Despite an aging population, fewer trainees are pursuing geriatric psychiatry fellowship in the United States. Nationwide, the number of fellows enrolled in geriatric psychiatry fellowship has decreased from 106 in 2002 to 58 in 2022. In recent years, only ∼30-40% of fellowship positions are filled, most of which are concentrated in urban areas in only 15 states. Most geriatric fellowship slots in rural or underserved areas, even in NY State, remain unfilled. The Statewide Columbia Geriatric Psychiatry Fellowship is unique in that it provides educational experiences in a variety of academic and federally designated medically underserved urban and rural settings, from its academic base at the Columbia University Irving Medical Center (CUIMC) to hospital centers in underserved areas including Greater Binghamton Health Center and Rockland Psychiatric Center. All fellows, in both the NYC and Upstate tracks, rotate at a wide range of clinical sites in NYC, Upstate NY, and Rockland County. In response to the slowing in fellowship applications, both nationally and in our Upstate track, we aimed to improve recruitment efforts into geriatric psychiatry fellowship. We attempted to enhance recruitment though multiple methods. We sent annual emails to 48 adult psychiatry programs in the Northeast United States and Southern Canada to introduce them to the fellowship program and offer geriatric grand rounds presentations to their programs. Drawing upon resources provided by the large academic medical center, we made efforts to incorporate in-person and telemedicine clinical rotations and research experiences at CUIMC for the Upstate fellow. Faculty collaborate with Upstate NY psychiatry residency programs to provide mentorship and informal supervision, attend local fellowship fairs, participate in geriatric interest groups at CUIMC, serve as honors scholar mentors for AAGP, and serve on the AADPRT IMG caucus and other subspecialty groups (e.g., rural caucus) at AADPRT to network with residency programs. We have worked to individually tailor the fellowship curriculum to the interests and career goals of our trainees. Lastly, we collaborate with psychiatry programs in underserved areas both in- and out-of-state to provide monthly geriatric psychiatry case conferences. Over the past 7 years, only 27-41% of geriatric psychiatry fellowship positions have filled nationwide (Table 1). However, the Statewide Columbia Geriatric Psychiatry Fellowship has filled 75% of their fellowship positions since 2017 (Table 2). During this time, 100% of the NYC track positions have filled, and 50% of our Upstate track positions have filled. In other words, our rate of filled fellowship positions is higher than the national average, even in the Upstate track. Yet, most applicants (22/30, or 73.3%) who are accepted into the Upstate track still decline the offer to accept a fellowship, academic, or clinical position at another institution. Upstate track fellows have consistently articulated that affiliation with an academic medical center and ability to tailor the fellowship curriculum to their interests are main draws to the fellowship, despite its remote location. We hypothesize that the fellowship's unique collaboration between an urban academic medical center and rural state-run hospitals has helped recruit applicants into our fellowship. Due to the slowing recruitment numbers nationally, geriatric psychiatry fellowship training directors must think creatively about how to expand recruitment efforts into the specialty. Such efforts may include collaboration with psychiatry residency programs in underserved areas, both to teach general psychiatrists about geriatric psychiatry, and to recruit the next generation of geriatric psychiatrists to serve our aging population. [ABSTRACT FROM AUTHOR]