Our geriatric fellowship graduates
Physicians in primary care devote their careers to understanding and meeting the needs of their patients across the life span. Some of these physicians find themselves drawn to work primarily with older patients and seek additional training to deepen their practice with this population. But who are these physicians? What draws them into geriatrics, and what joys and challenges do they find in their geriatric practice? How did they find appropriate training for their career goals?
Sparrow Hospital in Lansing, Michigan, in association with the Department of Family Medicine, College of Human Medicine, Michigan State University, offers a one-year training program. This fellowship program enhances physicians’ knowledge and understanding of the principles of excellent geriatric care delivered to patients at all levels of health and across a continuum of care settings. It is a dually accredited allopathic and osteopathic training program designed to meet the needs of internal medicine and family medicine physicians who seek a career in geriatrics.
We talked to six physicians who have graduated from the fellowship over the past decade, seeking answers to the questions posed above. Two had entered the fellowship directly from a residency program; two had been in medical practice for at least 10 years post-residency before specializing in geriatrics; and the final two had enjoyed other careers prior to entering medical school, but knew that they would focus their medical practice on geriatrics early in medical school journey. Four are women; two, men.
Several of the fellowship graduates recalled that accompaniment of elderly family members or family friends helped them recognize the importance of geriatric practice and stoked their own desire to obtain training in geriatric medicine.
For instance, Raza Haque, MD, recalls that his first nudge toward geriatrics came as an eight year old, when a grandfather who lived with his family experienced a stroke. It was his family responsibility to assist his grandfather; thus, he became intimately familiar with delirium and other health problems that can accompany both aging and neurological events. As he moved toward a career in geriatric medicine, these memories were vivid.
Kris Gaumer, DO, had always been comfortable around elders. For Dr. Gaumer, “medicine was a mid-career shift for me. I had a career prior to med school; then enrolled with the intent of doing geriatrics.” Companioning patients with chronic disease or approaching end of life especially drew her. She recognized that her patients often would not recover, but that she could help them attain an optimal quality of life.
Megha Tewari, MD, grew up in India and explains “Our culture and religion teach us to respect our elders, treat them with dignity, and revere them for their life experiences and knowledge.” Her grandfather died while she was in the United States for her medical internship. Absorbing this deep loss “strengthened my resolve to focus more on the elderly, whose complaints many times get overlooked.”
Positive role models on the fellowship faculty were crucial in motivating several of our respondents to choose the Sparrow/MSU Geriatric Fellowship for their advanced training.
James Mayle, MD, had practiced gastroenterology in mid-Michigan for 30 years and was a faculty member in the Michigan State University College of Human Medicine for 25 years before enrolling in the geriatric fellowship. At one point, both his parents and his in-laws were under the care of Mark Ensberg, MD, who at that time was directing the fellowship. He was impressed by the way Dr. Ensberg was able to care for his family members and began to consider a mid-career switch from gastroenterology to geriatrics. “I’m still impressed by him,” Dr. Mayle notes after five years in his new specialty.
Sister Edith Mary Hart, RSM, DO, had a similar experience of Dr. Ensberg as a role model who helped inspire her to become a geriatric fellow. She is a member of the Order of the Religious Sisters of Mercy and a graduate of the fellowship, now practicing geriatric medicine in Minnesota. When she encountered Dr. Ensberg during her family medicine residency, “His thoroughness, sensitivity, and holistic perspective was impressive to me,” she remembers. He often drew out information on how the patient was doing functionally at home. “That resonated with me,” she said.
While Dr. Haque was practicing internal medicine in a southern Michigan town, he had joined the medical staff of a local nursing home. He did not yet have advanced training in geriatrics, but recognized his need for additional knowledge. With that in mind, he had sought out Larry Lawhorne, MD, as an informal mentor. Since Dr. Lawhorne taught in the Sparrow/MSU Geriatric Fellowship, the idea of enrolling piqued Dr. Haque’s interest, and he would now say that this became the time when he “found himself” in his vocation.
Once enrolled in the fellowship, of course, fellows encounter both joys and challenges, as they live into their new identities as geriatricians.
One challenge noted by the graduates is the PGY-4 salary that they receive as fellows, low relative to what they might earn as practicing physicians; and those fellows who have been in medical practice for several years must make, perhaps, a greater adjustment to this reduced salary than those who enroll directly from their internal medicine or family medicine residency program.
But there were creative ways of addressing this challenge. For instance, Dr. Haque mentioned that he was able to take a year’s sabbatical from his position and receive a supplemental stipend from his employer on the condition that he would return to his position for three years following the fellowship.
Finding oneself in a full-time learning situation again after years as a practicing professional can require flexibility and self-discipline “especially when I encountered medical situations that I might have addressed differently in my own practice,” Dr. Haque recalls. “It was a humbling experience.”
Dr. Gaumer notes, “You have to get people who are both secure in their practice, but flexible enough to make that kind of cognitive shift.
Of course, the opportunities can outweigh such temporary challenges. Erin Sarzynski, MD, remembers working with Kevin Foley, MD, in the Memory Disorders Clinic in Grand Rapids as one of these high points. “The clinic was truly interprofessional, and the scope of cognitive deficits was a great learning experience.”
Dr. Hart, who is now medical director of a small town Minnesota nursing home and a hospice director, emphasizes, “The fellowship was very important in preparing me to do those roles…a real benefit.”
Without exception, these six graduates have embraced their new sub-specialty of geriatrics with enthusiasm. In fact, four of them have since become part of the Sparrow/MSU Geriatric Fellowship faculty (Drs. Gaumer, Haque, Mayle, and Sarzynski). When asked whether they would recommend geriatrics to their peers, the resounding answer was “yes.”
Dr. Mayle mentions the range of opportunities, “You can be an inpatient doc. You can be an outpatient doc. You can be a long-term-care doc. You can do a mixture of these.” He continues, “When I walk into the nursing home, I have a good, positive feeling. It is kind of cool. I’ve never had that feeling walking into a hospital. That says a lot about what I am doing; it feels very positive.”
Dr. Gaumer noted that paperwork can be burdensome, but that it is outweighed by the joy of working with elderly patients. When asked what keeps her engaged, she responded “The patients. Talking with them…It is not about controlling somebody’s blood pressure and refilling their medications. It is about meeting them at the human level of where they are in their lives. That has been my entire intention. And I get the feedback that ‘mission accomplished,’ I did that. That is what keeps me going.”
For Dr. Hart, her religious call informs her role as a geriatrician, and she is committed to “their good both physically and spiritually.” She adds that in the end, what really matters to patients is that they are known deeply and that she as a physician can spend time with them.
And finally, Dr. Haque exclaims, “I love every minute of it!” He is able to provide continuity of care in a way that was not possible in his previous internal medicine practice, and he recognizes that success may often mean journeying with his patients to assure them a pain-free death when physical recovery is no longer an option.
As Dr. Mayle did, he observes that a physician who choses geriatrics has a number of options regarding practice. In addition to practice in a nursing home or assisted living setting, it is possible to become a hospitalist, work in a geriatric outpatient practice, or find a niche in geriatric teaching or research. And of research, Dr. Haque adds, “This ocean has not been explored.”