- The Exam at a Glance
- Eligibility Checklist
- Dates and Fees You Must Remember
- Exam-Day Mechanics
- Domain Weights: Where the Points Live
- Diseases in the Elderly: The 45% Block
- Geriatric Syndromes: The 22.5% Block
- Caring for Elderly Patients: The 16% Block
- The Smaller Domains: Gerontology, Psychiatry, Function
- Scoring and Passing
- A Domain-Weighted Study Order
- After You Pass: Maintenance and Career Context
- Frequently Asked Questions
- The ABIM Geriatric Medicine exam is up to 240 single-best-answer questions, including about 40 unscored pretest items.
- Diseases in the Elderly carries 45% of the blueprint; adding Geriatric Syndromes at 22.5% covers two-thirds of the exam.
- You need current ABIM Internal Medicine certification plus 12 clinical months of accredited geriatric fellowship training to apply.
- The 2026 exam is November 10, but regular and late registration have closed; the 2027 exam is October 26.
The Exam at a Glance
This one-page review condenses what a Geriatric Medicine candidate actually needs to hold in memory: the logistics, the blueprint, and the clinical patterns the exam rewards. It covers initial certification through the American Board of Internal Medicine (ABIM). The examination is jointly developed with the American Board of Family Medicine (ABFM), whose applicants follow their own board's eligibility rules. Everything below refers to the ABIM pathway.
| Item | Must-know fact |
|---|---|
| Governing body | American Board of Internal Medicine (ABIM) |
| Delivery | Pearson VUE proctored test centers |
| Question format | Single-best-answer multiple choice, clinical vignettes predominate, multimedia may appear |
| Question count | Up to 240, including approximately 40 unscored pretest items |
| Structure | Four sessions, up to 60 questions and two hours each |
| Answering time | Up to eight hours within an approximately ten-hour appointment |
| Breaks and admin | 100 minutes pooled across the appointment |
| Penalty for guessing | None |
| Latest first-time pass rate | 94% in 2025 (229 examinees, including cosponsoring-board candidates) |
For a deeper treatment of how demanding the test feels in practice, see our guide on how hard the Geriatric Medicine exam really is, and for the numbers behind the cohort, what the pass-rate data shows.
Eligibility Checklist
Eligibility is the first place candidates lose time, so memorize the sequence. ABIM requires all of the following at application:
- Prior ABIM Internal Medicine certification held at the time you apply.
- A valid, unrestricted and unchallenged medical license.
- Satisfactory clinical competence and professionalism.
- 12 months of accredited geriatric-medicine fellowship training, all 12 clinical, with satisfactory program-director verification.
Accepted fellowship accreditation includes ACGME, the Royal College of Physicians and Surgeons of Canada, or the Collège des médecins du Québec. Training completed outside accredited U.S. or Canadian programs is not credited. Required training must be finished by October 31 of the exam year, subject to ABIM's published training-deficit policy. The governing document is the December 2025 edition of ABIM's Policies and Procedures for Certification.
Dates and Fees You Must Remember
Dates are published by ABIM and remain subject to change, so always confirm against the official exam page before you commit to a plan.
| Event | Detail |
|---|---|
| 2026 exam date | November 10 (regular registration closed June 15; late registration closed June 28) |
| 2027 exam date | October 26 |
| 2027 regular registration | December 1, 2026 through June 15, 2027 |
| 2027 late registration | June 16 through June 28, 2027 |
| Initial exam fee | USD 2,325 |
| Late registration surcharge | Adds USD 400 |
| International test center surcharge | Adds USD 500 when applicable |
The practical implication: a candidate who misses the regular window and registers late pays USD 2,725 before any international surcharge. Mark the June 15 deadline early. Our exam dates and deadlines guide and certification cost breakdown expand on both topics.
Exam-Day Mechanics
Knowing the rules removes avoidable stress on a long testing day.
- Four sessions, two hours each: up to 60 questions per session, so pace at roughly two minutes per item.
- Flag and review within a session: you may flag questions and return to them, but only while that session is open.
- Submitted sessions are final: you cannot reopen a session once submitted, so use leftover time before you submit.
- No penalty for guessing: never leave an item blank.
- Prohibited: personal books, notes, and calculators.
- Provided on screen: a calculator and laboratory reference ranges.
- Breaks: 100 minutes of pooled break and administrative time across the appointment, not per break.
Domain Weights: Where the Points Live
The ABIM blueprint lists six weighted categories. These are exam objectives rather than a prescribed curriculum, and the published percentages describe a typical exam, so actual content may vary slightly.
| Domain | Weight |
|---|---|
| Diseases in the Elderly | 45% |
| Geriatric Syndromes | 22.5% |
| Caring for Elderly Patients | 16% |
| Geriatric Psychiatry | 8.5% |
| Gerontology | 5% |
| Functional Assessment and Rehabilitation | 3% |
Two domains account for 67.5% of the exam, and the top three account for 83.5%. A complete explanation of each area is in our six-domain exam guide.
Diseases in the Elderly: The 45% Block
Domain 2: Diseases in the Elderly (45%)
This is essentially internal medicine viewed through the lens of aging. The exam expects you to know how presentation, workup, and treatment shift in older adults, not just the textbook adult approach.
- Atypical presentations: infection, myocardial infarction, and hyperthyroidism often present without classic signs.
- Cardiovascular disease, including heart failure, atrial fibrillation, hypertension targets, and anticoagulation tradeoffs.
- Diabetes management with individualized glycemic goals and hypoglycemia risk.
- Osteoporosis, fracture risk, and treatment selection.
- Chronic kidney disease and dosing adjustments for reduced renal function.
- Pulmonary, gastrointestinal, hematologic, and oncologic conditions as they appear in frail or multimorbid patients.
- Pharmacology: age-related changes in drug handling and high-risk medication classes.
Because this block is nearly half the exam, the question writers favor integrated vignettes: an 84-year-old with several chronic conditions and a new complaint, where the best answer weighs competing risks. Practice choosing the option that fits the patient's goals and life expectancy, not merely the guideline-concordant answer for a younger adult.
Geriatric Syndromes: The 22.5% Block
Domain 4: Geriatric Syndromes (22.5%)
This is the domain that most distinguishes the specialty. Geriatric syndromes are multifactorial conditions that do not fit neatly into a single organ system.
- Delirium: recognition, precipitants, nonpharmacologic prevention, and why antipsychotics are not a cure.
- Falls and gait disorders: multifactorial risk assessment, medication review, orthostatic hypotension, and vitamin D and exercise interventions.
- Dementia: subtype differentiation, reversible contributors, and behavioral symptom management.
- Urinary incontinence: stress, urge, overflow, and functional types, with bladder-anticholinergic cautions.
- Pressure injuries: staging, prevention, and wound care principles.
- Polypharmacy and deprescribing: using explicit criteria to identify potentially inappropriate medications.
- Frailty, malnutrition, weight loss, sleep disorders, and sensory impairment.
Key Takeaway
When a vignette describes an older patient with a sudden change in function, ask first whether a medication, infection, or metabolic disturbance is the trigger. Geriatric syndrome questions usually reward the answer that removes a precipitant before adding a new drug.
Caring for Elderly Patients: The 16% Block
Domain 6: Caring for Elderly Patients (16%)
This domain covers the systems, ethics, and care-setting knowledge that surround clinical decisions.
- Care transitions among hospital, skilled nursing, home, assisted living, and hospice settings.
- Advance care planning, surrogate decision-making, and capacity assessment.
- Palliative care and hospice eligibility concepts.
- Elder mistreatment: recognition, reporting duties, and intervention.
- Medicare coverage structures relevant to older patients and long-term care financing.
- Caregiver burden, driving safety, and interdisciplinary team roles.
Ethics and communication questions in this block often have two defensible-sounding answers. The tiebreaker is nearly always the patient's own stated preferences and decision-making capacity, followed by the legally designated surrogate.
The Smaller Domains: Gerontology, Psychiatry, Function
Together these three represent 16.5% of the exam, which is roughly the same as Caring for Elderly Patients, so do not skip them.
Geriatric Psychiatry (8.5%)
- Late-life depression, including pseudodementia and suicide risk.
- Anxiety, psychosis, and bipolar disorder in older adults.
- Psychotropic selection with attention to hyponatremia, falls, QT prolongation, and anticholinergic burden.
- Differentiating depression, delirium, and dementia.
Gerontology (5%)
- Normal versus pathologic aging across organ systems.
- Theories and biology of aging at a recognition level.
- Demographic and population trends affecting older adults.
Functional Assessment and Rehabilitation (3%)
- Activities of daily living and instrumental activities of daily living scales.
- Gait, balance, and cognitive screening instruments.
- Rehabilitation settings, therapy services, and assistive devices.
Functional assessment is the smallest slice, but its concepts bleed into falls, dementia, and care-transition questions elsewhere. Learn the instruments once and you gain points in several domains.
Scoring and Passing
ABIM does not assert a fixed percentage-correct pass mark. Passing requires meeting the specialty-specific standardized passing criterion, and overall traditional-assessment scores are reported on a 200 to 800 scale. That means you cannot reliably convert "I answered X% correctly" into a pass or fail prediction, so aim for broad mastery instead of a target percentage. Details are in our passing score explainer.
The most recent published first-time pass rate is 94% in 2025 among 229 examinees, including candidates from ABIM's cosponsoring board. A high pass rate reflects a cohort that has completed fellowship training and is well prepared; it does not mean the exam is easy to approach casually.
A Domain-Weighted Study Order
Sequence your preparation by blueprint weight, with spaced return visits to the heavy domains. This is the one place a timeline helps, because the order is driven by the exam's own weighting.
Diseases in the Elderly (45%)
- Cardiovascular, endocrine, renal, and bone disease with geriatric dosing and targets.
- Medication pharmacology and renal adjustment.
Geriatric Syndromes (22.5%)
- Delirium, falls, dementia, incontinence, pressure injuries, and deprescribing criteria.
Caring for Elderly Patients (16%)
- Advance care planning, capacity, hospice, care settings, and elder mistreatment.
Psychiatry, Gerontology, Function (16.5%)
- Late-life depression, psychotropic risks, screening instruments, and normal aging.
Mixed Practice
- Timed blocks of 60 questions to mirror one two-hour session, with review of every miss.
For a fuller plan, see the Geriatric Medicine study guide, and when you are ready to test yourself under realistic conditions, try the Geriatric Medicine practice test and track which domains cost you the most points.
After You Pass: Maintenance and Career Context
Certification stays valid while you meet ABIM Maintenance of Certification (MOC) requirements:
- Maintain licensure.
- Earn at least 100 MOC points every five years across all ABIM certifications you hold.
- Pass the required assessment by your assigned deadline, through either the traditional ten-year examination or the five-year LKA pathway.
On compensation, Doximity's 2026 Physician Compensation Report lists average geriatrics compensation of USD 304,411, based on 2025 survey data. That figure describes the specialty overall, not an earnings premium attributable to ABIM certification itself. Our salary guide and certification ROI analysis put the number in context.
Key Takeaway
Treat certification as a long-term commitment. The exam is the entry point; MOC points, licensure, and a recurring assessment keep the credential active for the rest of your career.
Frequently Asked Questions
The exam contains up to 240 single-best-answer multiple-choice questions, including approximately 40 unscored pretest items. They are delivered in four sessions of up to 60 questions and two hours each.
Diseases in the Elderly is the largest at 45% of the blueprint, followed by Geriatric Syndromes at 22.5% and Caring for Elderly Patients at 16%. The published percentages describe a typical exam, and actual content may vary.
The initial exam fee is USD 2,325. Late registration adds USD 400, and an international test center adds USD 500 when applicable. Review the full picture in our certification cost guide.
The 2026 exam is November 10, and registration for it has closed. The 2027 exam is October 26, with regular registration from December 1, 2026 through June 15, 2027 and late registration June 16 through June 28, 2027. Dates remain subject to change.
No. Personal books, notes, and calculators are prohibited. An on-screen calculator and laboratory reference ranges are provided within the exam interface.