Becoming a Geriatrician: Education and Training Pathway

The pathway to practicing geriatric medicine in the United States is a structured sequence of undergraduate preparation, medical school, residency training, and subspecialty fellowship. This page describes each phase of that pathway, the credentialing bodies that govern certification, and the decision points that distinguish geriatrics from adjacent specialties. Understanding this pathway matters because the US faces a projected shortage of geriatricians relative to the growing population of adults aged 65 and older.

Definition and scope

A geriatrician is a physician who has completed post-graduate subspecialty training specifically in the care of older adults and who holds board certification in geriatric medicine. In the United States, geriatric medicine is a recognized subspecialty under both internal medicine and family medicine, governed by the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine (ABFM), respectively.

The scope of the specialty encompasses the diagnosis and management of conditions disproportionately affecting older adults — polypharmacy, frailty, cognitive decline, falls, and functional impairment — as well as the coordination of care across multiple chronic diseases. A full orientation to what practicing geriatricians actually do in clinical settings is covered at what does a geriatrician do. The broader landscape of US geriatrics policy and workforce regulation is detailed at regulatory context for geriatrics.

The American Geriatrics Society (AGS) reports that fewer than 7,300 certified geriatricians were practicing in the US as of its most recent workforce data, a figure that stands against a population of more than 58 million Americans aged 65 and older (US Census Bureau, 2020 Decennial Census).

How it works

The training pathway follows a defined sequence:

  1. Undergraduate education (4 years): No specific pre-medical major is mandated, but coursework in biology, chemistry, biochemistry, and statistics is required for medical school admission. Relevant volunteer or clinical experience in elder care settings strengthens applications.

  2. Medical school (4 years): Graduates receive either a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. Osteopathic graduates may pursue geriatric fellowship training through the same ABIM/ABFM pathways following the merger of osteopathic and allopathic residency accreditation under the Accreditation Council for Graduate Medical Education (ACGME) in 2020.

  3. Residency training (3 years): Completion of an ACGME-accredited residency in internal medicine or family medicine is required before fellowship eligibility. Internal medicine residency is the more common precursor pathway.

  4. Geriatric medicine fellowship (1 year minimum): An ACGME-accredited geriatric medicine fellowship provides focused clinical training. The ACGME Program Requirements for Graduate Medical Education in Geriatric Medicine specify competency domains including patient care, interpersonal communication, systems-based practice, and professionalism (ACGME Program Requirements, Geriatric Medicine).

  5. Board certification: Following fellowship completion, candidates must pass the Geriatric Medicine Certification Examination administered jointly by ABIM and ABFM. Certification requires ongoing maintenance through ABIM's Maintenance of Certification (MOC) program, which includes continuous learning activities and periodic assessment.

Physicians interested in related subspecialties — geriatric psychiatry fellowship or hospice and palliative medicine fellowship — follow parallel but distinct credentialing tracks through the American Board of Psychiatry and Neurology (ABPN) and the American Board of Hospice and Palliative Medicine (ABHPM), respectively.

Common scenarios

Three distinct entry profiles characterize the population of physicians who pursue geriatric medicine:

Internal medicine residents identifying geriatrics during training. The most common pathway. A resident completing a 3-year internal medicine program applies to geriatric fellowship during the third year via the National Resident Matching Program (NRMP) Subspecialty Match. Match data from the NRMP show that geriatric medicine fellowship positions have historically had fill rates below 100%, reflecting the workforce shortage rather than competitive exclusion.

Family medicine physicians entering geriatrics. Approximately 15–20% of geriatric medicine fellows enter through family medicine residencies (AGS workforce estimates). This pathway emphasizes continuity of care and community-based practice models, well-suited to geriatric practice models in rural or underserved settings.

Mid-career physicians adding geriatric expertise. Physicians already board-certified in internal medicine or family medicine may complete a geriatric fellowship and sit for certification at any career stage. This pattern is documented in AGS membership surveys as a response to panel aging — the gradual demographic shift of an existing patient panel toward older age categories.

The home page of this resource provides orientation to the full scope of geriatric medicine topics addressed across this reference.

Decision boundaries

The critical distinction separating geriatric medicine from general internal medicine or family medicine is not disease category but patient complexity defined by age-related physiologic change, functional status, and multi-system interaction. Geriatrics vs. internal medicine addresses this boundary in detail.

Physicians should weigh the following factors when evaluating geriatric fellowship against remaining in general internal medicine:

The ACGME accredits 180+ geriatric medicine fellowship programs across the United States as of its most recent program count, distributed across academic medical centers and integrated health systems (ACGME Accredited Programs and Sponsors).

References

The law belongs to the people. Georgia v. Public.Resource.Org, 590 U.S. (2020)