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Pursuing a Career in the Healthcare Industry
At Johns Hopkins, where Applebaum did his residency in internal medicine after graduating from the University of Pennsylvania School of Medicine, faculty in the cardiology department had repeatedly urged him to follow up with a fellowship in that, an arguably more glamorous, field. He chose geriatrics instead, he says, for three primary reasons. First, there was the appeal of what Applebaum, 47, describes as geriatrics' intense humanism. "Medicine is both a science and an art, but I think geriatrics is one field that really pushes the art," explains Applebaum, who lives in Owings Mills, Maryland with his wife, Julie, and their two teenaged sons. "You have to know the science, but the art -- the personal engagement with your patient -- that's the key. In geriatrics, your patients have the most complicated medial problems, and you can't just go by the text. You have to educate them and help them make decisions about their options. And to do that, you have to form a bond with them. There's the humanity. That's the magical part for me." Geriatrics' emphasis on comprehensive care also appealed, adds Applebaum. That was the second reason behind his decision. Finally, there were the demographics. Even 20 years ago, demographers were raising alarms about the coming Age Boom and warning that the nation needed to prepare. To Applebaum, the son of an accountant who'd always been attracted to business and took numerous accounting and finance classes as a med student and resident, it was clear that success in geriatrics required both expertise in medicine and the ways of the marketplace. He was hooked. So, in 1989, when Erickson Retirement Communities, now one of the largest developers of continuing care retirement communities in the US, offered him a job as a staff physician and medical director, he accepted without hesitation. It was Applebaum's first job and he was Erickson's first staff physician and medical director -- in charge of care at Erickson's first community, outside Baltimore, which was home to 400 older adults. Last September, when he decided to make a bid for Maryland's open Third District seat, he was the Chief Medical Officer at Erickson, responsible for 14 communities, in 8 states, housing 17,000 seniors, and with a full-time medical staff of more than 70 providers. From the start, Applebaum, and Erickson, emphasized the importance of providing a supportive environment that offered social engagement, physical activity, nutritious meals, and comprehensive primary and preventive care. This, Applebaum's geriatrics residency had convinced him, would pay off both clinically and financially. And it did. "It's extremely satisfying that at Erickson, we were able to prove that if seniors lived in a socially supportive, active environment, with quality onsite medical care, the outcomes would be superior and the costs would be dramatically reduced," thanks to lower morbidity and hospitalization rates, Applebaum explains. Erickson's results, in fact, ultimately led the Centers for Medicare and Medicaid to approve a three-year Medicare Advantage demonstration project, launched in January 2006 that will, essentially, pay the corporation a monthly capitation for each resident who enrolls in its program, EricksonAdvantage. Under the terms of the project, Erickson will pay for all care, including hospitalization. Applebaum anticipates that the emphasis on primary, preventive care and care coordination will continue to keep costs in check, and make for both healthy residents and a healthy bottom line. "When people are healthier, overall costs will be lower," adds Applebaum, who last fall decided it was time to take this approach to healthcare nationwide -- with a run for the House. "Our biggest problem with medical care in this country is that we don't get results; we're spending enough money, but we can get a lot more out of the money we spend," he says. "There's never been a geriatrician in Congress, it's about time." In addition to enhanced primary care, Applebaum's platform calls for a reimbursement system that pays more for quality, rather than quantity, investment in electronic health information technology, and reforms to address the burdens of "bureaucracy and litigation" that are discouraging the best and brightest from pursuing careers in geriatrics in particular, and medicine in general. A field with so much to offer, adds Applebaum, shouldn't be struggling to recruit top talent. Throughout his career, Applebaum, now a consultant to Erickson, has always kept his hand in clinical care. As the business and his corporate responsibilities grew, the time he spent providing care lessened. But Applebaum still sees patients. Just weeks before the September 12 primary in which he'll face seven other GOP candidates, Applebaum put in a week of hospital work with the older patients who drew him to geriatrics to begin with. If he wins the primary and the November 7 election, he has no plans to change that. "For one thing, I find that it's all too easy to forget the daily challenges that both patients and providers face in our system unless you're there and part of it," explains Applebaum, who has the support of Maryland's Republican Governor. "And, just as important, seeing patients is something I need to do -- for myself." Dr. Applebaum came in second in the September primary, losing by fewer than 1,100 votes to John White, chairman and CEO of a sales and marketing company. In the November 7 election, White will face Democratic candidate John Sarbanes, attorney and son of US Senator Paul Sarbanes, who retires this year. "It was an honor to participate in the electoral process," Dr. Applebaum says. "The skills and contacts I've made in the last year will serve me well as I continue to work to improve healthcare for all Americans."
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As Gary E. Applebaum, M.D., describes it, his decision to run for Congress in Maryland's Third District this fall was a logical progression from his decision, nearly two decades earlier, to specialize in geriatrics.