(ABIM) first offered a 10-year certificate of added qualifications (CAQ) in the subspecialty of geriatric medicine.⁴ Originally CAQs were available only to physicians with at least 2 years of specialty geriatric training or to those who had substantial clinical experience (the “practice pathway”). In 1994 the ABIM and ABFM phased out the practice-pathway option, and in 1998 they lowered the training requirement to only 1 year, resulting in a slight upward trend in the recruitment of geriatric fellows. As seen in Figure 4-3, the number of physicians certified annually surged and then sharply decreased when the practice-pathway option was eliminated; only 13.4 percent of all new certifications occurred after the practice-pathway option ended.

Osteopathic physicians may pursue CAQs from the ABIM or ABFM and also from the American Osteopathic Board of Family Physicians (AOBFP) or the American Osteopathic Board of Internal Medicine (AOBIM), which have offered certification since 1991. The AOBIM ended the practice-pathway option in 1994, and the AOBFP ended it in 2002.

The American Board of Psychiatry and Neurology (ABPN) recognized geriatric psychiatry as a subspecialty in 1989 and first awarded 10-year CAQs in 1991 (ABPN, 2007a). In 1996 the ABPN phased out the practice-pathway option and subsequently reduced post-graduate training requirements from 2 years to 1 year. Figure 4-4 shows a similar surge and then a drop in certification related to these events.⁵ Only 13 percent of all geriatric psychiatrists ever certified became certified after the practice pathway was phased out.

As the geriatric certifications expire, many physicians do not pursue recertification; most of these physicians were certified via the practice pathway. Reasons for not recertifying are multifactorial, including retirement, the burden of the process, and the lack of perceived benefit. Table 4-4 shows that only about half of all physicians certified in geriatric medicine or geriatric psychiatry before 1994 have been recertified (ADGAP, 2005). By comparison, 89 percent of physicians who received specialty certificates in other disciplines⁶ from the ABIM between 1990 and 1995 enrolled in the maintenance of certification process; of those, 81 percent completed the process (ABIM, 2005). The comparable rate of recertification in geriatrics among other health professions is unknown.