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

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 Mentoring/TrainingPrograms
The American Association for Geriatric Psychiatry (AAGP) has several programs for medical students, residents, and fellows for the purpose of increasing exposure to and interest in geriatric psychiatry. These programs have been very successful in that students, residents, and fellows have had the opportunity to be mentored by senior geriatric psychiatrists, attend the AAGP Annual Meeting, receive the scientifically peer review journal, the American Journal of Geriatric Psychiatry, among other benefits and programmatic components. For the latest information on available AAGP mentoring/training programs, please visit www.AAGPonline.org.

NIH Research Loan Repayment Program
The National Institutes of Health offers Loan Repayment Programs to attract health professionals to careers in clinical, pediatric, health disparity, or contraceptive and infertility research. In exchange for a two or three-year (for Intramural General Research) commitment to your research career, NIH will repay part of your qualified educational debt. In addition, the NIH will make corresponding Federal tax payments for credit to your Internal Revenue Service tax account that you incur as a result of your LRP benefits. For more information, visit the NIH website at www.lrp.nih.gov.

AAGP Membership for Residents
Psychiatry residents and fellows are eligible to join AAGP as a Member-in-Training (MIT). Members-in-Training pay a significantly reduced membership fee (only $120 per year), but receive all the benefits of full membership.

AAGP Membership for Medical/Graduate Students
AAGP has initiated a 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 student membership:

  1. 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: $75/year.
  2. 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: $25/year.

For more information, contact:

American Association for Geriatric Psychiatry
6728 Old McLean Village Dr.
McLean, VA 22101
Phone: 703-556-9222
Fax: 703-556-8729
www.AAGPonline.org