David B. Reuben, MD, AGSF

UCLA School of Medicine

"I found that I loved geriatrics—it was everything I had hoped for and more."

In the 1960s, when David Reuben, MD, was growing up in a series of towns and cities in the Midwest and the South, most parents wanted their kids to become doctors, or, if not doctors, then lawyers, or professionals of one sort or another. Reuben's parents were no different.

"My father always said he thought I'd become a physician," says Dr. Reuben, who now heads the UCLA Multicampus Program in Geriatric Medicine and Gerontology, one of the largest and most influential geriatrics programs in the country.

Struggling to cope with his parents' health problems and, later, their divorce, Reuben didn't give much thought to a career until he was an undergrad. While at Atlanta's Emory University, he took a part-time job as a nursing aide at a hospital, and later, at a psychiatric hospital. It was a revelation.

"I discovered that I liked everything about healthcare," he says, adding that, thirty years later, he still finds the interpersonal aspects of providing care, and his roles as healer and patient advocate incredibly satisfying.

Having discovered that medicine really was for him, Dr. Reuben was so anxious to get started that he skipped his final year at Emory. He enrolled in the university's medical school without first completing his Bachelor's Degree. "I'm the only doctor I know who dropped out of college," he quips.

After med school, Dr. Reuben did a residency in internal medicine at Brown, then joined Brown's internal medicine faculty. He also met his future wife, Gail Greendale, MD, who eventually went on to specialize in geriatrics as well, and is now a researcher and professor of medicine at UCLA.

As a clinician-educator at Brown, Dr. Reuben excelled, winning a number of teaching awards. But after seven years, he began to feel restless, particularly after Greendale headed to Harvard for further training. "She was learning and learning and learning, and I was… jealous," Dr. Reuben says, with a chuckle.

When he approached the chief of his department, Milton Hamolsky, with plans for a sabbatical and further training, Hamolsky asked if he'd ever considered geriatrics. Dr. Reuben, who thought about how satisfying it had been to care for older adults, was interested. So Hamolsky put him in touch with Sid Katz, dean of the faculty at Brown and a pioneer in the field. Katz mentioned a Hartford Foundation initiative to retrain mid-career faculty in geriatrics, Dr. Reuben applied, was accepted, and headed to UCLA for training.

"I found that I loved geriatrics - it was everything I had hoped for and more," Dr. Reuben says. Among other things, he explains, he loved the holistic nature of the field, and its focus on teamwork. And he loved the challenge inherent in caring for older adults.

"Geriatrics is in many ways the most challenging and the most satisfying discipline," he says. "When you're caring for older people, it's really about what works for them-being their advocates. Sometimes, doing right by your patients means fighting for them to have surgery. Sometimes it means fighting for them not to have surgery. The challenge of trying to help them by providing what works for them is difficult, but also extremely rewarding."

At UCLA, Dr. Reuben's mentors included John Beck and David Solomon and other giants in what was then a very young discipline. Dr. Reuben did a great deal of research during his mid-career geriatrics training, much of it focusing on workforce issues and the importance of monitoring and preserving functional status in older adults. Just a year after completing his geriatrics training, he was appointed associate director of UCLA's geriatrics program. When Beck, then the director, retired four years later, Dr. Reuben took over. That was in 1993.

"I do everything –that's the greatest privilege of this position," says Dr. Reuben, describing his work life these days. "One of the best aspects of my career is that it's got tremendous diversity. On any given day at any given time, I can be doing a dozen different jobs. Some of it is patient care. Some of it is mentoring. I also have direct teaching opportunities and I'm senior enough that it's not just giving lectures; I can do creative things—I can teach things others never teach, like how to give a lecture and write a paper. And I conduct research."

Couldn't he find the same satisfaction in a similar position in another field—say, neurology or internal medicine? Probably not, Dr. Reuben answers.

"There have been opportunities for me in geriatrics that I would not have had had I gone into neurology or internal medicine –because geriatrics is a new field and in a new field there are so many opportunities for leadership," he notes. He cites opportunities to contribute to cornerstone research in such areas as age-related functional decline, as he did earlier in his geriatrics career. (His current research focuses on redesigning physicians' office practices to improve care to older adults, and the role of inflammation in disease and other adverse outcomes in older people.) He also cites opportunities to contribute to such seminal texts as Geriatrics at Your Fingertips -- he has been its lead author since 1997—and the American Geriatrics Society's Geriatrics Review Syllabus (GRS). In 1988, Beck, editor of the first edition of the syllabus, invited Dr. Reuben to serve as associate editor. He edited the GRS from 1988 to 1996, first as associate editor and then as lead editor.

"The syllabus was my entrée into the American Geriatrics Society," recalls Dr. Reuben, who is a past President of the American Geriatrics Society and the Association of Directors of Geriatric Academic Programs."Both the staff and the leadership of the Society were incredibly welcoming and the work I've done and continue to do with the AGS is very important to me. As a geriatrician you can contribute to the care of older adults in different ways. You can do this in your day to day interaction with patients. And you can do it through research. And you can do it by working on projects like the Geriatrics Review Syllabus or Geriatrics at Your Fingertips, or by joining the AGS in efforts to influence public policy in ways that can improve care for older people in general. All are important."

In July, 2010, Dr. Reuben was named Chair of the American Board of Internal Medicine (ABIM) Board of Directors. He continues to serve as a member of the Board and its Executive Committee.

Though geriatrics itself has grown up a bit in the last 20 years, it will continue to be a field of opportunity, Dr. Reuben predicts. The nation's changing demographics will ensure that. "We're going to have 75 million Baby Boomers marching through -- and someone's got to care for them," he says.

That said, Dr. Reuben also acknowledges that, at the moment, the field can be a hard go for clinicians, given the federal government's much maligned system for compensating physicians who care for Medicare beneficiaries. Several federal agencies and numerous lawmakers have already proposed changes to the system, however. And Dr. Reuben is confident that the feds will find a fix within the next few years.

"I think recognition of the value of geriatrics is only going to increase," he adds. "In the next five to 10 years, geriatrics will be seen for all it has to offer to both patients and the nation's healthcare system."