The graying of America will increase demand for specialists in geriatric medicine, but the proportion of filled fellowship positions in geriatric medicine has been falling recently. The objective of this study was to examine the financial return of additional training in geriatric medicine for general internists by using survey data from the American Medical Association and standard financial techniques. The return on educational investment over a working lifetime for a third-year resident in internal medicine who was considering specialty training in geriatric medicine between 1993 and 1999 was calculated.
Physicians self-identified as geriatricians had lower incomes and lower incomes per hour than age-matched general internists, although the disparities decreased somewhat over the period examined. Regression modeling suggested that incomes for geriatricians are lower than expected and that this disparity increased in the last 2 years of the study. Some of the income disparities may be attributable to the fact that geriatricians obtain a greater proportion of their total revenue from Medicare than is optimal in the generalist setting. Returns on educational investment for geriatrics training were negative, although less so in recent years. Analysis suggests that the pursuit of additional specialty training in geriatric medicine has a negative financial return. Financial returns and the incentives they create should be carefully considered in meeting the anticipated geriatrics workforce needs of the nation.