Profiles in Geriatrics

What drew you to geriatrics as your chosen career path?

A gut feeling. I took a leap of faith when I decided to go for a geriatrics fellowship after my residency at LSU University Medical Center—Lafayatte (now part of Lafayette General Medical Center) because I was the first one in my program to enter geriatrics.

I guess you could say my choice was unexpected, since I’d done a nephrology fellowship in West Africa before moving to the United States. So, when I arrived at Tulane University to begin my geriatrics fellowship, I didn’t know what to expect. I did know I’d return to my community after completing my geriatrics fellowship so that I could give back—there are so few trained geriatricians in Louisiana. I knew I’d enjoy working with older adults and making a positive difference in their lives.

What does your work environment look like, and how have your interactions with other health professionals driven geriatric care forward?

I joined the Veterans Health Administration (VHA) in 2004 because I saw the need to care for the large population of older adults who’d served our country. I’ve been active with the VHA Geriatric Patient Aligned Care Team (or GeriPACT) and in my community by offering geriatrics lectures to other healthcare providers. Though there are still too few geriatricians, my goal is to help train every healthcare provider around me in geriatrics expertise.

To that end, I’ve seen how my AGS membership has benefitted me personally and professionally. Today, I enjoy providing high-quality and person-centered care to our nation’s veterans—and I’m happy to belong to a community of colleagues who are living proof of that same passion every day.

You are a regular attendee of AGS Annual Meetings. Can you share a favorite meeting story?

When I attended my first AGS Annual Scientific Meeting in 2002 as a fellow-in-training, I was impressed by the friendly, supportive atmosphere, though I knew no one there. The AGS members were wonderful, and I knew I needed to belong to this organization.

During that first meeting, I was also struck by the willingness of AGS members to support and mentor junior fellows like me. For example, after I attended a lecture by Laura Mosqueda, MD, AGSF, on elder abuse, I introduced myself to her and she immediately volunteered to be my mentor and cheerleader. She believed in me and inspired me to complete my fellowship program. At that meeting I also met Kenneth Shay, DDS, MS, AGSF, and we talked about the prospect of working at the VA. I’ll always be grateful for that, especially since it led me to the career path I am on today.

Why do you continue to attend the AGS Annual Meeting—what are the benefits of returning each year?

I still attend the AGS Annual Meeting each year—even though it often coincides with my wedding anniversary! I’ve benefited from the many networking opportunities and I’ve made great friends from all over the country. I enjoy the meeting’s fun, diverse atmosphere, which fosters my professional growth. For example, the support I receive from AGS meetings enabled me to reach a personal goal of becoming an AGS Fellow in 2017.

The AGS is a place where everyone is valued and all opinions are respected. As a junior member, I suggested to then-AGS-President Barbara Resnick, PhD, CRNP, FAAN, AGSF, that new AGS Fellows should be recognized on stage during the Members Business Meeting. I was thrilled when that change was enacted.

How has being part of an interprofessional community helped you in your career and professional life?

As a clerkship director, I was looking to make changes for fourth year medical students and was feeling alone, so I turned to the greater geriatrics community on MyAGSOnline (AGS’s discussion forum). By posting just one question to ask for advice, I had chairs and clerkship directors from all over the country emailing me and sharing their curriculum, which was extremely helpful. While going for a promotion to Associate Professor with tenure at my university, it was very helpful to find external reviewers. They gave invaluable advice for the promotion. I have to say thank you to my AGS community.

As a young professional, what types of AGS resources are most important to you?

Clinical, educational, and research resources, as well as updates on health policies and new changes proposed.

How have your personal experiences and stories helped shape the way you practice?

I had complications while pursuing my geriatrics fellowship after an emergency surgery. It took a whole year to be fully diagnosed after many physician and specialist visits, and finally was resolved completely when a surgeon patiently listened to my full story. It taught me important lessons to listen to my patients and to believe them, as it can change their quality of life and get them the help they need. It has also helped me make healthier lifestyle choices, which I always discuss and encourage my patients to follow.

What inspires you?

Everyone at AGS inspires me, and that is why I keep coming to the meeting every year. It is an honor to meet hard working, motivated folks in geriatrics who every day go above and beyond what is expected of them to make someone else’s life better.

Do you have a favorite story about a patient, family caregiver, mentor or other person who has touched you personally and/or professionally?

Mrs. D was my first patient in my fellowship at a geriatric clinic. We started rather awkwardly—I introduced myself and told her I was new. She smiled, reassuring me we’d get along fine. At the end of the session she reminded me to send her the lab work early, and complimented me on a thorough visit. We had many more sessions over the next decade.

We discussed more than her health – her life, work and her children. When my twins were born, she brought them hand-knitted sweaters and socks. She never left a visit without seeing a picture of my children or asking how they’re doing. I realized there is never a one-way exchange in a relationship between physicians and patients.

After Mrs. D’s death, I called her daughter and she told me that many times in her last days, she remembered me and proudly discussed with the hospital staff that she had seen all the progress of my career. I feel truly blessed that she was my patient and it was an honor to know her.

When did you know you wanted to be a geriatrics healthcare professional?

My “Aha!” moment came during my internship at Montefiore Medical Center in New York. Before entering medical school I had worked in the breast oncology clinic at Memorial Sloan Kettering Cancer Center. I had entered medical school and internship with plans to become an oncologist. I was fortunate to have had a wonderful mentor, and at the end of my intern year we had a chat.

She told me she saw things in me that I didn’t see in myself—that I was drawn to palliative care (then a relatively new field), for example, and we started talking about geriatrics. I spent time in the geriatrics department, and I realized her encouragement was spot-on.

What’s your favorite thing about working in this field?

Geriatrics satisfies me in so many ways. I love the older adults I care for, in large part because I love hearing their stories. It’s rewarding to help older adults regain function and the ability to interact with people. I’m doubly fortunate in that my work at the Yale University School of Medicine in Connecticut also entails helping train future geriatrics healthcare professionals. My work teaching is every bit as gratifying as my clinical work, though for equally special yet unique reasons. When I work with trainees, I get to see things through their eyes; their perspectives are enlightening. Teaching really is a two-way street!

How has being part of an interprofessional community helped you in your career and professional life?

A terrific aspect of geriatrics is the community it represents. We all seem to be kindred spirits and a success for one is a success for all. I’m definitely living proof of that, because recently, I was extremely honored to receive the AGS’s Outstanding Mid-Career Clinician Educator of the Year Award. It’s a testament to the AGS that our members are so big-hearted: I was thrilled to receive so many congratulatory notes and accolades from my colleagues. Receiving the award was not only a wonderful professional tribute for me but also underscored the importance of the work we do together.

I suppose that’s part of why I’ve been an AGS member since 1999. Events like the AGS Annual Scientific Meetings have helped me celebrate my peers’ successes while also affording me the opportunity to see what they and other leaders are doing. Membership in the AGS is one key way I’ve learned about innovation in our field so I can stay current with research.

Another key aspect of my membership is that it exposes me to the advocacy AGS leads on our behalf. With health policy in flux these days, we all need to be advocates for our field, and—thanks to AGS—I’m inspired to add that to my own list of important things to do.

Can you tell us about your professional history before you came to The John A. Hartford Foundation? How did your geriatrics training help you in your leadership positions outside geriatrics?

The Journal of the American Geriatrics Society gave me an excellent opportunity to tell my story in the Pioneers section of the July 2015 issue. In the article, I was able to describe my extraordinary good fortune to begin my career at the Beth Israel Hospital in Boston during the years when the Harvard Division on Aging was founded. Jack Rowe, along with a stellar group of interdisciplinary colleagues, gave me a platform to delve into understanding the essence of acute care geriatric nursing and elaborate on what the profession of geriatric nursing could be. There, I also began my elder abuse research, which to this moment is central to my work. Those years were the harbinger for Nurses Improving Care for Healthsystems Elders (NICHE) and for the exciting work I was able to do at the Hartford Institute for Geriatric Nursing (HIGN) with Mathy Mezey and the outstanding HIGN team. One of the important lessons I learned working in geriatrics is that addressing the needs of older adults improves care for all people. For example, all patients benefit from person-centered care and team care. And because resources traditionally have not been as plentiful in the field of aging as in some other areas, there has always been a strong emphasis on collaboration and partnership. I believe that having that understanding makes me a more effective leader whether I’m working specifically in geriatrics or other areas.

Your career has spanned the clinic, the community, and the classroom in support of expert eldercare. Can you tell us a bit about why you have an interest in geriatrics and what led you to your new position at The John A. Hartford Foundation?

My interest in geriatrics was immediate as a young nurse, when I saw the opportunity to step up and lead improvements in practice for the frail older people who were in our care. There are many ways to influence better care for older adults. Whether you are teaching the next generation of clinicians, conducting research to generate new knowledge that improves care, informing policymakers with research, or focusing on practice models that improve care, there are many ways to make a meaningful difference. I had not considered the role of foundation president as a part of my career trajectory. However, when the opportunity presented itself and I began to explore the possibilities with the search committee, everything fell into place. I knew this would be one more exceptional way for me to improve care of older adults and I am thrilled to be at The John A. Hartford Foundation. This Foundation has shaped my career in innumerable ways and I am so grateful and proud to be able to serve as the President.

How did you choose to become a geriatrics health professional?

My path to my practice as a physician assistant (PA) in geriatrics was certainly inspired by my grandmother. A Russian émigré who died at 101, she was still navigating public buses in Southern California when she was 99. Her life was the epitome of what it means to age well.

However, geriatrics wasn’t the first profession I considered. In college, I spent a gap year in Africa. That trip changed my life. I cast aside other career notions (among them becoming a primatologist) and decided to train as a PA. I returned to college back in the U.S. and did my post-grad PA studies at Johns Hopkins University.

Initially, my PA training was in primary care. A former classmate encouraged me to work with him at a multi-disciplinary medical practice in Los Angeles. The practice had just joined the Medicare Advantage program and they needed someone to work with older adults. It became a perfect fit for me.

While there, I was offered a yearlong geriatrics fellowship training opportunity at USC, and that’s when I joined our Society.

What do you value about AGS membership?

I attended my first Annual Scientific Meeting back in 1985 or so, and I realized when I arrived that I was among people who shared my worldview and my commitment to caring for older adults.

Even though there were few other geriatric PAs back then, the physicians, nurse practitioners, registered nurses, and social workers were indeed my kindred spirits.

I’ve built great personal relationships with AGS members over the years, and I’ve been actively involved in various committees. The Annual Scientific Meetings provide great opportunities to meet the people whose research you’ve been following over the years. Another thing I love about the field, and I think this may be unique to geriatrics, is how eager we are to share our knowledge with others. I’ve enjoyed seeing AGS evolve over the years to become totally inclusive, and I really appreciate its focus today on interdisciplinary teamwork.

What do you wish people knew about your job?

One question I get a lot about my work in geriatrics is, “Don’t you find it sad to work with people who are so close to death?” And my answer is that it’s not sad at all. I get to travel to different cultures and even different eras through my work, because older people are so willing to share their life stories. I’ve heard first-hand about experiences I’d previously heard about only in history books. Geriatrics means you don’t just practice medicine; you get to know people, and to take care of them within the context of their own lives.