medical schools work to recruit aging health specialists –

By Grace Vitaglione

North Carolinians are getting older, but there aren’t enough people getting trained to care for them.

The population of people ages 65 and older in North Carolina is expected to nearly double to 2.7 million in the next couple decades. Many of those older adults will require care from doctors specializing in geriatric medicine, or doctors who are trained to focus on older adults’ ability to function and their need to balance multiple diagnoses.

But there’s a national shortage of these geriatricians. As of 2021, there were more than 7,400 certified geriatricians in the country to care for more than 58 million people over the age of 65 who, on average, will live almost 19 more years. By 2030, the country will need 30,000 geriatricians — specialists who care for people 65 and over — according to the American Geriatrics Society.

Recruiting the next generation of geriatricians has been a challenge. In 2025, fewer than half of the spots for fellows in geriatric medicine were filled nationally. Of the programs at North Carolina’s medical schools that train young doctors to focus on the needs of older adults, two of the 15 open positions went unfilled for the current academic year.

That shortage is something geriatricians are taking seriously as they try to figure out how to expose more students to the field, said Dr. Mamata Yanamadala, who leads the Geriatrics Fellowship Program at the Duke University School of Medicine.

Lower compensation and persistently negative societal views of older people are some factors in that shortage, geriatricians said. Exposing more medical students to the field and the broad range of care for older people will help recruitment.

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What is a geriatrician?

Most of the medical system is focused on diseases that affect different parts of the body — the heart, brain, lungs or kidneys — but geriatric medicine focuses on how the whole person is functioning in their environment, said Jeff Williamson, chief of gerontology and geriatric medicine at the Wake Forest University School of Medicine.

When he sees a new patient, Williamson said he wants to know about more than what medications they take or diseases they have.

“We are trained to think about physical and cognitive function in the context of the inevitable chronic diseases that occur as we age,” he said.

Geriatricians can be primary care doctors for older adults or can work in an inpatient geriatric service – such as the one at UNC Hospitals Hillsborough campus, said Maureen Dale, director of the UNC Chapel Hill Geriatric Medicine Fellowship Program. Some also serve as consultants, giving advice to patients and their primary care providers, or to the doctors taking care of them in the hospital.

Geriatricians balance the sometimes, multiple health conditions that can adversely affect older adults’ ability to live their life, Dale said. Some older adults have “geriatric syndrome,” a multi-factor set of problems that can include problems with frailty, frequent falls and dementia.

Older adults may also have multiple medical problems that require taking a lot of medications, which can interact with one another and affect their function as they age, Dale said.

Some people may even need geriatric care before they get to 65, she said.

Recruiting medical students

East Carolina University’s Geriatrics Fellowship program filled one of two fellowship spots for the current academic year. The Duke program filled all five of their spots, UNC’s program filled all four of their spots and Wake Forest University School of Medicine filled three out of four. Campbell University School of Osteopathic Medicine does not have a geriatric fellowship program.

For the upcoming academic year, UNC was only able to fill two of their four spots. ECU has no geriatrics fellows for the upcoming year and Duke is still in the recruitment process.

UNC saw fewer applications this year, Dale said. Generally, geriatric fellowships have lower numbers of applicants compared to other specialities, she said.

Williamson said Wake Forest’s medical school infrequently fills all four of the spots.

While Duke fills its fellowship spots pretty consistently, it’s “not a cake walk” to do so, said Yanamadala.

Outreach efforts help recruitment, she said. Medical schools also have interest groups, including one for geriatric medicine, where interested students can organize activities and hear from faculty in that specialty, she said.

In medical school training, students are exposed to very ill older people in the hospital, Williamson said. But they should be able to see the full spectrum of care for older people — “which is often filled with joy.”.

Yanamadala said fellows in geriatrics at Duke rotate between the Duke University Hospital, Durham Veterans Affairs Medical Center, continuing care retirement communities and local Programs of All-Inclusive Care for the Elderly, which provide comprehensive medical and social services to people living in the community.

Because there aren’t many geriatricians nationwide, it can be hard for medical students to get the opportunity to work alongside one, Williamson said. That compounds the problem, as fewer students are exposed to the field.

Williamson said that was true for him — he had been planning to specialize in gastroenterology until he got to see a geriatrician in action while he was a resident.

Barriers to expanding workforce

Geriatrics is also not as well-paid as other specialties, which can play a role in people’s decision-making, Dale said. Like primary care, geriatrics is also a lot of work. Taking care of these patients may take more time: the time to listen, the time to puzzle through how to balance many medications and the time to work through the social issues that can affect care. All this time spent isn’t always reimbursed in the same way as procedures are, she said.

Williamson said the health system tends to reimburse procedures better — but for geriatricians, their “procedure” is the conversation they have with the older patient, he said. That doesn’t garner as much payment.

Medicare, the federal health insurance program for people over 65 years and many folks with disabilities, also doesn’t reimburse providers as well as some other forms of insurance, he said.

Another influence is how “youth-oriented” our society is, Williamson said. For those who do go into geriatrics, it’s often because they were close with an older person in their life, he said. For him, that was his grandfather. But families tend to be spread further apart than they used to be.

“So many young people don’t really know the joy of being around an older person,” he said.

Meeting the demand

Reframing what aging looks like and exposing people early on in their medical training to geriatric medicine will help recruit more geriatricians to meet the demand of an aging population, Dale argued.

Also, because there are so few geriatricians out there, training future geriatricians to be teachers and leaders to others in geriatric care principles is important, she said. The UNC Center for Aging and Health educates providers statewide on better geriatric-focused care.

It can also be difficult for older adults in rural areas to access a geriatrician, Williamson said, but telehealth is emerging as one avenue to rectify that issue.

Yanamadala said she hopes future geriatricians can be trained to disseminate the principles of geriatrics beyond caring for a single patient. That could mean figuring out how to train individuals in supporting larger health care systems to be successful at caring for older adults to address the growing need for geriatricians.

Geriatrics is a long-term relationship with the patient, Williamson said. That can be rewarding, and it shows in the numbers: surveys of medical professionals each year show geriatricians as some of the happiest and most satisfied, he said.

He said many people he started taking care of in their sixties are now in their nineties.

“They’ve been like a family member,” he said.

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