What drives doctors to specialize in geriatric medicine?

Why do some young doctors, facing a vast menu of high-technology specialties, choose instead to devote their careers to the oldest and frailest members of society? A new Spanish study offers one of the most detailed answers yet, and its findings carry a message that could reshape how medical schools around the world prepare the next generation of physicians. The research, published in European Geriatric Medicine, surveyed 129 medical residents across Spain’s accredited geriatric medicine teaching units during the 2023/2024 academic year and found that the decision to specialize in geriatrics is driven by a powerful blend of personal connection and professional fascination — and that comprehensive training during medical school can dramatically change how students perceive the specialty.

The stakes could hardly be higher. Populations across Europe and much of the world are aging at an unprecedented pace, yet geriatric medicine consistently struggles to recruit new specialists. International surveys have documented a paradoxical decline of geriatric medicine as a profession in some countries, and workforce projections point to a looming geriatrician shortage that threatens the quality of care for older adults precisely when demand is rising fastest. In the United States, the National Resident Matching Program data reveal persistently unfilled positions in geriatrics, while European analyses of medical education show that many countries offer little or no undergraduate exposure to the discipline. Against this backdrop, understanding why the doctors who do choose geriatrics make that choice is a question of urgent practical importance.

The Spanish research team, led by investigators from hospitals including Hospital Universitario de La Ribera, Gregorio Marañón University Hospital, Navarra University Hospital and Ramón y Cajal University Hospital, approached the question with a qualitative descriptive design. Rather than testing a hypothesis with a randomized experiment, the researchers used intentional sampling and distributed an anonymous questionnaire to residents in accredited Spanish geriatric teaching units. The methodology reflects the exploratory nature of the question: career choice is a deeply personal phenomenon shaped by experiences, emotions and values that are difficult to capture with a purely quantitative instrument. By asking open-ended and structured questions together, the team was able to identify which factors residents themselves report as decisive.

The demographic and educational profile of the participants itself revealed something notable. Eighty-nine per cent of the residents said they were already familiar with geriatric medicine before entering their specialty training, and 46 per cent had received both theoretical and practical training in geriatrics during their medical degrees. This distinction proved to be statistically meaningful. Residents who had received complete training in the specialty — meaning both classroom instruction and hands-on clinical experience with older patients — were significantly more likely to have considered geriatrics as a potential career path before choosing it. Among the fully trained group, 75 per cent had considered geriatrics as a potential specialty, compared with only 54 per cent of those without such training, a difference the researchers report as statistically significant with a p-value of 0.02.

Even more striking was how training changed the way residents viewed the clinical content of their work. The clinical complexity of older adult patients — the intricate interplay of multimorbidity, atypical disease presentation, frailty, polypharmacy and functional decline that defines geriatric medicine — was rated as a relevant factor by 92 per cent of those with complete geriatric training, compared with 77 per cent of those without it (p = 0.027). In other words, far from being deterred by complexity, residents who had been properly taught geriatrics embraced it as one of the most intellectually stimulating aspects of the field. What many medical students perceive as a barrier — the messy, multi-system, challenging nature of older patients — appears to be reframed by good training into a source of professional satisfaction.

The ranking of motivating factors tells a vivid story about what draws people to this specialty. The most frequently cited factor, reported by 95 per cent of participants, was affinity with older persons. Close behind came communication with patients and families at 90 per cent, and multidisciplinary work at 86 per cent. The clinical complexity of older adults followed at 84 per cent, multimorbidity at 82 per cent, and — notably personal — relationships with older relatives at 76 per cent. This last figure underscores how biographical experience shapes career decisions: many residents explicitly connected their professional choice to grandparents, parents or other older people in their own lives. The pattern suggests that geriatrics attracts physicians who value longitudinal human relationships, teamwork and the intellectual challenge of patients who cannot be reduced to a single organ system.

These findings align closely with a growing body of international evidence. A French national survey of postgraduate medical students published in Age and Ageing found similar themes of human connection and clinical interest, while a Danish survey of junior doctors published in European Geriatric Medicine in 2025 examined the same question from a Northern European perspective. A British survey of UK specialist trainees likewise identified the rewarding nature of the work as a central attraction, in contrast to the perception that geriatrics lacks earning potential and prestige — a perception that has long been documented among medical students and identified in systematic reviews as one of the reasons medical students avoid the field. The hidden curriculum, in which elderly patients are sometimes subtly portrayed as less interesting or less rewarding to treat, has been shown to influence student attitudes in ways that formal teaching must actively counteract.

What distinguishes the Spanish study is its direct measurement of the training effect. Previous research has documented that undergraduate geriatric education varies enormously worldwide — a narrative overview of undergraduate geriatric medicine education found stark differences in curricula, teaching hours and clinical exposure across countries, and scoping reviews have mapped a changing landscape of geriatric curricula, topics and teaching methods. The Spanish findings now provide concrete evidence that the extent of this training is not merely correlated with career choice but appears to function as a mechanism: comprehensive education in geriatric medicine seems to transform the perceived difficulty of geriatric patients into an appealing professional challenge. This has immediate policy implications, because it suggests that expanding mandatory geriatric content in medical school curricula could be one of the most effective levers for addressing the workforce crisis.

The significance of this lever becomes clear when one considers the demographic mathematics. According to the United Nations World Population Prospects 2024, the proportion of adults aged 80 and above is rising steadily across Europe, and Eurostat data confirm that the European Union’s population structure is shifting year by year toward ever-larger cohorts of the very old. Spain itself has one of the fastest-aging populations on the continent, and the Spanish health system’s own indicators track this transformation. Geriatric medicine, as defined in position statements by the European Union Geriatric Medicine Society and refined in recent Lancet Healthy Longevity work on the role and reach of the geriatrician, is fundamentally about comprehensive geriatric assessment — a multidimensional, interdisciplinary diagnostic process that evaluates medical, psychological and functional capability in order to develop coordinated care plans. Teaching this approach requires both theoretical grounding and supervised clinical practice, which is precisely the combination that the Spanish study identifies as transformative.

The researchers are careful to note the limitations inherent in their design. As an anonymous survey of residents who had already chosen geriatrics, the study captures the motivations of those who entered the specialty rather than those who rejected it, and self-reported questionnaires are always subject to recall and social desirability bias. The intentional sampling within a single national system limits generalizability, and the qualitative descriptive approach, while rich in detail, cannot establish causation between training exposure and specialty choice with the certainty of an experimental design. Ethical approval was not required under applicable Spanish institutional and national regulations because the study involved an anonymous voluntary survey of healthcare professionals with no patient data, and participation was voluntary with consent implied by questionnaire completion.

Nevertheless, the study’s central message is both simple and actionable: interest in geriatric medicine is shaped by a combination of personal motivations and factors directly related to the specialty and the characteristics of the older adult population, and comprehensive training has the potential to transform commonly perceived barriers into rewarding aspects of the field. For medical schools, this means that the question is not whether geriatrics can attract talent, but whether curricula give students a genuine chance to discover what the specialty actually involves. For health policymakers facing aging populations and shrinking geriatric workforces, the Spanish experience suggests that investment in undergraduate geriatric education may pay dividends far beyond the classroom — in the form of a new generation of physicians who see the complexity of the oldest patients not as a burden to be avoided, but as the most stimulating and meaningful work medicine has to offer.