

20. 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.

21. Summary (I) Program directors – now 2/3 with fellowship training Number of applications per program declining Number of available 1 st year positions more than doubled over last decade

22. Summary (II) USMDs filling 1 st 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.

23. Contact Information Elizabeth Bragg, PhD, RN Email: Elizabeth.Bragg@uc.edu

24. Contact Information http://www.americangeriatrics.org/advocac y_public_policy/gwps Libbie Bragg, PhD, RN The University of Cincinnati Elizabeth.Bragg@uc.edu 513-558-5241 Gregg Warshaw, MD Email: Gregg.Warshaw@uc.eduGregg.Warshaw@uc.edu