Careers in Geriatric Psychiatry
Choosing the right residency program is an important
step in your medical career. Geriatric Psychiatry is an exciting
and rewarding field, and one that also has the distinction
of having a shortage of practitioners.
What is a Geriatric Psychiatrist?
A geriatric psychiatrist is a Doctor of Medicine or Doctor
of Osteopathy with special training in the diagnosis and treatment
of mental disorders, which may occur, in older adults. These
disorders may include, but are not limited to: dementia, depression,
anxiety, late life addiction disorders, and schizophrenia.
Older adults have special physical, emotional, and social
needs. Understanding this, the geriatric psychiatrist takes
a comprehensive approach to diagnosis and treatment, including
listening and responding to the concerns of the older adult,
helping families, and when necessary, working with other health
care professionals to develop effective approaches to treatment.
Co-existing medical illness and medications, family issues,
social concerns and environment issues are integrated into
a comprehensive program of care.
Shortage of Geriatric Psychiatrists
Numerous studies have repeatedly confirmed the increasing
incidence of mental illness among the aging population. The
proportion of the population over age 65 will increase from
12.4% of the U.S. population in 2000 to 20% by the year 2030
(U.S. Census Bureau, 2000). During the same time period, the
number of older adults with mental illness is expected to
double to 15 million (Jeste et. al., 1999).
This demographic transition will increase the current shortfall
of health care providers with geriatric expertise –
and specifically health care providers with geriatric mental
health expertise. Since 1990, approximately 2,500 psychiatrists
have received subspecialty certification in geriatric psychiatry.
This supply of physicians is woefully inadequate to meet the
future needs of the nation. According to estimates in the
President’s Commission on Mental Health Subcommittee
on Older Adults (2003), “at the current rate of graduating
approximately 80 new geriatric psychiatrists each year and
an estimated 3% attrition, there will be approximately 2,640
geriatric psychiatrists by the year 2030 or one per 5,682
older adults with a psychiatric disorder.” It has been
estimated that 4,000 – 5,000 geriatric psychiatrists
who provide patient care are needed (National Institute on
Aging, 1997) and an additional 1,220 physician faculty members
and 919 non-physician faculty members who provide training
in geriatric psychiatry to meet the future demand.
Think young–or old. Psychiatrists who want to
land the best jobs . . . will go after training in child
and adolescent psychiatry or geriatric psychiatry, job market
experts tell us. While no hard numbers are yet available,
recruiters have also seen a recent upturn in the number
of requests for clinicians trained in geriatric psychiatry.
And, based on the aging of the population and the prospect
of better Medicare reimbursements for psychiatric treatment,
geriatric training is a good long-term bet.
CLINICAL PSYCHIATRY NEWS, JANUARY 1999
Practice
The geriatric psychiatrist uses knowledge of biological, psychological,
and social factors in working with patients. Older adults
with a variety of concerns see a geriatric psychiatrist including:
difficulty coping with change; stress; death and bereavement;
depression; memory problems; family history of dementia; anxiety;
agitation; or poor sleep. Sometimes emotional problems occur
for the first time in older adults who suffer with chronic
pain, Parkinson’s disease, health disease, diabetes,
stroke, or other medical disorders. Initially, a comprehensive
diagnostic examination is performed to evaluate the current
problem with attention to its physical, genetic, developmental,
emotional, cognitive, educational, family, peer, and social
components. After arriving at a diagnosis, the geriatric psychiatrist
designs a treatment plan that considers all the components
and discusses these recommendations with the patient. Because
the geriatric psychiatrist also understands the family’s
role in caring for the patient, the doctor educates the family
about the nature of the illness and how they can best cope
and may include referral to other appropriate services.
Within the field of geriatric psychiatry, there are many
exciting career options including clinical practice, researcher,
academic, or clinician educator. Practice settings including
private practice, nursing homes, assisted living facilities,
in-patient, and veteran’s care.
The VA health care system currently offers a broad
range of opportunities for academic career development in
geriatrics. The VA has been a national leader in geriatrics
training and career development over the past 3 decades,
in large part due to the fact that the VA population is
considerably older on average than the general population.
Currently nearly 40% of the veteran population is aged 65
or over vs. 13% of the general population. Geriatrics and
long term care have increasingly become the major priority
of the VA health care system, and this focus on aging is
accompanied by increasing resources and career opportunities
in geriatrics. There are abundant opportunities for career
development and research funding at the junior and senior
faculty levels.
American Geriatrics Society
Training
Geriatric psychiatric training requires 4 years of medical
school, 4 years of approved residency training in general
psychiatry, and 1 year of specialty fellowship training in
psychiatric work with older adults in an accredited residency
in geriatric psychiatry.
In the general psychiatry training years, the physician achieves
competence in the fundamentals of the theory and practice
of psychiatry. In the geriatric psychiatry training, the trainee
acquires a thorough knowledge of specific body of scientific
knowledge about aging and mental health including patient
care, medical knowledge, interpersonal and communication skills,
practice based learning and improvement, professionalism,
and system-based practices.
To find a list of accredited geriatric psychiatry fellowship
programs, please refer to the Accreditation
Council for Graduate Medical Education website.
Certification
When the psychiatry residence has completed their geriatric
psychiatry fellowship and successfully passed the certification
examination in general psychiatry given by the American Board
of Psychiatry and Neurology (ABPN), he/she is eligible to
take the additional certification examination in the subspecialty
of geriatric psychiatry. Although the ABPN examinations are
not required for practice, they are an assurance of excellence
and an indication to patients and employers of expertise in
geriatric psychiatry.
For more information on certification in geriatric psychiatry,
please refer to the American
Board of Psychiatry and Neurology, Inc. website.
Members of the American Association for Geriatric Psychiatry
who have received their subspecialty certification report
a higher salary level than those who have not sat for and
passed the certification exam.
AAGP MEMBERSHIP SURVEY, 2003
| Career Satisfaction |
Physicians who specialize in the treatment of
children, newborns, the elderly and skin disorders
and who practice in the New England and West Central
regions of the country are more satisfied with their
careers than their colleagues in other specialties
and regions.
Researchers at UC Davis School of Medicine
and Medical Center, August 2002
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In fact, a recent study found that geriatric physicians
were more likely to have very high career satisfaction than
physicians from 32 other specialties.
Archives of Internal Medicine, July 2002
In a national survey of fellows who had trained in
geriatric medicine and psychiatry, the vast majority of
former fellows expressed satisfaction with their current
work. Satisfaction with a career choice in geriatrics was
significantly greater among those physicians who had practices
with large numbers of patients over 75, accepted Medicare
assignment, spent their time as clinician-researchers, and
had a medical school appointment.
Siu, Al; Beck, JC; UCLA Department of Medicine,
1990
Career Development Opportunities in Geriatric Psychiatry
AAGP Fellows and Stepping Stones Programs
The American Association for Geriatric Psychiatry (AAGP) offers
two programs to increase interest in geriatric psychiatry
among psychiatry residents by providing them with a direct
vehicle for participation with AAGP and exposure to geriatric
psychiatry. Eligible to PGY I-IV (U.S.) and PGY II-V (Canada)
residents from approved psychiatric residency programs, the
AAGP Stepping Stones Program grants one-year
fellowships to 60-70 individuals. Participants receive a one-year
membership in AAGP, complimentary registration, travel, and
lodging for the AAGP Annual Meeting, and admittance to the
Stepping Stones program that includes a one-day workshop as
well as networking sessions with geriatric psychiatry training
directors. Eligible to PGY- III (U.S.) or Canadian PGY-IV
psychiatry residents in approved psychiatry residency training
program, the AAGP Fellows Program awards
six two-year fellowships. During the two years of the award,
participants receive membership in AAGP, registration to the
AAGP Annual Meeting, complimentary travel and lodging at the
meeting. AAGP Fellows participate in structured mentoring
and career development activities throughout the term of their
fellowship including several career development sessions during
the AAGP Annual Meeting. Fellows are required to complete
a clinical case report or research project for possible publication
in a medical journal or clinical magazine.
Applications for each program are available in the late summer
and due to AAGP in the fall. Visit the AAGP
website for more information or to sign up to receive
an application.
NIH Research Loan Repayment Program
The National Institutes of Health offers a clinical research
loan repayment program in exchange for a two-year commitment
to a clinical research career. NIH will pay up to $35,000
per year of qualified educational debt, pay an additional
39% of the repayment to cover Federal taxes and may reimburse
state taxes that result from these payments. To qualify, a
physician must conduct clinical research for 50% of the time
for two years and his or her research must be supported by
a domestic nonprofit institution in the U.S.
UC-SD – Summer Research Institute
This one-week-long training experience focuses on the tools
needed to begin, maintain and succeed on an academic career
path in geriatric psychiatry. The one-week SRI provides training
to about 25-30 selected fellows or junior faculty from across
the country each year.
UC-SD – Medical Student’s Summer Research
Training
Summer Training on Aging Research Topics - Mental Health (START-MH)
Fellowship Program, funded by the National Institute of Mental
Health (NIMH) is a unique national program that offers competitive
scholarships to undergraduate, graduate and medical students
who may be interested in aging and mental health research.
The program gives fellows an opportunity to gain research
experience and work closely with an established mentor/investigator.
The training includes a rigorous research experience with
comprehensive mentoring and advising. During the 8–12
week summer program, students will work on specific projects
developed by, or in conjunction with their mentor.
For more information on the UC-SD programs, please ref to:
http://geropsych.ucsd.edu/Training.htm.
AAGP Membership for Medical Students
AAGP has initiated a new medical student membership category
to provide students with an opportunity to learn more about
the profession via publications, meetings, and networking
with those already involved in the field. AAGP offers two
types of medical student membership:
- Medical student membership with an online-only subscription
to the association’s journal, the American Journal
of Geriatric Psychiatry; access to the members-only portion
of the AAGP website with information on job opportunities,
position statements, etc.; and the receipt of member mailings
including the AAGP’s quarterly newsletter, Geriatric
Psychiatry News. Dues: $45/year.
- Medical student membership with all the benefits listed
in option 1, other than the online-only subscription to
the American Journal of Geriatric Psychiatry (AJGP). Dues:
$10/year.
For more information, contact:
American Association for Geriatric Psychiatry
7910 Woodmont Avenue, Suite 1050
Bethesda, Maryland 20814
Phone: 301-654-7850
Fax: 301-654-4137
www.AAGPonline.org
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