Dan Kwon, MD, left, a third-year resident in Mount Sinai’s integrated Internal Medicine-Geriatrics track, and Nick Safian, MD, Chief Resident in Internal Medicine, who will pursue his geriatrics fellowship at The Mount Sinai Hospital after completing his chief year.
Nick Safian, MD, remembers when his grandparents began showing signs of dementia while he was in college. His family faced difficult decisions about where they would live, how to keep them safe, and how to preserve their independence. He watched the strain on his mother and her siblings as they searched for appropriate care.
“There were limited options, and my grandparents weren’t always treated with dignity in medical settings,” Dr. Safian says. “No one seemed to step back and look at how everything was affecting them or how it was affecting our family.”
When he entered medical school, he knew he wanted to work with older adults.
Dr. Safian is a resident in Mount Sinai’s integrated Internal Medicine-Geriatrics track (Med-Geri), a four-year pathway combining three years of internal medicine residency with a fourth-year fellowship in geriatrics. He currently serves as Chief Resident in Internal Medicine and will pursue his geriatrics fellowship at The Mount Sinai Hospital after completing his chief year.
An Integrated Approach to Training
Helen M. Fernandez, MD, Vice Chair of Education and Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, leads one of the nation’s largest geriatrics and palliative medicine training programs through the Brookdale Department of Geriatrics and Palliative Medicine. The Department has trained an estimated one in five geriatricians and palliative medicine physicians nationwide.
Dr. Fernandez sees the integrated Med-Geri pathway as part of a broader effort to strengthen the pipeline of clinicians by introducing geriatrics at the start of residency and reinforcing that focus throughout training. The need is pressing as the nation’s aging population expands even as fewer physicians enter the field.
The United States currently has approximately 7,300 board certified geriatricians, according to the American Geriatrics Society—about one specialist for every 10,000 older adults. In the 2025 National Resident Match Program, only 213 of 382 geriatric medicine fellowship positions were filled, continuing a trend in which roughly half of training spots fill annually despite rising demand.
“Many students may enter residency with an interest in aging, often inspired by personal experiences or close relationships with older adults,” Dr. Fernandez says. “However, if that focus isn’t reinforced, if they do not see mentors practicing geriatrics or do not have consistent clinical experiences in the field, it can fade.”
“Many students may enter residency with an interest in aging, often inspired by personal experiences or close relationships with older adults,” says Helen M. Fernandez, MD, Vice Chair of Education and Professor of Geriatrics and Palliative Medicine. “However, if that focus isn’t reinforced, if they do not see mentors practicing geriatrics or do not have consistent clinical experiences in the field, it can fade.”
To sustain that early interest, the Icahn School of Medicine embedded structured exposure and mentorship directly into the Internal Medicine Residency. Close faculty guidance, Dr. Fernandez says, helps trainees see aging not as a niche focus but as central to medical practice.
Mount Sinai launched its Med-Geri pathway in 2020 as one of three pilot programs nationwide. The ACGME-accredited, four-year Primary Care-Geriatrics track introduces geriatrics at the outset of residency rather than as an afterthought and weaves aging-focused training across the residency.
Trainees complete six months of geriatrics training, participate in a continuity clinic focused on older adults, and then pursue a fourth-year fellowship offering advanced clinical experience and protected time for scholarship. About a dozen residents are enrolled across Mount Sinai Morningside and Mount Sinai West.
High Satisfaction Despite Lower Pay
Recruiting geriatricians remains challenging. Despite requiring an additional year of fellowship training, geriatricians earn lower salaries than many other internal medicine subspecialists. The field has historically carried less prestige within academic medicine, and outcomes are often measured in stability and quality of life rather than cure. Visits typically involve extended conversations about cognition, safety, independence, and family dynamics.
Yet physicians who choose geriatrics consistently describe deep professional satisfaction, citing the intellectual demands of managing complex conditions and the meaningful connections formed with patients and families.
Dr. Safian says what appeals to him most about geriatrics is the stories patients bring into the exam room. “They have lived so much life,” he says. “Getting to know those stories and seeing how they guide the choices we’re making together invigorates me.”
He also finds fulfillment in supporting families as they navigate difficult decisions about safety and independence. “You’re helping families think through what matters most,” he says.
Dan Kwon, MD, a third-year resident in the program at Mount Sinai West, began volunteering with older adults long before medical school and built on that commitment during residency.
Growing up in a close-knit Korean American household, he watched his grandparents thrive through connection and community—his grandmother teaching knitting at a local senior center and his grandfather playing golf every other day. That example shaped his early understanding of healthy aging.
When the COVID-19 pandemic disrupted those routines, he saw how quickly circumstances could change. His grandparents rarely left home, and Dr. Kwon delivered groceries to them twice a week, often serving as their only in-person contact.
As isolation increased, he noticed gradual changes in their energy, mobility, and emotional well-being. “Watching that contrast, seeing how the health system and social systems affect older adults, solidified my interest,” he says.
The experience reshaped his understanding of clinical care. Housing, transportation, family structure, and social connection, he learned, often shape outcomes as much as medical treatment.
Preparing for an Aging Nation
Dr. Fernandez frames the Med-Geri pathway within a broader demographic shift reshaping health care. Americans over age 65 account for nearly half of hospitalizations and face elevated risks of falls, delirium, medication complications, and functional decline. Most are treated by physicians without formal training in geriatrics.
The U.S Census Bureau projects that by 2030 one in five people in the United States will be over 65. That population now represents 34 percent of physician demand and is projected to account for 42 percent by 2034.
“We have to train clinicians to care for our increasingly older and sicker population,” Dr. Fernandez says. “Medical education must evolve to reflect who our patients are.”
To advance this transformation, physicians across all specialties must embrace a new approach to aging that prioritizes careful frailty assessment, aligns treatment with patient goals, and champions independence. “Geriatrics embraces that complexity,” she says.
Strengthening the Model
Dr. Fernandez attributes the program’s progress to close mentorship and consistent engagement throughout training. Residents who commit to aging care often become ambassadors within their programs, encouraging peers to consider the specialty and broadening exposure to geriatrics across disciplines, she says.
Nationally, the combined Medicine-Geriatrics pathway now includes about a dozen programs, with additional sites in development.
Dr. Fernandez advises institutions exploring similar models and shares lessons learned about implementation and long-term program development. Accrediting bodies have expressed support, and formal recognition of the model as a permanent national pathway could occur within the next two years.
That broader vision extends beyond residency training. With the launch of the ASCEND curriculum in fall 2024, the Icahn School of Medicine redesigned its MD program to integrate geriatrics and palliative care principles from the first year. Geriatrics fellows also serve as educators during inpatient and ambulatory rotations, reinforcing aging-focused care across clinical settings.
Ultimately, she says, geriatrics is not confined to a single discipline.
“Every specialty now cares for older adults,” she says. “Our responsibility is to prepare physicians who understand aging in all its complexity and can bring that perspective into whatever field they choose.”