title: Subspecialty Training and Certification in Geriatric Psychiatry: A 25-Year Overview.
abstract: The Institute of Medicine estimated that by 2030, from 10.1 to 14.4 million Americans aged 65 years or older will have mental health or substance use disorders. This article reviews the history and current status of training, certification, and practice in geriatric psychiatry against the backdrop of this "silver tsunami." The American Board of Psychiatry and Neurology (ABPN) administered the first subspecialty examination in geriatric psychiatry in 1991, and through 2015 3,329 certificates were awarded. The Accreditation Council for Graduate Medical Education approved the training requirements in 1993. After a surge in programs and fellows, the numbers appear to have stabilized at about 57 programs and 60-65 trainees per year with fewer than half of the positions filled each year. The majority of graduates seeks and obtains ABPN certification, and the majority of those who were fellowship trained have maintained certification. Despite the unprecedented demand for mental health services for older adults, it must be acknowledged that not enough geriatric psychiatrists can be prepared to meet the needs of an aging U.S.
  
  
  METHODS
  Strategies for addressing the shortage are discussed, including undertaking subspecialty training in the fourth year of psychiatry training, increasing the time devoted to the care of older adults in undergraduate and graduate medical education, and developing alternative training pathways such as mini-fellowships. It is not clear whether more favorable Medicare reimbursement rates for those certified in geriatric psychiatry would increase the numbers seeking fellowship training.
authors.affiliation: American Board of Psychiatry and Neurology, Inc., Buffalo Grove, IL. Electronic address: djuul@abpn.com.
authors.forename: Dorthea
authors.initials: D
authors.lastname: Juul
authors.affiliation: The West Virginia University Health System, Morgantown, WV.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Colenda
authors.affiliation: Department of Psychiatry and Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Lyness
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Dunn
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA.
authors.forename: Rita
authors.initials: R
authors.lastname: Hargrave
authors.affiliation: American Board of Psychiatry and Neurology, Inc., Buffalo Grove, IL.
authors.forename: Larry R
authors.initials: LR
authors.lastname: Faulkner
mesh_terms: D002568:Certification / Q000639:trends*; D005257:Fellowships and Scholarships; D005852:Geriatric Psychiatry / Q000193:education* / Q000639:trends; D006801:Humans; D013038:Specialization / Q000639:trends*; D000078329:Workforce
keywords: Subspecialty/fellowship training; geriatric psychiatry workforce; maintenance of certification; subspecialty certification