Family Practice Programs Research Articles

Geographical Distribution of Newly Accredited Anesthesiology Training Programs in Relation to Health Professional Shortage Areas and Medically Underserved Populations.

Expanding the physician workforce in underserved areas is imperative for addressing healthcare disparities. The creation of new residency training programs has assisted in these efforts. However, anesthesiology training programs are infrequently studied in this regard. Our objective was to compare the geographical distribution of newly accredited anesthesiology training programs with new surgery, obstetrics, and family practice programs with respect to health professional shortage areas (HPSAs) and medically underserved populations. The locations of residency training programs accredited between 2014 and 2024 were identified by querying the Accreditation Council for Graduate Medical Education and Fellowship and Residency Electronic Interactive Database Access System. Whether the postal address of the training program corresponded to a medically underserved area or population was then recorded. HPSA and maternal care target area (MCTA) scores were also collected as an indicator of poor access to primary care or maternal care for the postal addresses of each program. Bivariate US maps qualitatively compared the geographical distributions of newly accredited training programs, analysis of variance and t tests were used to compare HPSA and MCTA scores, and χ2 tests were used to compare the percentage of programs in medically underserved areas. Forty-eight anesthesiology programs became accredited between 2014 and 2024, as well as 127 surgical, 360 family medicine, and 68 obstetrical programs (total = 603). States with higher HPSA scores tended to have a relatively lower numbers of newly accredited anesthesiology and surgery programs. The mean HPSA and MCTA scores for anesthesiology programs were comparable to those for family medicine and obstetrical programs, respectively (P > .5). There was no statistically significant difference noted among the distribution of anesthesia, surgery, family medicine, or obstetrical training programs in medically underserved areas (P > .5). The geographical distributions of new anesthesiology and surgery training programs are qualitatively similar. Like family medicine and obstetrical training programs, newly accredited anesthesiology training programs are in HPSAs with comparable need priorities as evidenced by statistically similar HPSA and MCTA scores. However, with only roughly one-third of all newly accredited family medicine, obstetrical, surgery, and anesthesiology training programs in medically underserved areas, substantial work is still needed. States with higher HPSA scores tend to have a relatively lower number of newly accredited anesthesiology and surgery programs. The locations of newly accredited anesthesiology training programs are similar to those of newly accredited family medicine and obstetrical training programs as evidenced by similar HPSA and MCTA scores, respectively.

Assessment of the Status of Urban Family Practice Program in Iran from the Perspective of Experts: A Qualitative Study

Assessment of the Status of Urban Family Practice Program in Iran from the Perspective of Experts: A Qualitative Study

A Better World in the Future

A Better World in the Future

2469. Knowledge, Attitudes, Confidence, and Hesitancy Toward Vaccines Among Residents in Pediatric and Family Practice Programs

BackgroundHealthcare provider immunization education is vital to accurately address concerns regarding vaccines, but such training is not standardized across residency programs. To assess educational needs and develop a vaccine curriculum for pediatric (Peds) and family medicine (FM) residents, the Collaboration for Vaccination Education and Research (CoVER) was established. There is a need to identify knowledge, attitudes, and hesitancy regarding vaccines among residents.MethodsIn July 2017, an anonymous 30-item survey was sent to residents from 26 US institutions participating in CoVER. Items included (1) vaccine knowledge, (2) attitudes toward vaccines, (3) resident vaccine hesitancy, and (4) demographics. Differences in proportions were calculated using Fisher’s Exact test while the Kruskal–Wallis test was used to compare continuous outcomes.ResultsOf 1,447 residents invited, 746 completed the survey (52% response rate). Among participants, 12 were excluded due to inability to determine residency type and or year. The final cohort consisted of 734 residents (Table 1). Knowledge (Figure 1): Percent correct increased with residency year from PGY1 to PGY4 (49%, [95% CI 47–51]; 64% [95% CI 58–70]; test for trend P < 0.001). Compared with FM residents, Peds residents were more likely to answer knowledge questions correctly (56%; 49%; P < 0.001). Attitudes (Table 2): Confidence in communicating with parents increased with training (P < 0.001) but confidence in vaccination did not. Hesitancy (Figure 2): Three percent of residents (n = 21) self-reported as vaccine hesitant. They were more likely to be FM (75%, P < 0.001). Residents were more likely to delay a vaccine in someone without a medical contraindication with increased year of training (P < 0.001).ConclusionThis initial assessment of the residents’ knowledge, attitudes and hesitancy shows that despite increasing knowledge with training, vaccine confidence was unaffected. It was surprising to find hesitancy among residents, highlighting the need for further vaccine education. Future steps include evaluation of a vaccine education curriculum in residency training to increase confidence in the benefits of vaccination.Disclosures B. Pahud, Pfizer Foundation: Grant Investigator, Research grant. GlaxoSmithKline: Investigator, Salary. Alios Biopharma/Janssen: Investigator, Salary. Pfizer: Consultant, Consulting fee and Speaker honorarium. Sequirus: Consultant, Consulting fee. Sanofi Pasteur: Consultant, Consulting fee. B. R. Lee, PCORI: Grant Investigator, Research grant. KCALSI: Grant Investigator, Research grant. Merck: Investigator, Salary. D. Middleton, Merck: Scientific Advisor, Consulting fee. Pfizer: Scientific Advisor, Consulting fee. GlaxoSmithKline: Scientific Advisor, Consulting fee. Sanofi Pasteur: Scientific Advisor, Consulting fee.

Psychological factors explaining the referral behavior of Iranian family physicians.

Background:The recently developed policy of the family practice program in rural regions of Iran faced some challenges such as inefficient referral system. The health insurance organizations (purchaser) and health policy makers are concerned about the high rate of patient referrals from family physicians to specialists due to imposing unnecessary services and costs.Objectives:This study examined utility of the theory of planned behavior to explain intention of Iranian family physicians to reduce referral rate of patients with respiratory diseases to medical specialist.Patients and Methods:An exploratory cross-sectional study, employing a correlational design directed by the theory of planned behavior was conducted. A questionnaire was developed based on an eliciting study and review of literature. One hundred and seventy-four family physicians working at primary care centers in two provinces of Iran completed the questionnaire (response rate of 86%).Results:The finding revealed that intention of family physicians to reduce referral rate of patients to specialists was significantly related to two theory-based variables of subjective norms (r = 0.38, P < 0.001) and perceived behavioral control (r = 0.43, P < 0.001), and not to attitudes. A stepwise regression entering direct measures of the theory variables explained 35% of the variance on the intention, with perceived behavioral control being the strongest predictor. Adding background variables to the model achieved further 5% by variables of practice size and past referral rate behavior.Conclusions:The results indicated that psychological variables of the theory of planned behavior could explain a noticeable proportion of variance in family physician's intention to decrease the rate of referring patients with respiratory diseases to medical specialists. The intention is primarily influenced by normative and control considerations. These findings contribute to a better understanding of referral decisions by family physicians and are of great value in developing interventions to reduce the variation in referral rate of patients to medical specialists at primary care health centers.

Helping primary care teams emerge through a quality improvement program

Approaches to improving the quality of health care recognize the need for systems and cultures that facilitate optimal care. Interpersonal relationships and dynamics are a key factor in transforming a system to one that can achieve quality. The Quality in Family Practice (QIFP) program encompasses clinical and practice management using a comprehensive tool of family practice indicators. The objective of this study was to explore and describe the views of staff regarding changes in the clinical practice environment at two affiliated academic primary care clinics (comprising one Family Health Team, FHT) who participated in QIFP. An FHT in Hamilton, Canada, worked through the quality tool in 2008/2009. A qualitative exploratory case study approach was employed to examine staff perceptions of the process of participating. Semi-structured interviews were conducted in early 2010 with 43 FHT staff with representation from physicians, nurses, allied health professionals, support staff and managers. Interviews were audio-taped and transcribed verbatim. A modified template approach was used for coding, with a complexity theory perspective of analysis. Themes included importance of leadership, changes to practice environment, changes to communication, an increased understanding of team roles and relationships, strengthened teamwork, flattening of hierarchy through empowerment, changes in clinical care and clinical impacts, challenges and rewards and sustainability. The program resulted in perceived changes to relationships, teamwork and morale. Addressing issues of leadership, role clarity, empowerment, flattening of hierarchy and teamwork may go a long way in establishing and maintaining a quality culture.

P1-113 Patient satisfaction with urban and rural insurance and family physician program in markazi province

IntroductionFamily physician plan is one of the basic programs of the Fourth Plan on Economic, Social and Cultural Development in the health sector. This program more than 5 years old...

Discrimination against international medical graduates in the United States residency program selection process

BackgroundAvailable evidence suggests that international medical graduates have improved the availability of U.S. health care while maintaining academic standards. We wondered whether studies had been conducted to address how international graduates were treated in the post-graduate selection process compared to U.S. graduates.MethodsWe conducted a Medline search for research on the selection process.ResultsTwo studies provide strong evidence that psychiatry and family practice programs respond to identical requests for applications at least 80% more often for U.S. medical graduates than for international graduates. In a third study, a survey of surgical program directors, over 70% perceived that there was discrimination against international graduates in the selection process.ConclusionsThere is sufficient evidence to support action against discrimination in the selection process. Medical organizations should publish explicit proscriptions of discrimination against international medical graduates (as the American Psychiatric Association has done) and promote them in diversity statements. They should develop uniform and transparent policies for program directors to use to select applicants that minimize the possibility of non-academic discrimination, and the accreditation organization should monitor whether it is occurring. Whether there should be protectionism for U.S. graduates or whether post-graduate medical education should be an unfettered meritocracy needs to be openly discussed by medicine and society.

Colorectal cancer screening education, prioritization, and self-perceived preparedness among primary care residents: Data from a national survey

Colorectal cancer (CRC) screening remains underutilized in the United States. We conducted a national survey of CRC screening education, prioritization, and self-perceived preparedness among resident physicians in Family Practice (FP), Internal Medicine (IM), and Obstetrics and Gynecology (OB/GYN) training programs. Directors/administrators from 1085 FP, IM, and OB/GYN training programs were contacted by e-mail with a request to forward an invitation to participate in our Web-based CRC screening education survey to all residents in their program. Willing residents submitted responses in anonymous fashion. Data were analyzed using chi2 tests and analysis of variance methods. In total, 243 program directors/administrators forwarded our invitation, and 835 residents responded (384 FP, 266 IM, 177 OB/GYN, 8 undesignated specialty). Nearly all resident responders (89%) had received CRC screening education, but few content delivery methods were reported. Most felt at least somewhat comfortable or somewhat knowledgeable with respect to advising patients about CRC screening (90%), currently endorsed CRC screening guidelines (89%), and criteria used to identify familial CRC syndromes (50%). However, substantially fewer respondents reported feeling very comfortable or very knowledgeable in these areas (45%, 23%, and 5%, respectively). Program specialty, level of training, and gender were the strongest indicators of self-perceived preparedness. Although based on a relatively small sample of all FP, IM, and OB/GYN residents, these data suggest tangible opportunities to improve the CRC screening curriculum in primary care residency programs.

Outcomes from a National Multispecialty Palliative Care Curriculum Development Project

In 1998 we completed a successful regional pilot project in palliative care curriculum development among 32 internal medicine residency programs recruited from the mid-western United States. Between 1999 and 2004 this project was expanded to include 358 U.S. programs, from four specialties, based on new training requirements in internal medicine, family medicine, neurology, and general surgery. To assess the 1-year outcomes from residency programs participating in a national multispecialty palliative care curriculum development project. Outcome data obtained from residency programs' responses to a structured progress report 12 months after enrolling in the project and from published residency project reports. Three hundred fifty-eight residency programs, representing 27% of all eligible training programs in the four specialties, participated in the project. Outcome data was available from 224 residencies (63%). Most programs started new teaching in pain, non-pain symptom management, and communication skills. More than 50% of programs integrated palliative care topics within established institutional grand rounds, morbidity/mortality conferences or morning report. More than 70% of internal medicine and family practice programs began new direct patient care training opportunities utilizing hospital-based palliative care or hospice programs. New faculty development initiatives and use of quality improvement projects to drive curriculum change were reported in less than 50% of programs. Focused short-term instruction in palliative care curriculum development, in a diverse group of residency programs, is feasible and associated with significant curriculum change.

97: 12-Lead Electrocardiogram Interpretation Skills of Senior Medical Students Entering Emergency Medicine, Family Practice, and Internal Medicine Residency Training Programs

Electrocardiogram (ECG) interpretation is an important clinical skill for senior medical students (MS) entering emergency medicine (EM), family practice (FP), and internal medicine (IM) residency programs. Research shows senior MS have deficiencies in ECG interpretation and that these skills do not change over the final year of medical school. However, little information is available describing these skills among senior MS entering these programs. This study aims to describe how residency aspiration impacts ECG interpretation skills.

A National Survey of Terrorism Preparedness Training Among Pediatric, Family Practice, and Emergency Medicine Programs

Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, < 50% of emergency medicine programs report adequate training for children. Didactic classroom-based lectures were the most commonly used method of training. Emergency medicine programs were more likely to use scenario-based exercises. Among programs that use scenario exercises, 93% report that they never (40%) or only sometimes (53%) incorporate child victims into the scenarios. Time, funding, access to subject matter experts, and availability of training material are the most important barriers to effective training. Children are a precious national resource and a vulnerable population in disasters. Despite the availability of terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

Mental health and psychiatry training in primary care residency programs: Part I. Who teaches, where, when and how satisfied?

Objective Some 40% of patients treated by primary care physicians have significant mental health problems. Only about half eventually receive mental health care, usually by the primary care physicians, often inadequately. Recently, there has been an increased attempt to incorporate psychiatry in primary care training programs. The authors sought to assess the current status of psychiatry training in Internal Medicine (IM), Family Practice (FP), Pediatrics (Peds) and Obstetrics and Gynecology (Ob/Gyn) residency programs. Method All 1365 directors of accredited residency training programs in IM, FP, Ob/Gyn and Peds received a 16-item anonymous questionnaire in 2001–2002, collecting descriptive data concerning their psychiatry training. Results A great majority of IM (71%), Ob/Gyn (92%) and Peds (85%) training directors felt that the training was minimal or suboptimal, as compared to 41% of FP training directors ( P<.001). Sixty-four percent of FP program directors were satisfied with their training ( P<.001). In contrast, 54% of other PC program directors were dissatisfied with their psychiatry training. All programs utilized ambulatory care setting extensively. Family Practice programs had more types of mental health teachers, teaching formats and teaching settings ( P<.001). A majority of IM (57%) and Peds (70%) residencies desired more psychiatry training in their programs compared to only a third of FP and 40% of Ob/Gyn programs ( P<.001). Teaching in clinical settings was preferred by all except Ob/Gyn programs ( P<.001). Psychiatry departments contributed more to IM and Peds programs than others. Conclusion A majority of primary care training programs are dissatisfied with the current status of their psychiatric training except for FP programs. Family Practice programs have the most variety in training formats, venues and teachers. There are some specialty-specific differences in perceived needs and desires in psychiatric training.

Mental health and psychiatry training in primary care residency programs: Part II. What skills and diagnoses are taught, how adequate, and what affects training directors' satisfaction?

Objective The purpose of this study is to describe the psychiatric skills and diagnostic categories taught in primary care training programs, their adequacy, the perceived needs and desires for curriculum enhancement and the factors affecting training directors' satisfaction. Method All 1365 directors of accredited residency training programs in Internal Medicine (IM), Family Practice (FP), Obstetrics and Gynecology (Ob/Gyn), Pediatrics (Peds) and psychiatry received a 16-item anonymous questionnaire about psychiatry training in their program. Responses to the questionnaire to items concerning the skills and diagnostic categories taught, assessment of adequacy of teaching and desires for curriculum enhancement for specific skills and diagnostic categories were analyzed. The factors affecting training directors' satisfaction were explored. Results Interviewing skills were taught by a majority of all training programs and were considered adequate by 81% of FP and 54% of IM programs, in contrast to less than a majority of Ob/Gyn and Peds programs ( P<.001). A majority provided diagnostic interviewing and counseling training, but only FP considered it adequate. A majority taught psychopharmacology and various psychiatric diagnoses, but only in FP did a majority consider them adequate. Both Peds and FP programs teach child psychiatry; significantly, more Peds compared to FP consider their training to be adequate. A vast majority of IM, Ob/Gyn and Peds programs, and 50% of FP programs desired more training in interviewing techniques and diagnostic interview. A majority of all programs desired more counseling and psychopharmacology training and more training in disorders of childhood and adolescence. The overall satisfaction rate for psychiatric training across specialties was 46% ( n=657). Sixty-four percent of FP programs were satisfied compared to 31% of non-FP programs. Satisfaction was associated with increased amount of psychiatric training, diversity of training formats, venues, faculty and settings, the amount of contribution to teaching by psychiatry departments and the presence of current teaching in interviewing skills. There were specialty-specific differences in factors associated with satisfaction. In general, a smaller size of residency program was associated with satisfaction except in IM, where larger size was associated with satisfaction. Satisfaction was associated with the opinion that primary care physician should be ready and willing to treat more psychiatric conditions. Conclusion Most primary care training programs currently offer training in most psychiatric skills and disorders, but a majority of training directors are dissatisfied with their psychiatry training. There is a difference in the estimation of adequacy concerning training between FP, which consistently rates their teaching to be adequate, and all other primary care programs, which consider their teaching inadequate. This difference may be partly due to actual differences in amount and diversity of training as well as differences in the threshold for satisfaction. A vast majority of primary care training programs desire more training in almost all aspects of psychiatry, and there may be specialty-specific needs and areas of curriculum enhancement. To enhance satisfaction, we should improve the quality as well as the quantity of training, as well as the diversity in training formats, venues and faculty.

Supervision and Boundaries in a Combined Family Practice and Psychiatry Residency Training Program: The National Capital Consortium Experience

The combined discipline of family practice and psychiatry was created in 1995. There are no established guidelines for 1) teaching residents how to integrate these two specialties, 2) providing appropriate supervision, and 3) helping residents develop personal and professional boundaries. The authors share their approach and aim to stimulate dialogue and promote the establishment of standards for combined programs. The authors review some of the difficulties encountered in supervising family practice-psychiatry residents and the rationale for their approach. Providing residents with clear boundaries of practice and supervision that initially separate the two specialties during training facilitates the development of specialty knowledge and skills as well as the capacity to form clear boundaries. Our experience suggests that only when residents learn the appropriate practice and boundaries of each specialty can they successfully integrate the two without boundary or role confusion.

Evaluating the Effects of an Applied Learning Exercise on Students' Interest in Social Policy

There is ample evidence that points out that the majority of social work students have little interest in social policy analysis. In this study, the impact a classroombased policy construction exercise had on the interest level in policy of a differentiated sample (N = 43) of MSW students, in which participants were enrolled in either a community- or family-practice program, was measured. Results of a paired samples t-test suggest that the exercise significantly increased the participants' interest in social policy, as t(42) = 2.59, p < .05. When comparing the effects of the intervention on the respective subsamples, only the family-practice group yielded significant results, as t(20) = 2.14, p < .05. The implications this study has for social work educators striving to increase students' interest in social policy, particularly among aspiring micro practitioners, are also discussed.

Roux Stasis Syndrome: Clinical Improvement With Tegaserod

*Family Practice Program, UMDNJ-RWJUH at Capital Health Program, Columbus, NJ, †Department of Family Medicine, Family Practice Residency Program at Capital Health Program, Plainsboro, NJ, ‡Gastrointestinal and Liver Diseases, Lawrenceville, NJ

A national survey of flexible sigmoidoscopy training in primary care graduate and postgraduate education programs.

Expanding the pool of primary care endoscopists to perform flexible sigmoidoscopy (FS) has been advocated as a strategy for building colorectal cancer screening capacity. The principal aim of this study was to evaluate the availability and structure of FS training among internal medicine (IM), family practice (FP), physician assistant (PA), and nurse practitioner (NP) training programs. A postal survey of all accredited IM (n = 445), FP (n = 471), PA (n = 118), and NP (n = 149) training programs nationwide was conducted. The primary outcome was the proportion of programs offering or mandating FS training; and secondary outcomes, if applicable, were the number of participating trainees, the number of required procedures, the availability of instruction in endoscopic biopsy technique, mentors, and barriers. The overall response rate was 63%. Most IM (89%) and FP (99%) programs offered FS training versus only 12% of PA and 0% of NP programs. Family practice programs were more likely to offer training (p < 0.0001), require training (p < 0.0001), and teach biopsy techniques (p < 0.0001); Internal medicine programs were more likely to have minimum requirements (p < 0.0001) and required >/= 25 procedures per trainee (p < 0.0001). Physician assistant programs were less structured and often lacked minimum requirements. Flexible sigmoidoscopy training is widely available among FP and IM programs but more restricted or nonexistent among PA and NP programs. The lack of minimum standards for ensuring competency highlights the need for a standardized credentialing process.

The Teaching of Chest Auscultation During Primary Care Training: Has Anything Changed in the 1990s?

To survey the teaching time and importance given to cardiopulmonary auscultation during internal medicine (IM) and family practice (FP) residencies, and to compare current practices to those of the early 1990s. A nationwide mail survey of IM and FP program directors (PDs). All Accreditation Council for Graduate Medical Education-accredited IM and FP residencies. A total of 538 of 939 PDs (57.5%). In contrast to the early 1990s, when there had been no significant difference in teaching practices between IM and FP programs, more IM than FP residencies taught cardiopulmonary auscultation in 1999 (cardiac auscultation: IM residencies, 48%; FP residencies, 29.2% [p < 0.001]; pulmonary auscultation: IM residencies, 23.7%; FP residencies, 12.2% [p < 0.001]). Across the decade there also had been a significant increase in the percentage of IM programs offering structured education in chest auscultation (cardiac auscultation increase, 27.1 to 48% [p < 0.001]; pulmonary auscultation increase, 14.1 to 23.7% [p < 0.02]), but no significant changes for FP residencies. IM PDs gave more clinical importance to auscultation and expressed a greater desire for expanded teaching than did their counterparts in FP programs. This study indicates a significant gain over the last decade in the percentage of IM residencies offering structured teaching of cardiopulmonary auscultation. This same gain did not occur for FP programs. Whether these differences in attitudes and teaching practices will translate into improved auscultatory proficiency of IM trainees will need to be determined.

Geriatric medicine fellowship programs: a national study from the Association of Directors of Geriatric Academic Programs' Longitudinal Study of Training and Practice in Geriatric Medicine.

This report documents the development and growth of geriatric medicine fellowship training in the United States through 2002. A cross-sectional survey of geriatric medicine fellowship programs was conducted in the fall 2001. All allopathic (119) and osteopathic (7) accredited geriatric medicine fellowship-training programs in the United States were involved. Data were collected using self-administered mailed and Web-based survey instruments. Longitudinal data from the American Medical Association (AMA) and the Association of American Medical Colleges' (AAMC) National Graduate Medical Education (GME) Census, the Accreditation Council for Graduate Medical Education (ACGME), and the American Osteopathic Association (AOA) were also analyzed. The survey instrument was designed to gather data about faculty, fellows, program curricula, and program directors (PDs). In addition, annual AMA/AAMC data from 1991 to the present was compiled to examine trends in the number of fellowship programs and the number of fellows. The overall survey response rate was 76% (96 of 126 PDs). Most (54%) of the PDs had been in their current position 4 or more years (range: <1-20 years), and 59% of PDs reported that they had completed formal geriatric medicine fellowship training. The number of fellowship programs and the number of fellows entering programs has slowly increased over the past decade. During 2001-02, 338 fellows were training in allopathic programs and seven in osteopathic programs (all years of training). Forty-six percent (n = 44) of responding programs offered only 1-year fellowship-training experiences. PDs reported that application rates for fellowship positions were stable during the academic years (AYs) 1999-2002, with the median number of applications per first year position available in AY 2000-01 being 10 (range: 1-77). In 2001-02, data from the AMA/AAMC National GME Census indicated a fill rate for first-year geriatric medicine fellowship positions of 69% (259 first-year fellows for 373 positions). During 2001-02, more than half of programs (53%) reported having two or fewer first-year fellows, whereas 31% had three or four first-year fellows. Thirty-three programs (36%) reported having no U.S. medical school graduate first-year fellows, and another 25 (28%) reported having only one. Of the 51 programs offering second-year fellowship training, PDs reported 61 post-first-year fellows (median 1, range: 0-7). During the past 10 years, 27 new allopathic geriatric medicine fellowship programs opened; there are now 119 programs. There are also seven osteopathic programs. The recruitment of high-quality U.S. medical school graduates into these programs remains a challenge for the discipline. Furthermore, the retention of first-year fellows for additional years of academic training has been difficult. Incentives will be needed to attract the best graduates of U.S. family practice and internal medicine training programs into academic careers in geriatric medicine.