A quarter century in developing geriatric programs at three academic health centers: highlights and lessons learned

J Am Geriatr Soc. 2014 Jun;62(6):1179-83. doi: 10.1111/jgs.12844. Epub 2014 May 13.

A quarter century in developing geriatric programs at three academic health centers: highlights and lessons learned.

Hazzard WR1.

PMID: 24823875 DOI: 10.1111/jgs.12844

In 1975, Bob Petersdorf, my Medicine chair at the University of Washington (UW), called me to his office and without preamble asked me to assume leadership of the nascent program on gerontology and metabolism recently initiated in his department at the Veterans Administration (now called Veterans Affairs) (VA) Medical Center by Ed Bierman, my research mentor (who had just agreed to move to University Hospital as head of Endocrinology and Metabolism). Petersdorf extended his hand, I shook it, and the deed was done: no negotiations about positions, space, or salary and little discussion of its mission other than his stipulation that geriatric medicine—the medical care of elderly adults—needed to be added to gerontology (the study of aging) as the program grew toward divisional status.

Why did I immediately accept this offer? Most of all because I respected and trusted Bob, we loved Seattle, and I needed a job! At the time I was a 39-year-old untenured associate professor and investigator of the Howard Hughes Medical Institute (HHMI) as Director of the National Heart, Lung, and Blood Institute–funded Northwest Lipid Research Clinic (NWLRC) at Harborview Medical Center, the safety net public teaching hospital in central Seattle. I had learned over my decade at the University of Washington that this new and growing medical school was conceived in an academic model heavily dependent on National Institutes of Health (NIH) funds and that to remain on the faculty, I would have to assume an important departmental role, even while effectively remaining self-supporting from nongovernmental sources, NIH research grants and clinical funds. At Harborview, I could leverage NWLRC resources to direct my research toward a program of preventive gerontology, with special focus on hormonal modulation of the sex and gender differential in lipoprotein metabolism, cardiovascular disease, obesity, diabetes mellitus, and longevity, and as a young medicine faculty attending physician active on the wards, I was a familiar face to faculty and house staff at that busy inner-city hospital. So, impulsively entrusting my future to my charismatic chairman, I placed my fate in his hands—but with no real sense at the time of what opportunities and challenges I would face in my new career in gerontology and geriatric medicine.

Thus, with the continuing support of Ed Bierman, we set out to build the “SeniorCare” geriatrics continuum at Harborview with encouragement from leaders there in hospital administration, nursing, and social work. Most instrumental in my education in this field was a full year of sabbatical study (with HHMI support) in 1977–78. Upon the advice of (Sir) Paul Beeson, recently recruited by Petersdorf to the University of Washington from Oxford, our family spent the year in the United Kingdom for me to study the British approach to geriatrics as a visiting lecturer in their famed National Health Service. In Oxford, geriatrics was a department in its own right, centered in the Cowley Road Hospital, a nineteenth-century institution on a “poor farm” campus, and had little connection with the Department of Medicine or the rest of Oxford University near the center of town. Suffice to say that, although I treasure indelible memories and lessons learned from that year, I returned to Harborview convinced that in the United States, geriatric medicine should be developed at the most prestigious academic health centers (AHCs) on the same platform of excellence in cutting-edge research as any other NIH-funded specialty to ensure that “the best and the brightest” would be attracted to our futuristic field—an upward-directed trajectory that would be self-sustaining and in the best interest of aging and elderly Americans to extend their “health span” until very near the end of their God-given life span.

So I returned to Harborview and the NWLRC determined to earn the continuing respect of University of Washington colleagues and leverage our resources through NHLBI-funded metabolic clinical research with the assistance of talented metabolism fellows and faculty. Early on, this seemed promising, especially when our first geriatric fellow, Marsha Fretwell, a charismatic former chief resident recommended by Petersdorf, proved a veritable Pied Piper to students, residents, and future fellows, and the growing multidisciplinary SeniorCare program flourished in new inpatient and outpatient facilities.

However, .....................................

https://www.ncbi.nlm.nih.gov/pubmed/24823875 http://onlinelibrary.wiley.com/doi/10.1111/jgs.12844/full