A Career in Geriatrics: Options and Satisfaction
by Carrie Hoarty, MD, Chair of the AGS Fellows-in-Training Section

May 10th, 2010

Many readers of this newsletter are likely in a similar place as I am -- either a resident considering a career in geriatric medicine, or a geriatrics fellow trying to decide what to do next. 

I have taken a tortuous route in my career path thus far.  I completed medical school in a primary care program and entered into a family practice residency.  My family medicine nursing home rotation enticed me into the field of geriatrics -- I loved watching Dr. Malloy sing his beloved Irish song, “Danny Boy,” to his patients in the middle of their exercise class.  I found it fun and rewarding working with patients and families in a variety of settings as we negotiated plans of care.

During my first year of training, I decided to transition into a joint Internal Medicine and Pediatrics residency program.  I was drawn to taking care of both children and older adults;  I couldn’t help but recognize the similarities in these two fields.  Both require much rapport-building with the patient and the  caregiver—in pediatrics, with children and their parents; in geriatrics, with older adults and their grown children.  In pediatrics, the patient has often not gone through the developmental stages necessary to negotiate and understand treatment plans.  In geriatrics, we often care for patients who have lost their ability to make certain decisions on their own and seek the input of loved ones.  My rotation with our inpatient geriatric service sealed the deal in my decision to seek a career in geriatrics. 

While I am still in training, I am grateful that I have chosen a career in the field of geriatrics.  The variety available in this field is vast.  We are able to work in academic medical centers where we are clinicians, researchers and clinician educators.  We can work in private practice, as hospitalists, as medical directors in skilled nursing facilities, and as palliative care physicians.  We can see patients at home, in the hospital, in their long-term care facility, and in clinic.  We have the option of being primary care physicians or acting as consultants on complex patients.  Geriatricians are sought after, for their negotiating skills,  on hospital committees, as we are trained to lead multidisciplinary teams in creating appropriate treatment plans for our patients.  These administrative skills can be used to negotiate new policy implementation and quality and safety improvement within health systems.  

I have found caring for older adults challenging and rewarding.  Many patients teach us how they have aged successfully, and many share with us the intimate moments surrounding their deaths. The complex medical and social situations we navigate together naturally lead to strong and satisfying physician-patient relationships. 

I am not alone in my satisfaction with caring for older adults.  A 2002 Archives of Internal Medicine article, “Physician career satisfaction across specialties,” shows that, among 12,474 physicians surveyed, geriatric internal medicine doctors are those most likely to be very satisfied in their careers.   A 2009 article in BMC, “Physician career satisfaction within specialties,” further shows that, along with physicians in several pediatric subspecialties, geriatric medicine physicians experience significantly higher satisfaction levels than family medicine physicians, who are used for comparison purposes.  Interestingly, satisfaction was also positively related to working in an academic medical center and not, surprisingly, with income.

Another 2008 BMC article, “Factors associated with the subspecialty choices of internal medicine residents in Canada,” shows that residents tend to choose fields that provide intellectual stimulation, provide a challenge in diagnosis, and are consistent with their personality.  Further, this study points out that lifestyle, role models, and relationships with a mentor impact choice of specialty.  Geriatrics certainly provides intellectual stimulation, constant diagnostic challenges and meaningful relationships, not only with patients and their families, but also with the team providing care.  The American Geriatric Society has done a wonderful job of connecting successful career geriatricians with trainees who seek mentorship.  

Dr. Dan Rath, who sought a geriatric fellowship after 21 years as a family medicine physician in Canton, South Dakota, states that, “I wasn’t as good as I thought I was at caring for older patients.”  He thinks his geriatric training will help him in many aspects of his practice.  For example, he now more fully appreciates the importance of family input in deciding on treatment plans for his patients.  He will leave his fellowship with better behavior management strategies for patients who suffer with dementia.  

I wish you a happy, satisfying and rewarding career -- hopefully in the field of geriatrics!