Higher Intelligence and Later Maternal Age: Which Way Does the Causal Direction Go?

To the Editor: In a recent publication, John Morley highlights how geriatric medicine has improved the quality of life of older persons through the development of wide ranging interprofessional programs. Despite evidence that geriatricians are the most satisfied of physicians and enormous demand for geriatricians that the aging of the population is bringing about, there has been a decline in board-certified geriatricians in the United States since 1996. Morley proposes a number of strategies to reverse this trend, including electronic referral systems; advertising on prime time television, radio, and social media; and a return to a 2-year fellowship program. Faced with a similar shortfall of geriatricians and recruitment of trainees into the geriatric medicine program in Victoria, Australia, the Australian and New Zealand Society for Geriatric Medicine adopted a different approach. All stakeholders involved in specialist training in Victoria agreed to collaborate to form a statewide geriatric medicine training program. Rather than competing for a limited number of trainees, the focus shifted to expanding the number of trainees. All hospitals agreed to release trainees for half a day per week for statewide training and other educational activities that could be delivered at a higher standard than any single hospital could provide. Professional-quality training was embedded in the scientific curriculum. Satisfied trainees became ambassadors for recruitment of junior doctors into the 3-year training program. The number of trainees in Victoria increased from 26 in 2007 to 89 in 2017. The number of specialist geriatricians in Victoria, with a population of 6 million people, increased from 99 to 209 over this time. The model of the Victorian Geriatric Medicine Training Program has now been successfully adopted in other Australian states and also by other specialties that had been experiencing difficulty recruiting.