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Question: Why are you completing a Geriatrics Fellowship?
This following list of answers reflects the viewpoint of various members of the AGS Fellows Section. The question was sent out via the AGS Fellows Section List serve to obtain a variety of viewpoints across the country on this question.
Salas Sabnis, Geriatric Fellow
St. Vincent’s Manhattan
I never thought I would be a geriatrician. I always liked older folks but I thought I was going to go into some high tech field like radiology. I actually even took a year off to pursue some clinical research in radiology while in med school. I think the biggest reason why I chose Geriatrics was my exposure during residency at St. Vincent’s to our geriatrics faculty, particularly our geriatric hospitalist. I maybe initially felt geriatricians were not as adept at inpatient medicine but that impression changed during my floor month with Dr. Scanlan. He was able to integrate some of the most complex medical decisions with more “geriatric” issues in a way that really took me by surprise. I started to realize that geriatrics is challenging and intellectually rigorous. I realized that geriatrics was the perfect fit for me. I wanted to deal with complex patients but not necessarily do procedures. I now like other aspects of geriatric care but the need to remain relevant to inpatient medicine was important to me. If you are interested in inpatient medicine, a geriatric fellowship is a quick way to set yourself apart from your internal medicine peers. It also offers options to transition to a more outpatient setting once you burnout doing inpatient medicine.
Maha Ghosn
After I finished my 3 years of residency in IM, I felt that I needed extra training in dealing with patients in the outpatient setting. Through the Geriatrics fellowship you are offered a great opportunity to train in more than one setting. You actually get to rotate in outpatient clinic, nursing home, assistant living, and hospice. Also, elderly patients constituted the bulk of ill patients so being attuned to their medical problems expedite their treatment and subsequently leads to a faster recovery.
And since mental health reflects to a great extent physical health, it's important to be able to address psychiatric issues when they present to you. In Geriatrics we deal mainly with patients with dementia, depression, and adjustment disorder. These are extremely important issues that have a huge impact on patients' and care givers' quality of life...
Mina Zeini, MD
Family Medicine/Geriatric Medicine/Hospice and Palliative care
Hospice of St. Francis, Titusville, Florida
I realized that I wanted to have Doctors who specialized in the elderly as I wanted someone who understood the needs of my parents as they got older. I have found joy in not only treating elderly functional fairly healthy patients but also those who are the frailist and who are dying.
Jim Wallace, MD
University of Chicago - Oncology/Geriatrics
I am a Geriatrics-Oncology fellow. My interest stemmed from an enthusiasm for caring for elderly patients - people with complex opinions and liberated viewpoints that challenge your knowledge. Further, they often have diverse perspectives on quality of life that continually suprise when making a collective decision. Finally, there is no area more explosive in the realm of funding opportunity - especially within oncology. There is a great need for our expertise, and certainly much room to develop as an academic physician in a supportive environment.
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This following list of answers reflects the viewpoint of various members of the AGS Nurses Section. The question was sent out via the AGS Nurses Section List serve to obtain a variety of viewpoints across the country on this question.
Stella Mora Henry, RN
Director and Founder of Vista del Sol Care Center (nursing and assisted living facility) in Culver City
On November 11th, 1969, I accepted my first position as a Director of Nurses in a long-term-care facility. During the past 37 years I have shared the road with thousands of families in their caregiving travels, a role I highly recommend. There are those who mistakenly believe that geriatric nursing requires less skill and knowledge because it is not ICU or CCU nursing. This is not so. A geriatric nurse is required to be knowledgeable in all areas of health care and called upon to make observations and assist physicians who are not on-site.
In May 2006 Harper Collins published my book, The Eldercare Handbook: Difficult Choices, Compassionate Solutions. It was my geriatric nursing experience that Harper Collins appreciated. Geriatric nursing deserves serious consideration by anyone considering a nursing career. It has offered me an incredible career.
Anne (Plymouth, MN)
As someone who has seen adverse affects from hospitalized elders, I would think a CNS in geriatrics would be an invaluable asset in helping to care for hospitalized elders. Whether there are opportunities/job openings is another question; you may have to sell yourself. However, with an aging population, that may not be so difficult. Check the stats on elders who are admitted to acute care.
Helen Lach, PhD, RN, BCGCNS
Saint Louis University
As a Geriatric Clinical Nurse Specialist (CNS) and faculty member teaching students pursuing this track, I find that there are job opportunities for nurses with this advanced practice degree. Our school has a distance-learning program and so our students are from all over the country. Some pursue the nurse practitioner degree and others the clinical nurse specialist designation. The CNS role is not used consistently in any setting, but our CNS graduates have jobs in hospitals, geriatric centers, research programs, staff development offices, and nursing homes. I regularly receive notices of job opportunities for CNS graduates. Three recent requests have been from hospitals in San Diego, CA, Denver, CO, and Baltimore, MD.
Carolyn (Portland, OR)
With the changing demographics and the over 80 population being the fastest growing population, I would say yes, there are opportunities for clinical nurse specialists in geriatrics. There are even more opportunities for clinical nurse specialists in states where they have prescriptive privileges.
Frances (Hancock, VT)
I've had my own problem getting a job as a GNP here in Vermont and New Hampshire. When I first sent my resume out, I had no success. I was fortunate to get a part time job in the Bronx, NY, but I had to commute from my home and my full time job here in Vermont. My father then got sick and I needed to spend more time with my parents in Vermont and had to quit my job in the Bronx.
When I applied for a job in Vermont for a Nursing Home, I was told that I didn't qualify because I didn't have an Adult NP certificate. I am a bit discouraged, but I haven't given up hope.
Frances Dumont, Newcastle, NSW Australia
Clinical Nurse Consultant for Dementia in the Acute Care Services, Hunter New England Area Health Service in New South Wales, Australia
I was a Geriatric Nurse Practitioner for the Evercare division of United Health Care. I found the opportunities to be fantastic. During my 5 years with them I watched the Boston office grow from 12 NPs to over 65. I was privileged to provide primary health care for 120 residents of 2 Nursing Homes.
I then left the United States and am currently employed as a Clinical Nurse Consultant in Dementia for the Hunter New England Area Health Service in New South Wales Australia. The Australian system does not encourage the development of Nurse Practitioners, and the few brave individuals that are paving the way are running into stumbling blocks around prescription writing privileges. They have a long way to go.The opportunities in the States are many and varied and I would whole heartedly encourage anyone interested in the well being of the older generation to pursue becoming a Geriatric Nurse Practitioner. They are highly valued by patients and families.
Martha S. Anderson, MS, APRN, CS, FNGNA
Senior Services Consultant
Carilion Clinic Center for Healthy Aging Carilion Medical Center
Our health care system has over 10,000 employers and about 25 clinical nurse specialists. 3 of them are geriatric CNS's. We have current opportunities for others also. I believe that the example of one innovative, productive, expert CNS has set such a good example here that others are being sought and are actually having jobs created for them. Also, as our system pursues education and research further, the CNS role is being sought over the NP role, which was in demand about 5-7 years ago.
Ann M. Mayo, RN; DNSc
John A. Hartford Foundation/Atlantic Philanthropies Claire M. Fagin Fellow
University of California, San Francisco, School of Nursing
I see many opportunities for CNSs in the area of geriatric nursing practice.
With the growing population of older adults, especially 80+, there will be many opportunities for CNS specialty practice to promote health, including cognitive vitality, which is so essential to maintaining function. The advanced practice role of the CNS in the U.S. is especially important because it establishes credibility and autonomy of CNSs to implement programs to promote older adult health. Health care systems may be unlikely to implement many changes as they currently see many health promotion programs as cost ineffective for older adults. But the CNS can design and identify appropriate outcome measures, obtain funding, implement, and evaluate such programs. This process (always emphasizing the "appropriate" selection of outcomes) is tailor-made for CNSs. All of these competencies are taught in CNS educational programs across the country.
Marianne E. Miller, RN, BSN, MSN, CNRN Clinical Nurse Specialist, Spectrum Health Hospitals
I have been a CNS in Geriatrics in a large acute care setting for 12 years. I am also aware, with the focus on improving the care and outcomes of the acutely ill hospitalized elderly, that many of the recent "magnetized" acute care hospitals have some variant of an elder friendly program. Acute Care of the Elderly (ACE) units have become an increasingly popular concept nationally. All of these efforts require a master's prepared clinician/educator to design, implement, educate, round and do teaching at the bedside in order to make these programs and the subsequent clinical outcomes real. The Age Wave crest is still around the corner. The Medicare issues are real. JCAHO is focused on clinical problems like falls and pressure ulcer that are particular to the elderly hospitalized at risk patient. I'm confident that job security is not a problem.
Mara Ferris, MS, RN, CS, CPHQ, EMT
President, AGE: Association for Gerontologic Education, Exeter, NH
Although I see a great need for Geriatric Clinical Nurse Specialists, I see very few positions specifically recruiting or seeking such expertise. I have created my own job but bounce from one health care organization to another, providing services when they are in crisis. If these organizations would create positions for CNSs, the crises would be fewer.
I work as an independent nurse consultant to health care organizations. Most often I step in as the Interim Director of Nursing for skilled nursing facilities that have gotten into serious issues providing poor services, generally pointed out by surveyors. I have also worked with hospitals where generally I am asked to work on several quality improvement projects. In addition, I am also a lecturer.
Peggy A. Szwabo Ph.D., Rn APN, CCS - Mental Health/Psychiatry, Private Practice,
Clinical faculty Saint Louis University Medical School, Department of Psychiatry, Geriatric Psychiatry; Department Of Internal Medicine, Geriatric Medicine
Having been in the aging field for 20 plus years, I see a host of opportunities for CNS from a direct patient care role in a variety of settings, an educational-consultant role, teaching in the nursing discipline and teaching in other disciplines aging related topics and approaches. As well, there is ample opportunity to create an independent practice and research opportunities. I have found that in different chapters of my career, I have been involved in all of the above. Aging is the field that seems to tie all disciplines together for the good of the patient or client. There is a more collaborative, nurturing environment to create and establish a continuity of care. I find my practice challenging and full of opportunities for intervention with the patient, their families, the community, colleagues and as an advocate on micro and macro levels.
For More Information on Clinical Nurse Specialists please visit:
The National Association of Clinical Nurse Specialists (NACNS)
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Question: What opportunities are there in Geriatric Social Work? What satisfaction does the field afford?
This following list of answers reflects the viewpoints of social workers who have devoted their careers to caring for older adults. Many are members of the AGS Social Work Section and others responded to queries that were sent to social workers who are members of the Gerontological Society of America. The responses represent a variety of viewpoints across the country on this question.
Gretchen Alkema, PhD, LCSW
Postdoctoral Fellow
VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior
John A. Hartford Doctoral Fellow in Geriatric Social Work 2005-2007
Los Angeles, CA
I was first exposed to geriatric social work while volunteering at a local adult day health care center. I knew I enjoyed working with people and preferred older adults to kids. However, I had no idea about the richness, complexity, and deep value gained by working with older adults. As a volunteer and later a staff member, I received mentorship from Carolyn, a long-time social worker who had worked with various populations. She described her affinity for geriatric social work practice as the great opportunity to promote dignity, choice, and interdependence throughout the life cycle, regardless of one’s health and functioning. Her perspective inspired me to pursue a Master’s in social work with a specialist in aging certificate. This decision led me to meaningful career opportunities in direct clinical practice, policy development, and research focused in improving the lives of older adults and their loved ones. Geriatric social workers are trained to assess aging adults using a biological-psychological-social-cultural-environmental perspective, and provide therapeutic interventions including coordination with various health and social care resources in the community. This education is so useful because regardless of the population one chooses to work with (e.g. children/youth, developmental disabilities, substance abuse), aging issues are always present in the direct consumer, their caring loved ones, or both. A helpful resource to learn more about geriatric social work is the Geriatric Social Work Initiative funded by the John A. Hartford Foundation (www.GSWI.org).
Lisa A Blume, LSCSW
Kansas City, MO
I am a geriatric clinical social worker and I prefer older adults because they are each a long, often wonderfully historic story in human form. Most know the words “please” and “thank you!” Additionally, the family work is challenging and rewarding when you can bring order to chaos and fear.
Caroline Cicero, MSW, MPL
Doctoral Student in Gerontology
University of Southern California
Los Angeles, CA
As a social worker interested in combining housing and social services, I was introduced to the field of aging through my first social work internship. I found that I loved working with older people, and I worked for several years as a geriatric case manager in Los Angeles. Within social work school, however, my emphasis was not on clinical work but on community organizing, planning and administration, and I also pursued a degree in urban planning. In my case management job, my clients and I faced the same huge problems again and again: housing affordability and accessibility and affordable and useable transportation. These policy issues have led me to pursue a PhD in Gerontology with an emphasis on public policy. I would like to impact local, state and federal policies and make cities more elder-friendly. The interaction between the physical environment and older people's health is my main concern.
Susan Stark, LCSW, MSSW
Director, PROGRESS Geriatric Social Work Program
University of Denver Graduate School of Social Work
Social work in the field of geriatrics is rewarding and challenging. Our professional role often affords us the opportunity to work intergenerationally with family members of older adults as they face life transitions and crises. We act as advocates on their behalf as they negotiate the complexities of medical, financial and social support systems. Our approach is geared toward enhancing strengths and quality of life for aging adults. I love this field so much that even after 30+ years of clinical practice, I am now committed to training the next generation of geriatric social workers!
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