Adam G. Golden, MD, MBA; Michael A. Silverman, MD, MPH, CMD; and Michael J. Mintzer, MD From the University of Central Florida College of Medicine and Orlando Veterans Affairs Medical Center, Orlando; West Palm Beach Veterans Affairs Medical Center, West Palm Beach; and University of Miami Miller School of Medicine and the Miami Geriatric Research Education and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida.

Geriatric medicine was established as a discipline to care for the complex needs of elderly patients (1). After much pioneering work, the American Board of Internal Medicine and American Board of Family Medicine granted geriatric medicine a Certificate of Added Qualifications in 1988. Board eligibility required completion of an accredited 2-year fellowship or qualification under the practice pathway based on practice experience.

Even with this recognition, geriatric medicine in the United States has struggled to clearly identify its clinical niche and to attract interest among physicians (2). After closure of the practice pathway in 1994, the number of physicians seeking certification decreased 4-fold (3). In an attempt to increase the number of geriatric fellows, the duration of fellowship was shortened from 2 years to 1 in 1998. In 2006, the American Board of Internal Medicine elevated geriatric medicine to a subspecialty under internal medicine, allowing physicians to recertify in geriatrics without recertifying in internal medicine. Additional incentives to create fellowship positions included exemption from limits to the number of graduate medical education positions funded by Medicare. Yet, despite a continual albeit small increase in available fellowship positions, 44% remain unfilled (4). Geriatrics remains an unpopular career choice among graduates of U.S. medical schools (4). Furthermore, only about half of all internal medicine geriatricians recertify in their subspecialty board, compared with 81% among other subspecialties (3).

With the graying of America, geriatric medicine should, in theory, be a thriving subspecialty. Instead, 2 questions arise: Why the lack of interest in geriatric medicine? Can the subspecialty survive?

Despite surveys that report high job satisfaction, geriatric medicine remains an unpopular career choice for physicians because of perceived low prestige, futility of care, and low remuneration. Indeed, geriatricians' salaries are lower than those of either general internal medicine

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Is Geriatric Medicine Terminally Ill?