An Update on AGS Fellows-in-Training

Spring 2001

Unlike my decision to pursue a career in Geriatric Medicine, which in retrospect seemed to be my kismet, my choice of academic geriatrics followed a path marked by serendipity, epiphanies and self-reflection. My plan had always been to provide primary care to frail older adults. I envisioned a community practice in the inner city. In truth, I had never considered academic medicine. I didn't think that I was good enough nor did I believe I had the qualities academic medicine demanded. Then, during my second year of fellowship, I had the extreme good fortune to listen to David Solomon, M.D. as he discussed career options. He spoke passionately about academics. His enthusiasm and ability to inspire awakened in me the first leanings toward academic geriatrics.

My epiphanies followed close on the heels of this dawning. A month later, while writing my chart notes on the hospital floors, I overheard a resident say, "But Granieri says Benadryl is bad for older adults". That was my first realization that my words could have a broad impact both on the care of the patients I wanted to serve and those learning to provide that care. Later that month, another resident said, "Don't ever let Granieri hear you use the word 'gome'; it's older adult".

Aha! My second epiphany. Not only might it be possible to affect care, but maybe, just maybe I might be able to stimulate awareness of ageism and alter attitudes. Here then was a combination of possibilities I could not pass up; practice patterns, knowledge base and attitudes. How much more effectively could I serve and provide care for older adults that through academic geriatric medicine? My decision to proceed down that path was cinched, at least in my heart. But, there were issues in my head with which I needed to come to terms with. I was a nontraditional student. While others my age had been working in their profession for fifteen years, I was just beginning. Plus, I was almost one hundred thousand dollars in debt. I was also being recruited for positions with a salary double what I was being offered by my first academic appointment. I did the usual and made lists - pro and con academics. While the length of the lists was similar, the quality of the factors on the pro side made the balance tip over to academic geriatric medicine.

It has been over ten years since I made that decision and I am frequently asked about career choices in geriatrics. The years have provided me with a richness of experience that allows me to reply firmly and with consistent conviction. The question evolves into not just why I chose academic geriatrics, but why I stay the course. My response to the latter is much more complex and ultimately more satisfying. Traditional academic medicine conjures up the image of the triple threat. In academic geriatrics, I prefer the notion of the quadruple opportunity and how one can be afforded the chance to partake in all aspects of this challenge.

First, fulfilling my original intent, I can provide care for the frailest older adults and serve the needs of their caregivers. These are often patients who take time and have issues that demand resources that may not be available in a community practice. The variety of setting in which I work allows me to follow my patients throughout the continuum. It is in these venues of care that academic geriatricians can also address the greater good, a societal mission that attends to the neediest with little regard for remuneration.

Secondly, my role in academic geriatrics has allowed me to develop a concentration in pedagogy. Medical students, residents, fellows and trainees in other disciplines provide continual cognitive stimulation. The opportunity to influence and write curricula, to enlighten members of the academic community about the needs and worth of geriatrics, to teach and to disseminate information creates a ripple effect that would be impossible if one were to work outside of the academy. The avenues of education extend beyond the tower's walls to the community and the private and public sectors. This endeavor, I hope, is teaching the teacher. Each student, patient, caregiver, clinician with whom you have contact will potentially influence the cognizance of geriatrics principles and thus the way in which older adults are cared.

The third benefit of academic geriatrics is the opportunity to contribute to the generation of new information through research. Because our knowledge of aging issues is at best embryonic, the potential to engage in clinical and bench investigation is almost limitless. And how best to apply and teach that new knowledge than in the practice of academic geriatrics.

Finally, the societal implications of an aging society demand that as geriatricians we take an active role in making the decisions that will shape policy. It is incumbent upon us to become involved at all levels - from the institutions to the community; from the local and state, to the national front. As the needs are so encompassing, academic geriatrics affords unparalleled means to develop administrative and policy-making skills. Because of the broad scope of our responsibilities, we can provide a voice for patients and caregivers, clinicians, educators and researchers. We can serve to enlighten legislators and militate for change and help promote a balanced view of what is and will be required in the care and service of older adults.

Throughout my involvement in all phases of the quadruple opportunity, I have had the privilege of working with an incomparable cohort of professionals and laypersons from myriad disciplines. Many have become lifelong friends. They have been a committed group sharing a similar mission and whose driver has been the optimal care of older adults. There is no doubt that academic geriatrics can be cognitively, physically and emotionally challenging. I have never looked back upon my decision with doubt or condition. Truly, I can conceive of no combination of roles that could be richer or more fulfilling than a career in academic geriatric medicine and I look forward to shepherding others into this life of continued service.