The State of Geriatrics Training Programs: Findings from the National Study of Internal Medicine Manpower (NaSIMM)

ebate over reform of medical workforce policy has reD vealed the precarious professional standing of geriatrics.’ Within the field, discussion about the degree of primary care versus “subspecialty” orientation has dominated the professional The perceived unattractiveness of the field,6 the dearth of faculty with interest and expertise in geriatrics at all levels of training,’.’ and the levels of funding for training and research’ have been cited as major constraints on the growth and excellence of the field. A number of solutions to the precarious professional standing of geriatrics have been proposed. Hazzard has argued that barriers to entering geriatrics should be reduced, enrollments dramatically increased, and new clinical pathways formulated.” Others believe that the field should proceed much more modestly in the mode of a subspecialty, concentrating on research and faculty development.’ ‘*12 In this latter mode, geriatricians would function most as teachers and researchers, exposing and educating other primary care disciplines in the complexities and nuances of treating aging patients. In 1993, the National Study of Internal Medicine Manpower (NaSIMM) at the University of Chicago conducted a special survey of geriatrics fellowship programs in order to better understand the evolution of the field from within, from the perspective of training programs and program directors. In the same spirit as a recent essay, “We are what we do,”13 the results of the survey provide evidence for those who believe “We are what we are trained to do.”