By 2040, the number of Americans 65 and older will reach 78 million, more than double the number from two decades ago. However, the U.S. health care system was not built to handle this increase in older adults, and there are not enough specialists to meet the surging demand for geriatricians in the coming years.
The United States has roughly 7,000 board-certified geriatricians, only a percentage of whom are actively practicing. That is about one geriatrician for every 10,000 older Americans. Meanwhile, only one in 10 U.S. medical schools requires any clinical experience in geriatrics, down from one in four just 15 years ago, geriatrician Jeremy Gurwitz wrote in STAT.
Every state is feeling this shortage. More than 60% of U.S. counties lack a single geriatric specialist of any kind, according to research published in JAMA. Understanding the scope and scale of this workforce crisis can help journalists covering aging, health policy, workforce, or local health systems and enhance their local reporting.
The scale of the problem
The supply-demand mismatch in geriatric medicine is not new, but its consequences are growing more acute. The national shortage of full-time geriatricians continues to worsen, according to the American Geriatrics Society. Geriatric nurse practitioners partially offset that decline, with their numbers growing by 125% between 2010 and 2020. But that increase is only a drop in the bucket.
The financial incentives that shape physician specialty choice work against geriatrics. Geriatricians earn an average of $20,000 per year less than internists who did not complete a geriatric fellowship, despite an extra year of training. Older patients’ needs are more complex and time intensive; that approach runs counter to the clinical payment models that reward shorter appointments and patient volume over quality of time spent on care.
A generation ago, a quarter of U.S. medical schools required students to do clinical rotations in geriatrics. Today, that number has fallen to just one in ten, the American Geriatrics Society notes.
This leads to a domino effect. Students who don’t encounter geriatrics as a discipline during training are unlikely to consider it as a career. Geriatric medicine fellowship fill rates remain among the lowest of all medicine subspecialties — although a 2025 paper notes the fill rate improved to around 70% for the 2022–23 match, up from the 43% reported in earlier analyses. Without adequate role models or institutional support, geriatrics still competes poorly against specialties that carry more prestige and pay.
There’s also a generational transition underway within the existing workforce. A significant proportion of practicing geriatricians trained in the field’s early decades are approaching retirement age themselves, and the Association of American Medical Colleges’ 2024 physician workforce projections estimate an overall physician shortfall of 13,500 to 86,000 by 2036, with geriatrics among the hardest-hit specialties.
Some advocates are pushing back against the doom-and-gloom narrative, saying the field is advancing rather than declining. They point to the integration of geriatric principles across other medical specialties and new care delivery models.
Reporters can ask their local experts whether a broader model of “geriatrics-informed” care is an adequate substitute for a specialist workforce, or a well-intentioned but inferior workaround to a genuine shortage that still needs addressing.
Patients suffer from the shortage
The argument is that geriatricians bring a distinct set of skills that most generalists are not trained to provide. They are better equipped to manage polypharmacy, the potentially dangerous use of multiple medications that is common in older patients, prevent and evaluate falls, assess cognitive decline, identify delirium, navigate end-of-life planning, and integrate the preferences and values of patients into care decisions.
Without that expertise, older patients may receive medications that are contraindicated for their age group, go undiagnosed with early dementia or depression, experience preventable hospitalizations, or receive aggressive treatment that isn’t aligned with their own goals. The age-friendly care movement, built around the 4Ms framework of what matters, medication, mentation, and mobility, was specifically designed to address these gaps. (See AHCJ’s September 2024 tip sheet on age-friendly care for a deeper dive into how hospitals are implementing this model.)
For rural and low-income patients, the access gap is widening. The Commonwealth Fund’s first State Medicare Scorecard, released in October 2025, documented wide variation in outcomes for Medicare beneficiaries across all 50 states; geographic access to specialist care is a significant driver of that variation. Vermont, Utah, and Minnesota ranked at the top; Louisiana, Mississippi and Kentucky at the bottom.
Workarounds and their limits
- Some health systems are working to address this shortage through approaches like team-based models. A single geriatrician works in tandem with nurse practitioners, geriatric social workers, and trained care coordinators. Programs like ALIGN from Mount Sinai Hospital in New York, use one geriatrician to co-manage surgical patients over 65 across multiple units. Rather than handling every patient encounter directly, the geriatrician functions as a consultant, educator, and support for a larger team.
- Telehealth is another stopgap, allowing geriatric specialists in urban centers to consult on cases in rural hospitals and clinics they could never serve in person. But, digital access barriers including limited broadband, tech literacy gaps, and the specific challenges of remote cognitive and functional assessment make telehealth a less than ideal substitute, particularly for the oldest and most complex patients. Broader Medicare coverage of telehealth services and locations is authorized until December 2027; it’s unclear whether Congress will return to more narrow restrictions. The HRSA workforce projections dashboard tracks these trends by geography and specialty.
- Programs like Nurses Improving Care for Healthsystem Elders, or NICHE , train nursing staff in geriatric principles across institutional settings. Founded in 1992 and now operating in more than 350 hospitals across more than 40 states, NICHE is among the most established models for embedding geriatric expertise throughout a hospital without requiring a geriatrician in every unit.
Story ideas
- Policy questions: Can adaptive models genuinely compensate for a specialist shortfall, or, are they masking a crisis that needs deeper solutions, like changes to medical education requirements, fellowship funding, and Medicare reimbursement rates for complex geriatric care. The AGS is lobbying for reauthorization of the Geriatrics Workforce Enhancement Program (GWEP) and Geriatric Academic Career Award (GACA), both expired in September 2025.
- The team-based workaround. Find a local hospital or health system using a geriatric consultation or co-management model similar to Mount Sinai’s ALIGN program. How does it work? Whom does it serve? What does it leave uncovered?
- The local numbers: The American Geriatrics Society publishes state-by-state geriatrician counts. Is your state above or below the national ratio of roughly one geriatrician per 10,000 older adults?
- Local medical schools: Is clinical geriatrics training required? Optional? Nonexistent? Medical school deans and department chairs in geriatric medicine are often willing to speak about this.
- Financial disincentives: Talk to geriatric fellowship directors about match rates and how many slots go unfilled each year. AGS workforce data break this down by year. What are fellows being paid, and what debt are they carrying?
- Rural access: In the 63.9% of counties with no geriatric specialists, who is caring for the most complex older patients? Primary care physicians, hospitalists, and emergency physicians in rural areas carry a burden of geriatric care they weren’t fully trained to provide. Their perspective is underreported.
- The nursing and direct care workforce: Certified nursing assistants, home health aides, and geriatric care managers are the frontline of elder care, and there’s also a severe shortage of these professionals. The PHI 2025 Direct Care Workforce report projects 9.7 million total job openings in direct care from 2024 to 2034, with a median wage of just $17.36 per hour. The geriatric specialist shortage doesn’t exist in isolation.
