Aging, the Medical Subspecialties, and Career Development: Where We Were, Where We Are Going

Arti Hurria, MD; Kevin P. High, MD, MS; Lona Mody, MD; Frances McFarland Horne, PhD, MA; Marcus Escobedo, MPA; Jeffrey Halter, MD; William Hazzard, MD; Kenneth Schmader, MD; Heidi Klepin, MD, MS; Sei Lee, MD, MAS; Una E. Makris, MD, MSCS; Michael W. Rich, MD; Stephanie Rogers, MD; Jocelyn Wiggins, BM, BCh; Rachael Watman, MSW; Jennifer Choi, BS; Nancy Lundebjerg, MPA; Susan Zieman, MD, PhD

Disclosures

J Am Geriatr Soc. 2017;65(4):680-687. 

In This Article

Abstract and Introduction

Abstract

Historically, the medical subspecialties have not focused on the needs of older adults. This has changed with the implementation of initiatives to integrate geriatrics and aging research into the medical and surgical subspecialties and with the establishment of a home for internal medicine specialists within the annual American Geriatrics Society (AGS) meeting. With the support of AGS, other professional societies, philanthropies, and federal agencies, efforts to integrate geriatrics into the medical and surgical subspecialties have focused largely on training the next generation of physicians and researchers. They have engaged several subspecialties, which have followed parallel paths in integrating geriatrics and aging research. As a result of these combined efforts, there has been enormous progress in the integration of geriatrics and aging research into the medical and surgical subspecialties, and topics once considered to be geriatric concerns are becoming mainstream in medicine, but this integration remains a work in progress and will need to adapt to changes associated with healthcare reform.

Introduction

As recently as 20 years ago, the medical and surgical subspecialties were not focused on the needs of older adults. At that time, Drs. William Hazzard and Donna Regenstreif of the John A. Hartford Foundation (JAHF) outlined a vision and launched an initiative to integrate geriatrics and aging research into the subspecialties of internal medicine (later called the T. Franklin Williams Scholars (TFWS) Program), and the late Dr. Dennis W. Jahnigen articulated a vision for and led an analogous JAHF-sponsored effort focused on surgical and related medical specialties.[1,2] The internal medicine specialties program engaged the breadth of internal medicine subspecialties through their professional societies, and realization of this integration vision accelerated in 2006, with the efforts of a small, interdisciplinary group of investigators who established a home for internal medicine specialists within the annual meeting of the American Geriatrics Society (AGS). Since then, many subspecialties have followed parallel paths to integrate geriatrics and aging research (Table 1). With the aging of the U.S. population and the emerging realization by all specialties that care of older adults is central to their spheres of practice, these topics are becoming mainstream in internal medicine specialties.

Efforts to integrate geriatrics and aging research into the subspecialties have focused largely on career and curriculum development. Annual AGS meetings and biennial alumni meetings have included sessions on job searches, mentoring relationships, grant-writing skills, and research methodologies critical to aging populations, among others. Outside the AGS meetings, the TFWS programs have supported the integration of aging research into career development within the medical subspecialties, which the Atlantic Philanthropies and JAHF have funded and the Association of Specialty Professors (ASP), part of the Alliance for Academic Internal Medicine (AAIM), have administered. Similarly, AGS administered the Dennis W. Jahnigen Scholars Program, which supported career development for surgical and related medical specialists. Approximately 15 grants that the National Institute on Aging (NIA) awards annually through its Grants for Early Medical and Surgical Specialists Transition to Aging Research (GEMSSTAR) program and a number of professional societies across internal medicine now support these efforts.

Since its inception in 2002, the TFWS program has represented an investment of just over $10 million, with TFWS scholars garnering approximately $151 million in grant funding from the National Institutes of Health (NIH) and additional funding from foundations (e.g., JAHF, Atlantic Philanthropies) and other federal sources (e.g., Department of Veterans Affairs). The program has received more than 300 applicants and sparked the careers of 99 scholars. TFWS scholars have matured into valued faculty at every level (including full professors and division chiefs) in 12 internal medicine specialties and have conducted ground-breaking research in their fields (e.g., connections between impaired mitochondrial fatty acid oxidation and insulin resistance in aging,[3] interventions to prevent infections in nursing home residents[4]). Other TFWS scholars have identified potential therapeutic targets in hypertension-associated left ventricular hypertrophy,[5] explored new research directions in high-impact areas such as venous thromboembolism in older adults after joint replacement,[6] shown efficacy of high-dose influenza vaccine in older adults,[7] promoted antimicrobial stewardship in long-term care facilities,[8] reviewed management of persistent pain in older adults,[9] developed tools to understand pelvic floor dysfunction,[10] predicted toxicity and survival in older adults undergoing chemotherapy,[11,12] and conducted randomized controlled trials of interventions against pneumonia.[13] Among the most recent scholars, one is now an NIA Paul Beeson Career Development awardee who has established the prognostic value of frailty in liver transplantation,[14] and another has recently published a paper on the overtreatment of diabetes mellitus in older adults with tight glycemic control.[15]

This is the last year that TFWS scholars will be funded through the Atlantic Philanthropies and the JAHF, because the Atlantic Philanthropies are completing their mission, and the JAHF is moving in new directions. It is therefore a good time to reflect on the progress made in integrating geriatrics and aging research into the medical subspecialties, particularly with respect to career development. This was the focus of a May 16, 2015, session at the annual AGS meeting.

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