The proportion of the population in the United States over age 65 will increase substantially in the next 20 years. Despite this fact, geriatric psychiatry fellowship programs and fellows in the United States have been declining in number. With the aim of finding ways to increase recruitment into the field, studies have attempted to elucidate the factors involved in the choice to pursue geriatric psychiatry as a career. Residents and psychiatrists already interested in the field have indicated in surveys that factors including excellent supervisors, positive personal experiences with “elders,” positive clinical exposure and experiences, early exposure to geriatric-psychiatry patients, and the strong neuropsychiatric focus of the field have significantly influenced their decision to care for geriatric patients (1, 2). To the best of our knowledge, surveys have not yet been conducted to determine what deterrents or factors are at play to dissuade residents from pursuing a fellowship in geriatric psychiatry. If such barriers could be eliminated or diminished, interest in the field might improve and recruitment increase.

We conducted an IRB-approved, anonymous, web-based survey of all Mayo Clinic psychiatry residents and fellows in August 2010 to collect demographic information and assess experience and exposure to geriatric psychiatry in medical school and residency, future career plans, and factors involved in the decision to pursue a fellowship. Survey questions were based on previously developed surveys (1, 2). Two follow-up surveys were sent, at 1-month intervals, to enhance response rates.

Of 39 residents receiving the survey, 22 responded, an overall response rate of 56%. More than half (55%) were Postgraduate (PGY) Years 3 and 4, and 13 (59%) were men. Only 2 residents (9%) indicated interest in pursuing a geriatric-psychiatry fellowship; 18 residents (82%) indicated no interest in doing so, and 2 residents (9%) were undecided. The undecided residents were in the first 2 years of residency. Ten residents (45%) reported exposure to geriatric-psychiatry patients in medical school, including both residents who were interested in pursuing a geropsychiatry fellowship. Four of 21 respondents (19%) considered a career in geriatric psychiatry while in medical school; 2 of them now indicated no interest in pursuing a geropsychiatry fellowship.

Respondents answered “Yes” or “No” to five questions about possible factors involved in the decision about whether to pursue a fellowship in geriatric psychiatry. Sixteen of 21 residents (76%) indicated that the prognosis of geropsychiatry patients played a role in their decision; 13 of these were uninterested in pursuing a geropsychiatry fellowship. Personal experience with elderly patients was a factor for 10 residents (48%); both residents who indicated interest in pursuing a geropsychiatry fellowship also indicated this as a factor in their decision. Employment opportunities in geropsychiatry and income played a role for only 7 residents each (33%), and competition for fellowship positions was affirmed as a factor for only 4 (19%). The majority of residents (13; 59%) reported satisfaction with their geropsychiatry training in residency. Three residents (14%) affirmed being dissatisfied with their training, and all three were among those uninterested in doing a geropsychiatry fellowship.

Our survey results affirm that interest in pursuing a fellowship in geriatric psychiatry among residents at our institution is low. These findings are consistent with the national trend. Perceived poor prognosis of geropsychiatric patients is an important potential deterrent to considering a career in geriatric psychiatry, and, in our study, was a highly relevant factor. Informal discussions with the residents in our program reveal that many feel emotionally burdened by the preponderance of advanced-dementia patients on the inpatient unit, for whom it is that felt psychiatric intervention will have minimal effect on outcome. In our survey, a minority of residents uninterested in geropsychiatry indicated that income influenced their interest in geriatric psychiatry, but the authors question this finding's validity, as some may have felt uncomfortable admitting that financial factors play a role in their career choice.

Exposure to geropsychiatry patients in medical school may have played a role in fostering interest in pursuing specialized geropsychiatry training, although the majority of residents who indicated such exposure were not currently interested in pursuing a fellowship. Both residents who indicated uncertainty about pursuing a fellowship were in the first 2 years of training, suggesting a potential opportunity for recruitment. Satisfaction with the geriatric component of psychiatry residency training may have related to interest in pursuing a fellowship, indicating that there may be a role for enhancing training experiences to increase recruitment. Further work is needed to enhance interest in the field among trainees, identifying and addressing the disincentives to pursuing a career in geropsychiatry.

Dr. Lilly was a geriatric psychiatry fellow at the Mayo Clinic in Rochester, MN, when he completed this project.

The authors have no competing interests to disclose.