The numbers are sobering: According to the American Geriatrics Society, there are 7,500 geriatricians in the U.S. – but 17,000 are needed now to care for our aging population. And with the growing numbers of Baby Boomers entering their senior years, this shortage is only getting worse.
That’s the bad news, but here’s the good news: Accomplished, ambitious, and energetic young doctors like Dr. Randi Rothbaum are looking to be part of the next generation of geriatricians who conduct research, teach others and care for medically complex older patients.
“All my life, I’ve been fascinated by the stories of older people,” she says. “At my own wedding, I missed my favorite part – the cake service – because I was talking to my husband’s 98-year-old cousin.”
Dr. Rothbaum is part of the Harvard Medical School Multi-Campus Fellowship in Geriatric Medicine, in which Hebrew SeniorLife is a key teaching partner. Established in 1978, it’s one of the oldest such programs in the country. More geriatric fellows have trained at Hebrew SeniorLife than at any other single teaching institution in the U.S.
Each year, eight fellows – doctors who have completed their residencies and seek to specialize in geriatrics – come to Hebrew SeniorLife and five other teaching sites in the Boston area. The fellows see patients in a variety of settings, including long-term chronic care at Hebrew Rehabilitation Center, plus acute care hospitals and outpatient clinics.
Fellows complete one year to become board-certified geriatricians. They can choose to stay for a second year if they’d like to pursue a career in academics or research.
Dr. Rothbaum has opted to stay for the second year, during which she is conducting research about hip fractures in seniors with advanced dementia. She will work with mentor Dr. Sarah Berry, a researcher at HSL’s Institute for Aging Research who is also the fellowship program’s director. Dr. Rothbaum also sees patients in skilled nursing at HSL’s Orchard Cove community and in post-acute rehabilitative care at Hebrew Rehabilitation Center in Boston.
“I love being a clinician, but I want to do research that impacts my patients and can also be shared with other providers,” Dr. Rothbaum says. “The mortality rate in the first 6 to 12 months after a hip fracture is 30% to 60%. My research looks at the outcomes of patients with advanced dementia who experience a hip fracture and choose surgery versus those who don’t choose surgery. What was their quality of life? How does that event change the patient’s advance care planning? The results will give clinicians, patients and families more information to use in making health care decisions.”
Fellows also benefit from working in interdisciplinary teams – including nurses, pharmacists, social workers, and physical and occupational therapists – and train alongside geriatric psychiatrists and dentists. “Our fellowship program teaches you how to think holistically about a patient and his or her goals of care,” explains Dr. Rothbaum.
Reflecting on her experience, Dr. Rothbaum says, “It’s been inspiring to work with the staff at Hebrew Rehabilitation Center to see how long-term chronic care can be practiced. The nurses know who the patients are as people, and that really helps to inform their medical care. HRC’s model of always having a doctor on site, and having doctors dedicated to each floor, is unique. I was at HRC for a two-month rotation, and on my last day, I hugged all of my patients. I didn’t see them as patients, they were grandparents or friends.”
About Teaching at Hebrew SeniorLife
Hebrew SeniorLife is the only long-term care teaching hospital in the United States, and the only senior care organization affiliated with Harvard Medical School. About 90% of HSL’s medical staff is involved in teaching. We train more than 700 students, interns, residents and fellows each year in multiple disciplines – including nursing, physical therapy, social work, pharmacy and more – to prepare them to be the clinicians, researchers, leaders and policymakers of tomorrow. Since 1966, we have trained more physician fellows in geriatric medicine than any single teaching program in the country.