- What the Credential Actually Is
- Who Certifies It and How the Exam Is Built
- Eligibility: Who Can Sit for the Exam
- Inside the Exam: Format and Exam-Day Rules
- The Six Content Domains and Where the Points Are
- Fees, Registration Mechanics and Dates
- Scoring and Pass Rate
- Keeping the Certification Active
- Career Context: Who Hires and What It Pays
- Sequencing Your Preparation by Domain
- Frequently Asked Questions
- Geriatric Medicine certification is an ABIM subspecialty credential built on prior Internal Medicine certification plus 12 months of accredited fellowship...
- The exam has up to 240 multiple-choice questions, about 40 of them unscored pretest items, delivered in four two-hour sessions.
- Diseases in the Elderly carries 45% of the blueprint and Geriatric Syndromes 22.5%, so those two domains drive most of your score.
- The initial exam fee is USD 2,325; late registration adds USD 400, and an international test center adds USD 500.
What the Credential Actually Is
Geriatric Medicine certification is a board credential that documents a physician's specialized knowledge in caring for older adults. It is a subspecialty certification: you do not earn it straight out of medical school or residency. You earn it after becoming certified in Internal Medicine and completing dedicated fellowship training in geriatrics, then passing a secure, proctored examination.
If you are still orienting yourself to the field itself, our primer on what geriatric medicine is covers the clinical discipline, while this article focuses on the credential and the exam that validates it. For a broader overview of the credential landscape on this site, see the page on Geriatric Medicine certification.
Who Certifies It and How the Exam Is Built
The certifying body is the American Board of Internal Medicine. ABIM administers the examination through Pearson VUE at proctored test centers. The exam is jointly developed with the American Board of Family Medicine, which means family physicians who pursue geriatrics sit for the same underlying assessment, though their eligibility is determined by their own board.
The content is defined by the ABIM Geriatric Medicine certification examination blueprint. That blueprint is an exam-objectives document, not a curriculum: it tells you what can be tested and in what proportions, not how to organize your learning. ABIM also notes that the published percentages describe a typical exam, so the actual content mix on your test date can vary somewhat.
The governing rulebook is ABIM's Policies and Procedures for Certification, currently the December 2025 edition. When any question arises about an edge case in eligibility or training credit, that document and the Geriatric Medicine subspecialty policy page are the authorities, not forum posts or colleagues' recollections.
Eligibility: Who Can Sit for the Exam
ABIM eligibility for Geriatric Medicine rests on several requirements that must all be satisfied. For a full walkthrough, see our guide to Geriatric Medicine requirements; the essentials are below.
- Prior ABIM Internal Medicine certification at the time of application.
- A valid, unrestricted and unchallenged medical license.
- Satisfactory clinical competence and professionalism, as attested through program-director verification.
- 12 months of accredited geriatric-medicine fellowship training, all of it clinical, with satisfactory verification from the program director.
Which fellowships count
Eligible fellowship accreditation includes programs accredited by the 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 toward the requirement. International medical graduates should confirm that their fellowship was in an eligible accredited program before assuming they qualify.
The October 31 training deadline
Required training must be completed by October 31 of the exam year. ABIM's published training-deficit policy governs situations where a fellow falls short of the required months, so anyone with leave, a delayed start or a gap in training should read that policy early rather than discovering a problem at registration.
Inside the Exam: Format and Exam-Day Rules
The Geriatric Medicine examination consists of up to 240 single-best-answer multiple-choice questions. Approximately 40 of those are unscored pretest items that ABIM is evaluating for future use; you will not know which ones they are, so every question deserves a full effort. Clinical vignettes predominate, and multimedia items may appear.
Session structure
The test is divided into four sessions. Each session allows up to 60 questions and two hours. That adds up to as much as eight hours of answering time inside an appointment of roughly ten hours, which includes 100 minutes of pooled breaks and administrative activities. Pacing is therefore about two minutes per question, and the long day makes stamina a real factor.
| Feature | Detail |
|---|---|
| Question type | Single-best-answer multiple choice, vignette-heavy |
| Total questions | Up to 240, including about 40 unscored pretest items |
| Sessions | Four, each up to 60 questions and two hours |
| Maximum answering time | Up to eight hours |
| Total appointment | Approximately ten hours, with 100 minutes of pooled breaks and administrative time |
| Delivery | Pearson VUE proctored test center |
What you can and cannot bring
Personal books, notes and calculators are prohibited. An on-screen calculator and laboratory reference ranges are provided within the exam interface, so you do not need to memorize normal lab values, but you should practice using the on-screen tools beforehand so they do not cost you time.
Flagging, review and guessing
You may flag questions and review them within the current session. Once a session is submitted, it cannot be reopened. There is no penalty for guessing, so never leave an item blank; use elimination and commit to your best answer before submitting each block.
Key Takeaway
Because submitted sessions are locked, use your final minutes in each two-hour block to resolve flagged items and answer every question. Practicing in timed 60-question blocks mirrors this structure far better than untimed question review does.
If you are wondering how demanding this format is in practice, our analysis of how hard the Geriatric Medicine exam is breaks down what makes it challenging.
The Six Content Domains and Where the Points Are
The blueprint divides the exam into six weighted categories. The weights tell you where to invest your time, but remember they describe a typical exam rather than a guaranteed split. For deeper domain-by-domain coverage, read our complete guide to all six content areas.
| Domain | Weight |
|---|---|
| Domain 1: Gerontology | 5% |
| Domain 2: Diseases in the Elderly | 45% |
| Domain 3: Geriatric Psychiatry | 8.5% |
| Domain 4: Geriatric Syndromes | 22.5% |
| Domain 5: Functional Assessment and Rehabilitation | 3% |
| Domain 6: Caring for Elderly Patients | 16% |
Domain 2: Diseases in the Elderly (45%)
This is the heart of the exam. Nearly half your score depends on how older adults present with, and are best managed for, the full range of medical conditions seen in practice.
- Atypical presentations of common illnesses in older patients
- Cardiovascular, pulmonary, endocrine, renal, gastrointestinal, musculoskeletal and neurologic disease as they manifest in later life
- Infection, cancer and perioperative care in the older adult
- Therapeutic decisions that account for comorbidity, limited life expectancy and altered drug handling
Domain 4: Geriatric Syndromes (22.5%)
The second-largest domain captures the multifactorial conditions that define geriatric practice and rarely map to a single organ system.
- Falls and gait disorders, delirium and dementia
- Incontinence, pressure injuries, sleep disturbance and sensory impairment
- Frailty, weight loss and failure to thrive
- Polypharmacy and medication-related harm, including deprescribing logic
Domain 6: Caring for Elderly Patients (16%)
At 16%, this domain is far larger than many candidates expect, and it rewards judgment rather than rote recall.
- Care settings and transitions across home, hospital, post-acute and long-term care
- Palliative and end-of-life care, advance care planning and decision-making capacity
- Ethical and legal questions, including elder mistreatment
- Caregiver support and the structure of services for older adults
The smaller domains: Geriatric Psychiatry, Gerontology, and Functional Assessment
Geriatric Psychiatry (8.5%) covers late-life depression, anxiety, psychosis and behavioral symptoms of dementia. Gerontology (5%) addresses the biology and physiology of aging. Functional Assessment and Rehabilitation (3%) covers evaluation of activities of daily living and rehabilitation principles. Together they make up 16.5% of the exam, small individually but meaningful in aggregate.
Notice the implication: Diseases in the Elderly and Geriatric Syndromes together account for 67.5% of the blueprint. A candidate who is excellent at those two areas but neglects the rest can still stumble, yet a candidate who spreads effort evenly across all six domains is under-investing where the points are concentrated.
Fees, Registration Mechanics and Dates
The initial examination fee is USD 2,325. Two surcharges can apply: late registration adds USD 400, and selecting an international test center adds USD 500 when applicable. Budget for these before you register, and read our Geriatric Medicine certification cost breakdown for a fuller look at the total financial picture.
| Cost Item | Amount |
|---|---|
| Initial exam fee | USD 2,325 |
| Late registration surcharge | USD 400 additional |
| International test center surcharge (when applicable) | USD 500 additional |
Upcoming exam dates
- 2026 exam: November 10. Regular registration closed June 15 and late registration closed June 28, so that window has passed.
- 2027 exam: October 26. Registration runs December 1, 2026 through June 15, 2027, with late registration June 16 through June 28, 2027.
All dates remain subject to change, so confirm them on the ABIM Geriatric Medicine exam page before committing to a plan. Our exam dates and deadlines guide tracks these windows in more detail.
Scoring and Pass Rate
Passing requires meeting ABIM's specialty-specific standardized passing criterion. Overall scores for traditional assessments are reported on a 200 to 800 scale. Importantly, there is no fixed percentage-correct pass mark: the standard is set by ABIM's methodology rather than a simple "you need X% right" threshold. Our article on the Geriatric Medicine passing score explains how to interpret this.
The latest published first-time pass rate is 94% in 2025, among 229 examinees, a cohort that includes candidates from ABIM's cosponsoring boards. That figure is encouraging, but read it carefully. First-time takers in this subspecialty have already passed Internal Medicine boards and completed a year of fellowship, so the pool is highly selected. A high pass rate reflects a well-prepared population, not an easy test. See what the pass-rate data shows for more context.
Keeping the Certification Active
Earning the credential is not the end of the process. Certification remains valid while you meet ABIM's Maintenance of Certification (MOC) requirements. These include:
- Maintaining licensure in good standing.
- Earning at least 100 MOC points every five years, counted across all ABIM certifications you hold.
- Passing the required assessment by your assigned deadline, through either the traditional ten-year examination or the five-year Longitudinal Knowledge Assessment (LKA) pathway.
Because the 100-point requirement is counted across all certifications, a physician who holds both Internal Medicine and Geriatric Medicine does not need to double up on points for each. Plan your MOC activities with that in mind, and review ABIM's pages on assessment options and participation activities to choose the route that fits your practice.
Career Context: Who Hires and What It Pays
Board-certified geriatricians work in a range of settings: academic medical centers and geriatrics divisions, hospital-based consult and co-management services, outpatient geriatrics and memory clinics, post-acute and skilled nursing facilities, long-term care, home-based primary care, and health systems building programs for older adults. Palliative and hospice teams also draw on geriatric training. For a closer look at roles, see our overview of Geriatric Medicine jobs.
On compensation, Doximity's 2026 Physician Compensation Report, drawing on 2025 survey data, reports average geriatrics compensation of USD 304,411. Treat that as specialty-wide context rather than a certification premium: it reflects what geriatricians earn on average, not an amount attributable specifically to holding ABIM certification. Our salary guide and the analysis of whether the certification is worth it explore how credentialing interacts with hiring, credentialing and career mobility.
Sequencing Your Preparation by Domain
Because the blueprint is so heavily weighted, your preparation calendar should be too. Rather than a generic schedule, think of the weights as a budget. A fellowship year already exposes you to much of the content, so the goal of dedicated review is to consolidate, fill gaps and practice the vignette format. Our Geriatric Medicine study guide goes deeper; here is a weight-driven outline.
Diseases in the Elderly
- Spend the most time here because it is 45% of the exam
- Focus on atypical presentations and treatment trade-offs in multimorbid patients
- Close each week with a timed block of vignette questions
Geriatric Syndromes
- Work through delirium, dementia, falls, incontinence, frailty and polypharmacy
- Practice medication-review and deprescribing scenarios
Caring for Elderly Patients and Geriatric Psychiatry
- Review care transitions, capacity, advance care planning and ethics
- Cover late-life mood, anxiety, psychosis and behavioral symptoms of dementia
Gerontology, Functional Assessment and Rehabilitation
- Cover these small domains efficiently, then run full mixed timed sessions to build stamina for the four-session day
When you want quick refreshers close to test day, a one-page Geriatric Medicine cheat sheet can help consolidate high-yield facts, and you can test yourself on realistic vignettes with the practice questions at Geriatric Medicine Exam Prep.
Key Takeaway
Simulate the real exam. Complete several full-length practice runs in 60-question, two-hour blocks, flag and revisit items, and answer every question. The format, not just the content, is part of what you are being tested on. Start with a baseline set at our practice test site to see which domains need the most attention.
Frequently Asked Questions
It is a subspecialty board certification offered through the American Board of Internal Medicine, with the examination jointly developed with the American Board of Family Medicine. It requires prior Internal Medicine certification, 12 months of accredited geriatric-medicine fellowship training, and passing a proctored examination. For related definitions, see this overview.
The exam includes up to 240 single-best-answer multiple-choice questions. Approximately 40 of them are unscored pretest items, but you cannot tell which ones, so treat every question as if it counts.
Diseases in the Elderly is the largest at 45%, followed by Geriatric Syndromes at 22.5%. Caring for Elderly Patients is 16%, Geriatric Psychiatry 8.5%, Gerontology 5%, and Functional Assessment and Rehabilitation 3%. These weights 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. Registering by the regular deadline avoids the late surcharge.
Certification stays valid as long as you meet ABIM's Maintenance of Certification requirements: maintaining licensure, earning at least 100 MOC points every five years across all your ABIM certifications, and passing the required assessment by your assigned deadline through the ten-year exam or the five-year LKA pathway.