Reviewed by the Help Dementia Editorial Team — our editors review every article for accuracy against guidance from the National Institute on Aging, the Alzheimer’s Association, and peer-reviewed sources.
Medical schools across the United States are urgently expanding their geriatric training programs because the nation faces a severe shortage of geriatricians at precisely the moment when the aging population most needs them. The U.S. currently has approximately 7,500 board-certified geriatricians to serve nearly 60 million Americans aged 65 and older, yet the Accreditation Council for Graduate Medical Education reports that fewer than 15% of medical school graduates pursue geriatric fellowships. As dementia diagnoses continue to climb—with an estimated 6.7 million Americans currently living with the disease and projections suggesting that number will nearly double by 2050—the disconnect between supply and demand has become impossible to ignore.
The shortage is not simply a matter of numbers; it reflects a systemic failure to prepare physicians for one of the most prevalent and complex conditions they will encounter in practice. Many primary care doctors admit they feel underprepared to manage cognitive decline, make accurate diagnoses, or coordinate the multidisciplinary care that dementia requires. For example, research from Johns Hopkins found that patients with early-stage dementia were often diagnosed years after symptom onset, missing the critical window when certain interventions might slow progression. In response, medical schools including Mayo Clinic’s School of Medicine, the University of California system, and Columbia University have redesigned curricula to embed geriatric competencies throughout all four years of medical education, not confined to optional electives.
Table of Contents
- What Is Driving the Crisis in Geriatrician Shortages?
- How Dementia Specifically Intensified the Need for Specialized Training
- Medical Schools’ Curriculum Redesign and Geriatric Training Expansion
- The Role of Telemedicine and Extended Practice Teams in Addressing the Shortage
- Barriers to Recruitment and How Institutions Are Removing Them
- International Models and What the U.S. Can Learn
- The Future of Geriatrics in Medical Education and Practice
- Conclusion
What Is Driving the Crisis in Geriatrician Shortages?
The shortage of geriatricians is rooted in several converging factors. First, the population is aging faster than any previous generation—the 85-and-older demographic is the fastest-growing age group in America. Second, fewer physicians are choosing geriatrics as a career: a 2023 survey by the American Geriatrics Society found that among medical residents with career interests in primary care, only about 5% identified geriatrics as their intended specialty. Third, many institutions offer limited fellowships or support for geriatric training. In rural areas, the situation is even more acute; Wyoming, Montana, and the Dakotas have fewer than one geriatrician per 100,000 residents, compared to a national recommendation of 10 to 12 per 100,000.
The financial model of medicine partially explains this gap. Geriatricians typically earn 20–30% less than procedurally focused specialists, despite managing highly complex patients who require more time per visit. A geriatrician in a small Midwestern city might spend two hours managing a patient’s dementia diagnosis, medication interactions, and caregiver support, only to be reimbursed at rates designed for brief office visits. Meanwhile, a cardiologist performing a catheterization can bill substantially more. This financial disparity, combined with the emotional demands of the specialty, has discouraged many younger doctors from pursuing it despite their interest in older adults.
How Dementia Specifically Intensified the Need for Specialized Training
Dementia represents a unique challenge that demands expertise many general physicians simply do not possess. The condition is not a single disease but a syndrome with multiple underlying pathologies—Alzheimer’s disease accounts for 60–80% of cases, but vascular dementia, Lewy body dementia, and frontotemporal dementia each present differently and require distinct management approaches. A geriatrician is trained to distinguish between these variants, recognize when cognitive changes are attributable to delirium (a temporary, treatable condition) versus irreversible dementia, and manage the behavioral and neuropsychiatric symptoms that often overshadow memory loss.
However, a critical limitation exists: even geriatricians cannot reverse most forms of dementia once significant cognitive decline has occurred. What they can do—and what general physicians often cannot—is provide early detection, implement lifestyle modifications that may delay symptoms, manage the cascade of complications (falls, infections, medication interactions), and coordinate palliative care when appropriate. Yet the vast majority of dementia diagnoses are made in primary care settings by doctors without formal geriatric training. A study in JAMA Neurology found that 40% of dementia cases in primary care were unrecognized or misdiagnosed, sometimes attributed instead to depression, medication side effects, or normal aging.
Medical Schools’ Curriculum Redesign and Geriatric Training Expansion
Recognizing the crisis, leading medical schools have begun overhauling their curricula to embed geriatric medicine throughout the four-year degree rather than treating it as an optional track. At the University of California, San Francisco, first-year medical students now receive 45 hours of geriatric content integrated into neurology, psychiatry, and internal medicine blocks. By their third year, students rotate through clinics where they care for older adults with multiple chronic conditions under supervision.
Stanford University School of Medicine has partnered with local elder-care facilities to create longitudinal experiences in which students follow the same patients over months, witnessing the natural progression of chronic illness and dementia. Columbia University College of Physicians and Surgeons implemented a “geriatric intensive” curriculum requirement in which all students spend a month dedicated to comprehensive geriatric assessment, including home visits to understand the social and physical environment that shapes a patient’s health. This experiential learning contrasts sharply with the traditional lecture-based approach and has shown encouraging outcomes: graduates of programs with immersive geriatric experiences report higher confidence in managing older patients and better preparedness to care for those with cognitive decline. Mayo Clinic has gone further by creating tracks in which interested students can elect a “distinction in geriatric medicine,” combining clinical experience with research in aging and dementia.
The Role of Telemedicine and Extended Practice Teams in Addressing the Shortage
Medical schools are also reimagining the delivery model for geriatric care, recognizing that geriatricians alone cannot solve the supply problem. Programs like the University of Washington’s Center of Innovation for Healthy Maturity are training primary care physicians, nurse practitioners, and physician assistants to manage dementia competently, effectively multiplying the impact of senior geriatricians who serve as consultants and educators. Telemedicine is expanding access in rural and underserved areas—a patient in rural Kentucky can now have a video consultation with a geriatrician at Mayo Clinic or Johns Hopkins, though broadband availability and technology access remain barriers for some of the oldest and most vulnerable patients.
However, this distributed model has a tradeoff: the quality and depth of geriatric assessment may not be equivalent when delivered via video compared to in-person. The physical examination, home assessment, and direct observation of gait, balance, and function that a geriatrician provides in person remain invaluable. Additionally, the burden of knowledge transfer falls heavily on busy primary care doctors who already feel overwhelmed by their caseloads. A rural family medicine physician managing dementia care alongside diabetes, hypertension, and acute illness may lack the time and resources to develop true expertise, even with consultation support.
Barriers to Recruitment and How Institutions Are Removing Them
Even as medical schools expand geriatric training, recruitment remains difficult. Medical students entering the field are motivated by innovation, technology, and the opportunity to cure disease—geriatrics, by contrast, is often framed as managing decline rather than achieving breakthroughs. To counter this narrative, forward-thinking programs are highlighting the innovation and complexity in geriatric medicine: advances in cognitive assessment, emerging treatments for mild cognitive impairment, the development of specialized facilities for dementia care, and the evolving science of frailty. The University of Pennsylvania’s Perelman School of Medicine created a research-focused geriatric track, pairing clinical training with laboratory experience in Alzheimer’s disease mechanisms, attracting research-oriented students who might otherwise pursue neurology or psychiatry.
A second barrier is the emotional toll of the specialty. Geriatricians frequently witness suffering, decline, and death—and they are often the first to have difficult conversations about goals of care, hospice, and mortality. Medical education rarely prepares students for the psychological resilience required. Schools are beginning to address this by integrating palliative care and mental health support into geriatric training, normalizing the discussion of clinician burnout, and partnering with mentors who model sustainable, meaningful practice in geriatrics. The warning here is essential: without adequate psychological support and mentorship, even well-trained geriatricians risk burnout and attrition from the field.
International Models and What the U.S. Can Learn
Some countries have achieved better geriatrician-to-population ratios by embedding geriatric principles into all physician training rather than creating a narrow specialist pipeline. Germany and the Netherlands, for instance, require all medical graduates to demonstrate competence in geriatric assessment, even if they do not pursue geriatrics as a specialty. The result is a workforce better equipped to recognize and manage cognitive decline across all settings.
The United Kingdom’s National Health Service has invested in structured geriatric training programs with built-in financial incentives for practice in underserved regions, successfully deploying geriatricians to rural areas where they were previously absent. The U.S. could adopt similar strategies, but it would require change at the policy level—altering reimbursement rates to reward time spent in cognitive assessment and care coordination, expanding loan forgiveness programs for geriatricians who practice in underserved areas, and mandating geriatric competencies in all medical licensure exams. Some progress is being made: the Centers for Medicare & Medicaid Services have introduced new billing codes that better reflect the complexity and time requirements of geriatric care, and the National Institute on Aging has increased funding for geriatric workforce development initiatives.
The Future of Geriatrics in Medical Education and Practice
Looking ahead, the field is poised for significant transformation. Medical schools are likely to continue expanding immersive geriatric experiences, moving away from the model in which students encounter older adults only incidentally in other rotations. Simultaneously, the rise of precision medicine and advanced diagnostics—including biomarkers for early cognitive decline and neuroimaging that can detect dementia pathology before symptoms emerge—is creating new opportunities for geriatricians to intervene earlier in the disease process.
This shift toward prevention and early detection may make geriatrics more appealing to a generation of doctors drawn to innovative medicine. However, the pace of change will determine whether supply can meet demand. If medical schools continue to expand geriatric training, if policy makers address reimbursement disparities, and if the specialty successfully attracts talented young physicians, the shortage may stabilize by 2035. If current trends persist, the gap will widen dramatically, leaving millions of older Americans with dementia in the care of physicians unprepared for the complexity of their conditions.
Conclusion
The shortage of geriatricians in America is not a problem that will resolve itself, but it is one that medical schools and health systems are actively confronting. Through curriculum redesign, experiential learning, and efforts to make the specialty more financially and emotionally sustainable, institutions are working to better prepare the next generation of physicians for the reality they will face: a rapidly aging population with rising rates of cognitive decline and dementia.
The responsibility extends beyond medical education; policymakers, health system leaders, and the medical profession itself must align incentives and resources to attract and retain geriatricians. For patients and families navigating dementia now, the priority is connecting with available expertise—whether through geriatric specialists, trained primary care physicians, or interdisciplinary teams. For medical students and early-career physicians, the field of geriatrics offers the opportunity to address one of the most pressing health challenges of our time and to provide care that profoundly impacts quality of life during the final decades of life.
