Advancing geriatrics fellowship programs through a community-based residency network.

BACKGROUND AND OBJECTIVES Our nation faces unprecedented challenges in caring for older adults. Geriatricians who provide care and teach geriatrics are underrepresented in the workforce, especially in non-metropolitan communities. In Michigan, geriatricians and geriatrics fellowship (GF) programs are clustered in the Southeast, suggesting that training site demographics may influence fellows' career location decisions. A project was undertaken at Michigan State University to determine if an established family medicine residency network (FMRN) could facilitate the accreditation of new GF programs in non-metropolitan communities, recruit fellows, and retain graduates to practice and teach in neighboring areas. METHODS A team (department chair, appointed GF network director, site program directors, and education specialists) conducted participating site needs and readiness assessments, facilitated collaboration between GF programs, assisted with completion of new program applications, led development of a curriculum utilizing shared instructional resources and evaluation tools, and provided career counseling to fellows. RESULTS Two GF programs were accredited and accepted applicants. Ongoing cooperative efforts resulted in the writing of a GF curriculum, organization of a joint Observed Structured Clinical Evaluation (OSCE), and monthly information-sharing teleconferences with program directors. Following training, graduates have chosen to practice in areas underserved by geriatricians in Michigan and elsewhere. CONCLUSIONS Early experience with this model of GF development indicates that new fellowships can be established in community-based residencies that competitively recruit and train fellows who are inclined to practice in areas of greatest need. Creation of more non-metropolitan GF programs could provide a means to stabilize and redistribute the geriatrician workforce.