Dr. Joshi explains that being a geriatric hospitalist is different than specializing in general internal medicine because she customizes the approach for each patient—including tailoring therapies to life expectancy. “Guidelines and evidence-based medicine are fine and very important, and we use geriatric guidelines on our teaching service,” she says. “But geriatrics liberates your thinking as a doctor. You treat the whole person—a diabetic with three days to live, and a 90-year-old with delirium and decubitus ulcers.”
She calls herself a surrogate primary care physician, seeing 12 patients most days. She consults frequently with other hospitalists on their toughest geriatric issues and makes daily multidisciplinary rounds—with discharge planner, pharmacist, physical therapist, palliative care specialist, nurses, and resident in tow.
“We keep length of stay and guidelines in mind, but the patient is the center of my universe,” Dr. Joshi asserts. “I deliver holistic, patient-centered care and use gentle teaching tools for our residents. I have the luxury of taking time to see the patient and talk to them and their families. It’s wonderful.”
Dr. Joshi’s attitude toward her profession reflects a consistent national finding: Geriatricians rank No. 1 in nearly every study of physician career satisfaction, from the American Medical Association to the American Geriatrics Society.
Across the country, Alpesh Amin, MD, MBA, FACP, professor and chief of general internal medicine and executive director of the University of California at Irvine’s School of Medicine Hospitalist Service, is making the most of the two geriatricians on his 15-hospitalist team. Starting about eight years ago, Dr. Amin—also a member of SHM’s board of directors—turned to his hospitalist geriatricians for a host of services: geriatric assessments, co-management of psychiatric problems, perioperative consults, critical care, and palliative care consults.
“Geriatricians have such knowledge and insight into elderly patients to share with the other hospitalists,” says Dr. Amin. “That’s why they work well side by side with internal medicine and family medicine hospitalists. They keep us aware of issues in geriatrics and the literature on what works best with these patients.”
Knowing that geriatricians are scarce, Dr. Amin accesses their expertise by using a system that focuses team members’ attention on their knowledge. There are journal clubs, frequent consults, monthly meetings, teaching rounds, geriatric fellowships, and other opportunities that keep the geriatrician’s unique perspective front and center for other team members. “They are so in tune with issues related to delirium, polypharmacy, falls risk, etc.,” he says. “Our model incorporates that expertise, and it works very well. We truly work as a multidisciplinary team with ownership and accountability of the special needs of our geriatric patients.”
—Fredrick Sherman, MD, FACP, medical director of Senior Health Partners and professor of geriatrics at the Mount Sinai School of Medicine in Manhattan
A New Generation
The rapid growth of hospital medicine has encouraged new physicians to choose this career path.
Claudene George, MD, recently completed a two-year geriatric fellowship at Mount Sinai Hospital in New York City and is starting as a geriatric hospitalist at Montefiore Hospital in the Bronx. “Becoming a geriatrician sort of surprised me because I thought I’d go into internal medicine,” she says. “But I love the approach to caring for the whole person and communicating with their families.”
As part of her contract at Montefiore, she negotiated a half-day-per-week rotation at the hospital’s outpatient clinic—part of her commitment to being a well-rounded physician.