Martin Levine, MD
Geriatrician, Center for Health Studies
As a fellow, you probably spend a lot of time thinking about what you'll do when your fellowship ends. I know I did. You may find it difficult to balance your ambitions with financial pressures, personal relationships or feelings about relocating. I too wrestled with these issues. But my first job search had a happy ending. Group Health Cooperative, a group model HMO in the Pacific Northwest, hired me to help improve primary care for older adults. For all of you wanting to hear the perspective of a recent graduate (2001), I would like to briefly describe what I do for a living.
First, I spend two days a week leading a clinical team (myself, two ARNPs, a pharmD) in a randomized controlled trial based in primary care. Part of my role has been to assist in the development of the trial intervention from conceptualization to piloting and implementation. The trial tests whether a geriatric team, working alongside primary care in several clinics, can boost functional outcomes. We provide geriatric assessment and management.
Additionally, we work to integrate our team members into the fabric of the primary care team. For example, we encourage primary care doctors to refer directly to the ARNPs (and skip the geriatrician's evaluation) when patients want to develop self-care strategies around problems like arthritis, incontinence and inactivity. I am responsible for diagnostic and pharmacologic decision making, as well as for identifying clinical priorities collaboratively with patients and families. I communicate findings back to primary care providers, typically face-to-face. Participating in this project has deepened my understanding of research, clinical evidence and the challenges of being innovative.
Outside of the trial, I am engaged in quality improvement. I provide geriatric consultations two days a week in a primary care clinic where I strive to foster better team care and use of community resources. One of my projects has been to affiliate the clinic with a county senior services self-care program. We measure enrollment and patient progress and then feed updates to the clinic on a monthly basis.
Working across four different clinics, in both rural and urban settings, I collaborate with about twenty primary care physicians. The doctors are all different: some with decades of experience, others just recently out of residency; some family doctors, some internists; some burned out, others burning with energy; some collaborative, others independent. Figuring out how to help each of these individuals with their practice is a constant and enjoyable challenge.
I receive more invitations to teach residents and fellows, present at CME and speak in the community
than I can handle; expect your geriatric training to be in demand! In a year and a half I have learned a great deal about models of geriatric care, team management and the science of individual and institutional change - all of which are areas that were not emphasized in my training. If you find yourself attracted to this kind of work, or, just want to touch base with someone living it day to day - look me up. If I can make your job search any easier, I'd be happy to help.
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