Geriatric fellowships in family medicine: status and directions

The American Board of Medical Specialties recently approved the concept of certificates of added qualifications in geriatrics within both internal medicine and family practice. Certification requirements have been worked out for each training model, and questions have quite naturally arisen addressing whether the developing family practice model is substantially different from the longer established internal medicine model. A survey was made of 12 family practice based geriatric fellowship programs. Program directors were asked how they felt family practice geriatrics differed from internal medicine geriatrics in approaches to patient care and training and in areas of research interests. Information was also gathered about program size, length of training, and operational status. Eight fellowship programs were found to be active at the time of the survey, but only two for more than six months. Of the eight functioning programs, four were currently without fellows--a forewarning, perhaps, of potential recruitment problems for additional programs under development. Survey responses indicated a universal feeling among directors of family practice geriatric programs that their model does serve a unique function. Within the "distinguishing characteristics" most frequently noted, an emphasis on psychosocial and family issues can be identified. This emphasis can also be seen in the suggestions for distinctive research, with an indication of special interest in the delivery of health care.