Making More Senior Moments
The UND School of Medicine & Health Sciences kicks off North Dakota’s first medical fellowship program in geriatrics.
Edith Wong remembers where she was when the idea of pursuing geriatrics—the branch of medicine that specializes in the health and care of elderly persons—first came to her.
“I was doing one of my first rotations in medical school and was paired up with a general practitioner in Ireland doing geriatrics,” says Wong over the phone from Fargo, N.D., of her medical training at Ireland’s University College Dublin. “I saw he was able to serve this very vulnerable population extremely well and take care of their needs. The reason he was able to do so was because he had a good staff and was able to organize support for patients. That’s something I really wanted to do.”
Of course, Wong adds, a fraught experience with her grandmother’s health didn’t hurt: “She was pretty sick recently and I realized how import geriatrics was for the health and wellbeing of older persons.”
So did Wong end up applying to the new Geriatric Medicine Fellowship offered through UND’s School of Medicine & Health Sciences, a one-year post-residency training program that offers fellows geriatric experiences in the clinic, hospital, and nursing home settings even as they pursue clinical research and quality improvement projects.
Meeting a Need
Three months in, Wong and her co-fellow Haris Ali, who is also completing his fellowship in Fargo, express no regrets.
“It is going well,” says Ali, a native of Pakistan who completed a residency in internal medicine through UND. “I enjoy interacting with the elderly. The atmosphere in the clinic, nursing home, and elsewhere is relaxed and conducive to learning. Our facilitators are accessible and helpful.”
The need for such young fellows is, of course, great. It is well-known that as America’s Baby Boom generation reaches not only retirement age but “elderly” status, the need for physicians dedicated to caring for senior citizens will only increase.
This fact is especially true in North Dakota, which, despite ranking first in the U.S. for Alzheimer’s disease incidence and claiming one of the highest “oldest–old” populations in the country, according to the Centers for Disease Control and Prevention, can name only nine board certified geriatricians still in practice.
“According to the American Geriatrics Society, North Dakota is short 40 formally trained Geriatricians,” explains Donald Jurivich, chair of the SMHS Department of Geriatrics and the driving force behind the fellowship. “The geriatrician shortage is a global phenomenon, though. In the U.S., over half of geriatric training programs go unfilled.”
The reasons for this chronic shortage are many and complex, continues Dr. Jurivich. Whereas some young physicians are reluctant to enter primary care, to which geriatrics is connected, others are dissuaded by the lack of geriatric training they receive during both medical school and residency, especially as it pertains to rural and medically underserved populations. And some simply think—often rightly—that specializing in geriatrics will make it harder for them to pay off medical school debt quickly, relative to other specializations that tend to be more lucrative. For even as health care evolves a vast majority of elderly patients are still insured via the federal Medicare system, which reimburses providers at a lower level than most private insurers for office visits and hospital procedures.
Even so, says Dr. Jurivich, one recent survey of physicians found that geriatricians are among the happiest and most fulfilled health care providers across professions.
“And new research suggests that we can not only measure biological age but prevent and possibly reverse the aging processes,” Jurivich notes, describing how geriatrics leads the way in studies of nutrition, exercise, and interventions such as senolytics—understanding and influencing the senescence (or deterioration) of cells and tissues. “All of these emerging tools of healthy longevity will be guided by geriatricians.”
So it is, says Dr. Jurivich, that the field of geriatrics is much more exciting than the typical student or health consumer imagines it to be—and it’s just beginning to find its voice.
UND’s Geriatric Medicine Fellowship includes slots in Fargo and Bismarck. The program was initiated in 2017 by Guy Tangedahl, MD, a UND clinical professor emeritus in Bismarck, and Jurivich in Fargo. Its incorporation was funded by the North Dakota State Legislature through the North Dakota Health Workforce Initiative, and it has the distinction of being the first ever advanced medical training program in state history.
Wong and Ali are the second and third fellows, respectively, to participate in the program; Karin Willis, MD, completed the fellowship in Bismarck in 2018. The fellowship programs are accredited by the Accreditation Council for Graduate Medical Education with the Fargo program also being given a Meritorious Citation.
Fellows interact with geropsychiatry, neurology, surgery, and rehabilitative medicine and help teach family medicine and internal medicine residents, as well as medical and pharmacy students. Included in their curriculum is training dedicated to improving older adult safety through fall-risk screening programs, an influenza vaccine “blitz” in Fargo, and specialty clinics for comprehensive geriatric assessment, fall prevention, and memory disorders.
The program includes four core faculty—Dr. Jurivich; Lindsey Dahl, MD, assistant professor of Geriatrics at UND; Darin Lang, MD, associate professor of Geriatrics at UND and co-chair of Sanford Health Internal Medicine; and Jane Winston, MD, assistant professor of Geriatrics at UND and certified medical director of the American Board of Post-Acute and Long-Term Medicine.
Exploring Both Sides
Managing the fellowship and assisting fellows with their research projects is Gunjan Manocha, assistant professor of Biomedical Sciences at UND who came to the School of Medicine & Health Sciences for the express purpose of studying Alzheimer’s disease.
“Alzheimer’s is the most common form of dementia and it affects a person’s ability to carry out daily tasks,” adds Manocha, who works to help fellows and other medical students understand Alzheimer’s and other diseases of old age from the laboratory perspective. “North Dakota has the highest percentage of persons with Alzheimer’s in the nation. For me, the impact that the disease has on caregivers is what drives me to continue to work in understanding the disease and help come up with a cure.”
Back in the clinical setting, Wong pauses when asked what she might say to medical students to encourage them to pursue geriatrics either as a physician or researcher.
“Dealing with geriatrics engages a lot of specialties,” she says after a moment of reflection. “It acts as a bridge between primary care and specialty care. In geriatrics you’re able to explore both of these sides of health care, which I find enjoyable. I’m able to become an expert in a field, but don’t have to give up being able to take care of the entire person in a holistic way—that makes me really excited.”