Geriatrics Fellowship Recruiting Series: Field-tested Strategies that Work, Part 2

Just four years after completing a fellowship in geriatric medicine at Boston University Medical College (BUMC), Serena Chao, MD, has quite an impressive CV.

An assistant professor of medicine at BUMC, Dr. Chao is also Associate Program Director of the medical school's fellowship program. With BUMC's Home Care Program, she makes house calls and provides primary care to 90 homebound elderly Bostonians. She's also the primary care physician for another 130 or so elderly patients who get care through the institution's Geriatrics Ambulatory Practice, and she runs its Consultation Geriatric Assessment Clinic. Dr. Chao also teaches medical students, internal medicine residents and geriatric medicine fellows, has played an integral role in curriculum development for all levels of trainees, and is a key faculty member for BUMC's pioneering Chief Resident Immersion Training (CRIT) program. If that weren't enough, she was a 2007 recipient of a federal Geriatrics Academic Career Award, which ensures her protected time for academic and educational work. She's using that time to develop initiatives that improve care and transitions of care for older hospitalized patients and better prepare other healthcare professionals to do the same.

Though she's already leaving her mark on the field, Dr. Chao wasn't planning to pursue a career in geriatrics when she started medical school. In fact, if it hadn't been for the aggressive recruitment efforts of the geriatrics faculty at Tufts University School of Medicine's Baystate Medical Center - where Dr. Chao did her residency - she might have followed her initial plan and become a primary care physician.

"I developed an interest in geriatrics in the process of working with Maura Brennan, who was a role model for the type of physician I aspired to become," says Dr. Chao, referring to her mentor at Baystate. Dr. Brennan, Associate Director of the fellowship program, is also Director of Baystate's Geriatrics Consultation Program, Associate Professor of Medicine at Tufts, the founder of Baystate's geriatric medicine track, and co-chair of the AGS Education Committee's Recruitment Subcommittee. Thanks to Dr. Brennan's mentoring, Dr. Chao says, "I began to see that there were many opportunities in the field of geriatrics."

At a time when new medical school graduates are staying away from geriatrics in droves, Baystate has an enviable record of placing promising residents like Dr. Chao in geriatric fellowships. Its own geriatric fellowship program, which accepts two fellows each year, hasn't had a single unfilled slot since its 1999 launch.

"This year alone, three of our graduating residents are doing geriatrics fellowships - two of them in our own fellowship program and the third at Mount Sinai in New York," Dr. Brennan says.

What are the secrets to Baystate's recruitment success? Ongoing resident exposure to geriatrics is one contributor. At the same time that Baystate launched its geriatric fellowship program it also created a geriatrics track for residents. "We have the residents with an interest in geriatrics get together with our geriatrics fellows on a regular basis for journal club and topic review, and involve the residents in a "teaching team" with the geriatrics fellows, medical students, and geriatrics nurses and social workers when possible," says Dr. Bellantonio. "The residents are also exposed to healthier older adults in a retirement community where I have a practice." In addition, the medical center has a large and active inpatient geriatric consultation service, and house officers regularly consult with the service's geriatricians, thereby getting a better sense of what geriatrics is all about.

"But I think that the most critical part of our recruiting efforts has been a very aggressive and personal style of mentoring that we've adopted and has largely worked through our geriatric medicine track," Dr. Brennan says.

Mentoring begins before interns even arrive on campus. Dr. Brennan and Sandra Bellantonio, MD, Director of the fellowship program, and co-chair of the AGS Recruitment Subcommittee, review incoming interns' personal statements. Then, during orientation, they seek out those who've expressed even the slightest interest in caring for older adults.

Recruitment efforts don't end there. Geriatrics faculty at Baystate meet informally with residents who've expressed interest the field, and share and discuss recent journal articles and topics in the field over meals. They encourage residents to organize and get involved in geriatrics journal clubs, and give talks concerning geriatrics to medical students and at local senior centers and nursing homes. Faculty members also encourage residents to devote projects and posters to interesting geriatrics cases and issues, and provide suggestions for and assistance with these.

Faculty also strongly encourage potential recruits to submit posters to and attend AGS' annual meeting, another important venue for getting a sense of the breadth and depth of the field, and the opportunities it affords.

Dr. Chao and fellow Baystate graduate Julie Phillips, MD, both cite mentoring and their experiences at the annual meeting as key determinants in their decisions to pursue careers in geriatrics.

"In my first year, Maura noticed in my entry essay that I mentioned leaning toward geriatrics, and from that point on she actively recruited me," says Dr. Phillips, now a Clinical Assistant Professor of Medicine at Albany Medical College and a geriatrician and hospice physician at the city's Stratton VA Medical Center. Taking Dr. Brennan's advice and attending AGS' annual meeting was seminal. "I was really impressed," Dr. Phillips recalls. "I thought, "Wow! A whole group of people who feel the same way as I do about the elderly!" It was a great experience."

As Associate Program Director of BUMC's fellowship program, Dr. Chao now makes use of the same recruitment strategies her Baystate mentors employed.

"When I've identified residents who have an affinity for geriatrics, I make myself available for teaching, advice, and support, much like Dr. Brennan did for me during my residency days at Baystate," says Dr. Chao.

Active in AGS' Resident Recruitment Subcommittee, Dr. Chao is also helping residents in programs throughout the US establish resident chapters of the AGS, and is the faculty advisor to the BUMC resident chapter of the Society. "Just like Dr. Brennan, I believe that trainees respond to attending physicians who demonstrate that they truly care about the trainees' personal and professional development," she says, with conviction.

The American Geriatrics Society (AGS) is also taking steps to boost recruitment. AGS' annual meeting includes a one-on-one mentoring program for residents and other trainees, a residents-only poster session, a students' poster session, a residents' luncheon, and a student special interest group. AGS has also started offering residents and students free online memberships, and offers trainees the opportunity to start a resident or student chapter at their institution.