Jerome Epplin, MD

Litchfield Family Practice Center

 “Caring for older people is something I really enjoy,” he says. “In fact, the more I do it, the more I enjoy it.” 

When Jerome Epplin, MD, started his practice in 1978, he saw patients of all ages, and delivered quite a few of them. But as his practice grew—it now includes six physicians—he focused increasingly on older adults. He stopped delivering babies altogether 10 years ago and older people now make up about 80% of his patients.

Caring for older adults is uniquely satisfying, says Dr. Epplin, who tells the story of one of his elderly patients to illustrate why. At 89, this particular patient had severe arthritis of the knee but was otherwise healthy. Unfortunately, the arthritis was worsening to the point that she had trouble managing on her own at home. It looked as though she'd have to move to a nursing home. After carefully considering the potential risks and benefits, as well as the state of her health and her functional abilities, Dr. Epplin urged her to consider knee surgery.

"Her initial response was "I'm too old," but the truth was, when you looked at the whole patient, not just the knee, she was quite healthy, so I kept trying to persuade her," he explains. "She finally had the surgery and is now pain-free and still living independently at home, and will probably be able to do so for some time. Seeing that and knowing you had something to do with it—with a patient being able to stay home and independent and continue functioning—is a wonderful thing."

Dr. Epplin, a clinical professor in the department of family medicine at Southern Illinois University School of Medicine, is an active member and fellow of the American Geriatrics Society. He's also a member, and former chair, of the committee that writes the American Board of Internal Medicine-American Board of Family Practice exam for the Certificate of Added Qualifications (CAQ) in geriatrics.

One of the primary tenets of geriatrics, Dr. Epplin notes, is: Consider the entire patient. That means all aspects of his or her physical, mental and emotional health, abilities and resources, not just whatever health concern is most problematic at the moment. Another is: don't assume impairment is an inevitable consequence of aging; rather, look for and address the underlying causes of impairments. A third is: focus on functioning because, while a cure may not always be possible, appropriate treatment will often help older patients function better and enjoy a significantly improved quality of life. These emphases—on the big picture, on underlying causes of impairment, and on maintaining function—make geriatrics unique, and make caring for older patients extremely challenging, Dr. Epplin says. So do the health problems many older adults face.

Unlike his 89-year-old patient with arthritis, many of the older adults he sees have multiple, chronic health conditions. Providing optimal treatment for these, while ensuring that treatment side effects and potential interactions don't significantly erode a patient's ability to function is an ongoing juggling act, he says.

The intellectual rigor of treating patients with multiple health problems—like the opportunity to significantly improve their quality of life—is a source of tremendous satisfaction, he says.

And he's not alone in his thinking. In surveys, geriatricians consistently report higher job satisfaction than other physicians. Even so, the field continues to lose practitioners, despite rapidly growing demand for geriatrics care, in large part because compensation lags. Most older patients are covered by Medicare and, a recent Congressional Budget Office analysis confirms, Medicare payments haven't kept pace with increases in practice costs. Organizations like the American Geriatrics Society are working to reform the Medicare payment system. In the interim, Dr. Epplin says, there are ways to earn a living in geriatrics. One way is by practicing in a rural area, as he does.

His practice, Litchfield Family Practice Center, is in Litchfield, Illinois—population 7,000—just 100 miles north of the small town where he was born and raised. While he was growing up, the highly respected family practitioner in his hometown was his role model. Both Dr. Epplin and his wife, Renee, a nurse who also grew up in a small town, were determined to raise their three children in a similar setting. Litchfield turned out to be a good location both personally and professionally, and Litchfield Family Practice Center qualified as a federal rural health clinic. As such it also qualified for higher Medicare and Medicaid reimbursement rates. To encourage healthcare practitioners to work in rural areas, where medical services are often in shorter supply than in suburban and urban areas, the federal government pays rural clinics higher fees.

"People talk about how it's tough to make it in geriatrics financially, but you can afford to do geriatrics in rural areas," says Dr. Epplin, who points out that rural areas also tend to have a higher proportion of older residents than do suburban or urban areas.

In addition to seeing patients at his practice, training students at Southern Illinois University School of Medicine, and working with the geriatrics CAQ test committee, Dr. Epplin is a medical director at two nursing homes, where he oversees resident care. Contrary to what most people expect at nursing homes, many of the residents are able to get around on their own, and participate in a variety of activities, he says. Often, they're at the nursing home only for a short period of time, while they recover from an illness, injury or surgery. "You can do a lot for these older adults," notes Dr. Epplin, who takes the students he trains to both his practice and to the nursing homes. "Most students have no prior experience with, and have a negative view of, nursing homes, but working at a nursing home can be extremely challenging. It's certainly not boring; you have to be on the ball."

Dr. Epplin has published numerous papers, articles, and book chapters on a range of subjects, including minimal trauma fractures in the nursing home, primary care of heart diseases, congestive heart failure, thrombolysis during acute heart attack, and nuclear cardiac stress testing. A member of the editorial board of the Annals of Long-Term Care for nearly a decade, he also served on the American Geriatrics Society committee that wrote AGS' guidelines for managing persistent pain in older adults.

Dr. Epplin says some of his older patients have begun asking—with some trepidation—if he has any plans to retire. He tells them all the same thing: Absolutely not.

"Caring for older people is something I really enjoy," he says. "In fact, the more I do it, the more I enjoy it."