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Chapter I: Expanding Academic Geriatrics Programs

5. Big Picture Perspectives on Expanding Geriatrics Programs

The challenge: To incorporate big picture trends into strategies for academic geriatrics programmatic growth and development

Summary

Leaders are challenged not only to improve core training, research, and clinical services, but also to think and act strategically regarding big picture trends that are likely to shape the future of academic geriatrics. “If you stay the same you fall behind — everybody has to compete just to maintain and to compete at every level,” stressed one geriatrics leader. Getting ahead of the curve requires building on program strengths, and being aware of how to align national trends with your institutional mission and locale. While no one can predict which trends will emerge as the most important in the field of aging and geriatrics, several physicians, whose careers in academic geriatrics have led to leadership roles at national organizations and major programs, urge an activist role for academic geriatrics in the following areas:

  • The growing quality care movement
  • Engagement with policymakers regarding key issues, such as “medical home” legislation, increased funding for training, and enhanced reimbursement based on credentialing
  • New partnerships with schools of public health.

Such challenges, along with others addressed elsewhere in this report, suggest the timeliness of creating a national center, as proposed by Dr. Christine Cassel, dedicated to enriching academic geriatrics management and leadership skills.

Strategies

Capitalize on the quality care movement. Dr. Cassel, who is executive director of the American Board of Internal Medicine (ABIM), suggested a focus on quality issues in geriatrics. “Any way in which geriatricians are seen as vital resources for hospital problems and challenges will help the field. This may mean that academic geriatrics programs will have to develop skills they don’t have, recruit those in quality improvement science and measurement, and develop a more sophisticated understanding of Medicare and other payers in their area.”

Engage legislators.

“Make legislators feel that what is going on in academic geriatrics and research is part of their community, part of something of national interest that should be high on their radar screens.”

Judith Salerno, MD, MS, Institute of Medicine

Engage in the public policy arena. Demonstrate excellence in key policy issues, raise the visibility of geriatrics in those areas, and enhance relationships with legislators. For example:

  • Develop expertise in policy issues. “The collective body [of academic geriatrics] needs to have more impact,” Dr. Cassel said. “But as we look at these struggling academic centers, I suggest that each program has a couple of people working on policy.” She notes the advantage to geriatrics of having faculty who can help the dean figure out how to utilize new opportunities. For example, although Dr. Cassel does not see academic leaders paying attention now, “as soon as there is money on the table, they will say, ‘Why can’t we be a medical home?’ Geriatrics programs need someone inside who goes to policy meetings to learn about the issues, and who can be valuable on their own campus.”
  • Increase the visibility of geriatrics in the policy arena. “The policy arena is very hot right now,” Dr. Cassel said. “We really need new blood, as well as sustained senior leadership in this area.” She strongly supported efforts to enhance the role of board-certified geriatricians in forthcoming Medicare demonstration programs, so that the primary care field does not dominate initiatives directed at frail older adults. “We [at the ABIM] are studying the primary care shortage with policymakers. Everyone has focused on the decline in primary care. What is happening in geriatrics is part of the same phenomenon, but more so.”
  • Focus on tying reimbursement to credentials. Jack Rowe, MD, professor at the Mailman School of Public Health at Columbia University (and retired Chairman and CEO of Aetna, Inc.), argued that the only way for the academic geriatrics model to become self-sustaining is to improve reimbursement. Referencing the April 2008 Institute of Medicine report, Retooling for an Aging America: Building the Healthcare Workforce—for which he served as chair—he emphasized that an “increase in payments is not only essential but also realistic. Senators are usually ‘allergic’ to increased payments, but substantial increased payment for those who are qualified is not really going to cost anything because of the small number of board-certified geriatricians.”
  • Don’t neglect modification in compensation schedules. Dr. Rowe’s interest in geriatrics “led me to get Aetna more involved in the Medicare program. I hired a geriatrician to be the head of Aetna’s Medicare and disease-management programs. Some of these programs focused on frail older adults are very promising. Coming out of Aetna, I saw the incredible power of modification in compensation schedules. Physician behavior is incredibly influenced by even small changes in compensation levels, and those in academic geriatrics have not focused on that.” (For further information on geriatrician compensation see Resources below.)
  • Bring legislators to the academy. Dr. Judy Salerno, who became executive director of the Institute of Medicine in 2008, noted: “When Congressional representatives are in their Washington offices, you might get in the door if you are from their districts. But you can have an even greater impact if you interact with them when they are in their district offices, where they can see the connections between academic geriatrics programs and community services. Invite them into academic settings to give a talk or have a tour.” (See Resources below.)
  • Create teaching moments. Dr. Salerno, whose background includes leadership of a multi-city program linking medical students and active older adults, Vital Visionaries, suggests seeking “ways to spotlight what you are doing through community-based programs. Those are teaching moments for the geriatrics community to educate members of Congress.” She also suggests a “National Take Your Senator to Home Care Day” to show them how “fundamentally important to quality of life and aging the geriatrics care team can be.”

Expand partnerships with schools of public health. Several CoEs utilize their schools of public health for research training for fellows. Some geriatrics faculty have MPH degrees and/or conduct collaborative research with public health colleagues. Two deans envision further connections. Linda Fried, MD, MPH, who left the geriatrics division at Johns Hopkins School of Medicine in 2008 to become dean of the Mailman School of Public Health at Columbia University, emphasized, “There needs to be intentional investment. I took the job at Columbia because I felt that in parallel with clinical geriatrics, we had to have public health embracing geriatrics, which is not done currently.” Dr. Robert Golden, dean of the School of Medicine and Public Health at the University of Wisconsin-Madison, reported that his school is going through a unique transformation: “It is the first in the country with a combined School of Public Health and Medicine that melds together the full continuum of basic science and clinical care. We have a geriatrics center and cancer center, and want to link community-based screening programs with molecular biology programs.” Crediting his predecessor, he reported, “This whole vision was crafted even before the National Institutes of Health Clinical and Translational Science Awards (CTSAs).” (For more on the CTSAs, see Chapter 2.)

Create a National Center for Academic Geriatrics. Dr. Cassel suggested creating a national center specifically focused on management issues necessary to develop and expand academic geriatrics programs. Geriatricians not only “need a broad spectrum of medical knowledge, but are also asked to be good systems managers, manage teams, and deal with managed care,” she explained. “These are all skills that require a lot of training, which most physicians don’t receive.” As a model she suggested the Center to Advance Palliative Care, which combines training, consultation, networking, and other resources.

Resources

For the Institute of Medicine’s 2008 report, Retooling for an Aging America: Building the Healthcare Workforce, and related PowerPoint and other materials, see the IoM web site:
http://www.iom.edu/?ID=53452

For information on geriatrician compensation and other geriatrics workforce issues, see the Association of Directors of Geriatric Academic Programs (ADGAP) Status of Geriatrics Workforce Study web site: http://www.adgapstudy.uc.edu/Home.cfm

See also the Health and Human Services Bureau of Health Professions National Center for Health Workforce Analysis web site at: http://bhpr.hrsa.gov/healthworkforce/

For information about Medicare’s Pay-for-Performance (P4P) programs, see the American Geriatrics Society web site: http://www.americangeriatrics.org/policy/2006p4p_indext.shtml

For information about geriatrics and health policy and advocacy, see the American Geriatrics Society web site: http://www.americangeriatrics.org/policy/

For information about a geriatrics and healthcare quality scholars program, see: the Special Fellowship Program in Advanced Geriatrics of the Center for Primary Care and Outcomes Research of the Stanford School of Medicine and the Center for Health Policy of the Greeman Spogli Institute for International Studies web site: http://healthpolicy.stanford.edu/fellowships/special_fellowship_program_...

For information about geriatrics quality assessment, see The RAND Assessing Care of Vulnerable Elders (ACOVE) project: http://www.rand.org/health/projects/acove/


Continue to Chapter Two, Managing Training and Research Activities ⇒

Chapter I: Expanding Academic Geriatrics Programs

4. Using Consultants

The challenge: To call in outside help—or not—when your program’s growth and development hits a roadblock

Summary

CoEs sometimes encounter roadblocks or reach plateaus. Leaders may wonder if it would be helpful to bring in outside consultants. In fact, a number of CoE directors have used consultants strategically; some thought their use should receive greater support because of the benefits.

Among the most popular consultants were senior geriatrics leaders who: (1) had extensive program development experience and were also knowledgeable about other CoEs; and (2) had specific areas of expertise, such as business models to establish palliative care services. External advisory committees were also mentioned by several leaders as sources of guidance and insights that have proved invaluable for early planning and during critical junctures when a change of course might be in order. Consultants can also be extremely helpful when embarking on a new initiative that is meeting resistance.

Strategies

Use a consultant for objective insights. A consultant with expertise in academic geriatrics can bring a reality-based perspective to your program. They can help you make crucial decisions about goals based on: (1) other successful programs; (2) their own program’s particular stage of development; and (3) roadblocks they have faced. A consultant can hold up a mirror and provide an objective perspective on what your program looks like from the outside. Consultants don’t always tell you what you want to hear, but the lessons are valuable by providing objectivity and advice on future directions.

A small investment can yield a big return.

“A consultant is a relatively small investment to obtain an external calibration of your program’s strengths and weaknesses.”

Christopher Callahan, MD, Indiana University

Use a consultant when you want your leadership to really hear what your program needs to succeed. A consultant from another well-established, highly regarded program can help get your dean’s or chair’s ear. Even if the consultant tells the leadership the same thing you have been telling them, they hear it in a different way. A geriatrics leader who has served as a consultant visited a CoE and met with the dean and the chair of medicine. Having been an interim dean himself, he was able to talk with the leadership in their own language about how to help their new division chief succeed, and how to position geriatrics within the larger institution.

Use a consultant to tell uncomfortable truths to administration. Senior consultants from well-established geriatrics programs can sometimes better explain and sell what a dean may not want to hear. Academic administrators are often focused on programs becoming financially self-sufficient, an outcome that relies, in part, on strong reimbursement for clinical services—clearly not the case for geriatrics. Nevertheless, while “self-sufficiency” may not be a realistic goal for academic geriatrics, a consultant can identify steps adminstration can take to ensure a robust program that contributes to the institutional mission.

Use a consultant to help launch new (or misunderstood) programs. Several CoEs have used consultants to help launch palliative care programs, particularly when meeting resistance from hospitals concerned with losing revenue. According to leaders who have brought consultants to their campuses, hospital administration was able to hear “the same message a little better” when it came from a consultant specializing in creating business plans for palliative care rather than when it came from geriatrics staff engaged in palliative care. There was a “180 degree shift,” noted one leader. (See Resources below.)

Close-up

A steady diet of consultants. Dr. Christopher Callahan reported that Indiana University’s geriatrics program used Harvey Cohen, MD, from Duke University as a consultant. Dr. Cohen had “an interest in providing advice and cheerleading for expanding the nation’s aging centers.” In turn, he recommended George Maddox, PhD, from Duke, who focused on Indiana’s aging research initiative. Drs. Cohen and Maddox helped geriatrics leaders understand various developmental phases, starting with the need to build a strong foundation. Their messages included the need for consistent leadership and investment over a long period with incremental growth, and for building on local strengths and local culture.

Dr. Callahan recalled that “consultants can also ‘speak truth to power.’ When asked by Indiana’s administrative leadership how long it would take our program to become self-sufficient, Dr. Cohen—director of one of the most successful programs in the country—answered, ‘Never.’ You could have heard a pin drop! However, Dr. Cohen explained what the institution could expect out of this endeavor in the short run, if they wouldn’t saddle it with too many research themes or curriculum development. Although it sounded shocking when he said it, it worked and was extraordinarily important,” he said. Dr. Callahan also noted the contributions of other senior leaders, such as Jeffrey Halter, MD, from the University of Michigan, who served on Indiana University CoE’s external advisory committee for the first few years.

Resources

For a case study of a palliative care consultation, see: Two Struggling Academic Palliative Care Centers Get Management Advice to Help Stabilize on the Robert Wood Johnson Foundation web site: http://www.rwjf.org/reports/grr/046742.htm



Continue to Section 5, Big Picture Perspectives on Expanding Geriatrics Program ⇒


Chapter I: Expanding Academic Geriatrics Programs

3. Fundraising Strategies

The challenge: To add local philanthropy to the mix of funding sources

Summary

Across CoEs, there is tremendous variation in fundraising activities among geriatrics programs, in part because it can be daunting to find one’s way through the development maze at some institutions. Institutional rules for approaching donors and channeling donations vary. For example, at one university, all gifts must be directed to the sole fundraising arm of the university, its 501(c)3 foundation.

Most institutions have development departments. However, geriatrics leaders report varying degrees of fundraising support for geriatrics and aging-related programs. Geriatrics programs also have to contend with the fundraising competition between the medical school and hospital development departments. This can lead to grateful patients and families overlooking the contributions of the medical school in favor of the hospital. Some programs with more resources, including those with high-profile centers on aging, have undertaken their own fundraising activities.

While some leaders are actively engaged in fundraising, others shy away from it because they are uncomfortable asking patients, family members, or community members directly for donations. Only a few geriatrics programs have dedicated development staff (either in the institutional development department or the geriatrics/aging program itself) who are available to manage fundraising, bridge the connections between potential donors and geriatrics leaders, and prepare physicians to talk to donors in an effective manner.

The approaches described here suggest ways that geriatrics leaders might become more actively engaged in local fundraising.

Strategies

People donate for excellence, not to pay the rent. People don’t like to give money for basic needs. Many donors already know from their experiences that a geriatrics program makes a valuable contribution. They may want to help develop excellence in a particular area, so pleading poverty is not a good way to raise money. These views are echoed by healthcare fundraising gurus and authors Fitzpatrick and Deller, who observed: “People give when there is a vision; need alone is not sufficient.” (See Resources below.)

Accentuate the positive. Be firmly convinced that what you are doing is a worthy cause to support. Don’t get into a bunker mentality about caring for aging patients and geriatrics. People want to hear why you are so hopeful—that geriatrics has so many opportunities—not that it’s so bad. And practice that!

Foster relationships with development officers and educate them about your program. Even where there is not an active officer focused on aging, development departments have lists of potential donors about whom they have gathered significant information, including their donor history, level of wealth, and particular interests. Development officers work in a highly competitive environment and are under tremendous pressure. Geriatrics leaders who stay in touch, share information about program successes, and in other ways make it easier for development officers to function, may receive more attention. For example, one geriatrics leader e-mails the development staff at her institution with updates on aging-related projects. She also includes development officers in funded project site visits, which is a perfect way for the officers to learn about the program. Another leader has an annual meeting with faculty and development staff to update them about new geriatrics initiatives, successes, and opportunities.

Give credit where credit is due.

“We want development officers to know that we see them as a friend and we give them public credit for any gift that is sizable. I write a letter to the dean and mention the specific development officer who helped us get the gift.”

Jeff Williamson, MD, Wake Forest University

Build a foundation of reciprocity. Recognize opportunities to establish a give-and-take with development officers. For example, if a development officer asks for a geriatrician referral for a donor or donor’s family member, use this as a time to reinforce your partnership with them. Remind them that when they encounter donors wishing to support geriatrics, they need to honor those wishes and not divert the donors to other areas.

Get word of your accomplishments out to development departments. Because development officers often look to public relations to highlight particular areas of interest to donors, send PR staff your program newsletters and press releases. Also, take advantage of the expanding media coverage of aging-related issues and geriatric medicine. (See Resources below.)

Take credit where credit is due. When the opportunity arises, make sure that patients and families, who are potential donors, recognize which program is responsible for the care received. A little PR about geriatrics is in order. The boundary between the medical school and the hospital is blurred in the patient’s or family’s mind, so the gift is often directed to the hospital. Even faculty can be seen as part of the hospital. This is particularly important because many hospitals have their own development staff who target the same potential donors.

Engage your audience. Be sure to speak to potential donors in lay terms and connect your work to something that is meaningful to them. Develop straightforward explanations of what you do, why you do it, and why it is important. At one institution, a development specialist observed, “We prep clinicians along with our aging center’s administrator. If we are introducing a physician to a donor, we give the physician personal and business background information on the donor. We also coach doctors to speak in lay terms, and tell them to limit graphs, which can be difficult for people to follow.” Physicians who are more at ease with donors are called on more often to discuss their work.

Train clinical faculty so they won’t be tongue-tied with potential donors. Develop practice sessions to help clinical faculty overcome their discomfort with discussing money with patients. Help them learn what to say when grateful patients and/or families express an interest in contributing money to geriatrics, and give them information materials that they can pass on to potential donors.

Create a geriatrics fundraising brochure. Develop a brochure to give to grateful patients and families that identifies opportunities to contribute to the geriatrics program. It should emphasize that any level of funding can make an important difference. Such a brochure can be a useful aide for clinical staff who may be uneasy speaking directly with patients and families about contributions. The brochure can give potential donors something to hang on to after discharge. It should include the contact information of whom to call (a program leader or designated fundraiser) for a detailed and personalized discussion about specific areas and levels of contributions. Ensure that such a brochure is readily available to clinical staff and visible to patients and families at key outpatient and inpatient sites.

Tune in to donors’ interests. Avoid trying to steer a potential donor towards a favorite project that may not be what the donor is ultimately interested in. Instead, tune in to donors’ own interests and find a match.

Offer a variety of opportunities to give. To the extent possible, provide options for different ways to give. One useful strategy is to set up targeted accounts with the development department so donors can direct their donations to areas that interest them, such as specific research areas, fellowship or junior faculty training, or clinics. At one institution, a year-end solicitation letter is accompanied by a wish list of specific items needed by researchers. When a specific option catches a donor’s attention, a $100 check could turn into a $400 fax/copier or a $1,000 chair scale, particularly for an older person who has previously teetered on a standard stand-up scale.

Get up close and personal. While mounting a gala event can generate large dollars, it also demands tremendous resources. An alternative—or additional—approach is to offer opportunities for more intimate discussions. At one institution with an active center on aging, small groups of potential donors are invited to meet with junior researchers, hear presentations about their research, ask questions, take a tour of a lab, and have lunch with them.

Find someone who is comfortable talking money if you are not. Some programs are able to afford at least a part-time dedicated fundraiser. But if you cannot count on your institution’s development department to manage fundraising for geriatrics, consider getting the names and information about potential donors and then creating your own fundraising opportunities. Some programs gently yet enthusiastically guide the potential donor(s) from the front-line clinical staff to the program leader, who is more comfortable talking about money.

Learn to be comfortable asking for money.

“Geriatricians create tremendous good will, yet are uneasy asking people for money, creating a group of donors from family members, or cultivating wealthy family members. My advice is, get over it! Wealthy people want to give, and they will give to someone!”

Christine Cassel, MD, American Board of Internal Medicine

Engage and educate estate lawyers. Geriatricians sometimes work on competency issues with lawyers who also do bequests and trusts. Ask lawyers you work with to keep your program in mind when they are discussing bequests with clients. At one institution, a leader reported that the largest gift it ever received was a settlement from a lawsuit in which the client wanted the money to go to the medical school to help the geriatrics program. When you get a call from a lawyer about a possible donation, give her very specific information about how to direct the donation to your program and not to the institution at large.

Close-ups

An activist for fundraising. For the University of Hawaii’s geriatrics department, fundraising from local donors accounts for 15 percent of their overall funding. The department chair, Patricia Blanchette, MD, stays actively engaged with the university’s development staff, because at times there is no development officer assigned to the medical school. “I continuously build relationships and send e-mails about important goings-on within our department. They say that I am one of the few department heads that keeps them in the loop, so they think of us when there is a potential major donor who is not committed.”

To address competition from the hospital’s development department, Dr. Blanchette teaches junior physicians that “if a family sounds grateful, one of the things they can say is, ‘I don’t know a lot about donating to the medical school, but may I introduce you to the school’s foundation officer?’ Even though our geriatrics ambulatory clinic is ‘very small potatoes,’ it has generated several large gifts given its size.” She believes this clinic and another small clinic dedicated to Alzheimer’s disease have received donations because of clear communication with the public. For example, signs identify that care is provided by the University of Hawaii School of Medicine, and that the clinics are part of the medical school and train practitioners. As a result, “grateful patients have come to us to support our clinical operations with both small and large gifts,” she said.

While the typical fund-raising process involves introducing families and patients to foundation officers, sometimes Dr. Blanchette takes the lead. “I have learned that it is important to know the donor’s wishes, and whether they may want to work directly with me rather than with a development officer. A particular donor did not like the way the university’s foundation wrote their thank-you letters, so now I write my own thank you worded in a way that I know she will appreciate. She now gives quite a lot of money and our program is in her will.” Dr. Blanchette also consults with estate lawyers on guardianship issues. “Because they know about our program, they have directed contributions from other clients’ estates or from lawsuits to our program.” Her largest gift to date—$600,000—came in this manner.

Allies in fundraising for aging and geriatrics. At the Baylor College of Medicine, the Huffington Center on Aging gives 100 percent of funds it receives to geriatrics education and research. Supporting clinical fellows has become the shared mission of George Taffet, MD, Baylor’s CoE director, and the Huffington Center director, Roy Smith, MD. “We have developed relationships with members of the development board and provided clinical care for them and their families,” Dr. Taffet explained. Along with funding second-year fellows, money raised by the Huffington Center has supported research. “We had a young Alzheimer’s researcher whose lab received $200,000 from local donations, Huffington Center money, families and others, including funds raised from the Huffington Gala, its Spring Forum, and a raffle.” Dr. Taffet works with a part-time, salaried development specialist at the Huffington Center. She has established cordial working relations with the college’s development department, which provides names of (and information about) potential donors to the center. For their part, she and center leaders keep development department staff informed and work to ensure that they “do not step on anyone’s toes.”

The Huffington Center’s development board, which is made up of prominent leaders in the community who meet four times a year, also plays an important role, particularly in supporting second-year geriatrics fellows. To give potential donors a choice and allow flexibility, the center has a variety of donation opportunities. A year-end solicitation letter, sent to approximately 3,000 former and potential donors, includes a “wish list” of specific items needed by the researchers in aging, such as a microscope.

The center’s face-to-face meetings between geriatrics leaders, junior faculty, and potential donors are a highly successful effort. The largest event is an annual luncheon called the Women’s Health Summit, which raises money for fellows. Prior to the luncheon, physicians from Houston and elsewhere speak to the lay audience about aging-related topics. To make things “more real,” the center hosts small luncheons that incorporate several consecutive lab tours and a talk by a researcher. These well-received and highly appreciated meetings usually attract 15 to 20 people, including new potential donors recommended by the center’s board. The development specialist added, “We bring in a young physician to speak to the board about what they are working on. It could be someone who is treating their family members. This makes the results of donations tangible. A young physician doing research is an easier sell than speaking about aging in general. It is a struggle to get people interested in aging, and there are other competing local charities, such as the MD Anderson Cancer Center and a children’s hospital. We also have a newsletter and we feature updates on fellows’ research.”

A low-key fundraising strategy that works. At Wake Forest University, Dr. Jeff Williamson, CoE director, has created a fundraising process that:

  • respects the doctor-patient relationship
  • minimizes the potential conflict of interest faced by physicians thrust into the fundraising role
  • addresses physicians’ discomfort with directly asking for money.

The strategy is a response to patients and families who wish to support the mission of the geriatrics program “because they believe in what we do,” Dr. Williamson said. “While clinical faculty have never asked one person for money, over the past eight years our program has garnered $7.5 million in philanthropic gifts.” Contributions range from $100 to $500,000.

Dr. Williamson holds an annual session with clinical faculty to help them respond to inquiries from patients and families who wish to donate to geriatrics. He uses practice scenarios of patients/families who inquire about making a contribution—situations in which faculty might get tongue-tied and miss an opportunity. Faculty members are given a script to work from that begins with expressing gratitude to the potential donors. They then share a brochure that describes opportunities to contribute to the geriatrics program mission, with Dr. Williamson’s contact information. Patients and families are reassured that Dr. Williamson will be happy to talk with them about the program’s needs. The program brochures are also displayed prominently in waiting rooms, clinics, and the hospital’s acute care unit.

“When potential donors call, I explain that without community support we could not do what we do and there are a number of ways to support us.” He mentions a range of options, such as “training doctors about caring for older adults, interesting scientific pilot studies that are ‘shovel ready’ but do not require a lot of money to get started, and major programs we want to develop.” He tells them he will send information and also asks what they are interested in. When they tell him, he responds, “I would love for your [patient’s] doctor and me to put together a list of possible things you could support, and we could have lunch with you in the next month or so.”

Before introducing the potential donor to the development office, Dr. Williamson prefers to wait until he has a pretty firm idea about what the donor wants to support. Sometimes he invites a development officer to the lunch to underscore the donor’s commitment to geriatrics. Each year, he also arranges for the development office to meet with faculty to hear what they are doing individually and what the program’s needs are. In turn, Dr. Williamson periodically speaks about geriatrics at one of the quarterly dean’s donor forums or the annual planned giving advisory board meeting. “Identify a development officer who will work closely with you, and be very generous with your credit to them in particular. Our VP for development has become such a strong believer in our work that he developed a named fund in honor of his parents. This fund sponsors a junior faculty member’s research project each year—evidence that we are on the same team.” He recalled advice from one of his mentors and former chair, William Hazzard, MD: “Always make sure that whatever you accomplish, the people supporting you feel that your success is their success.”

Dr. Williamson urges his colleagues to stay true to the primary mission: “To provide the best care and exemplary research and teaching, not convert to being a fundraiser.” He sees his program’s fundraising success as “30 percent brochures and 60 percent learning what to say, in the context of superb research, education, and clinical care.” He also urges his faculty to view gifts as donations to the entire group. “While much of a gift might go toward a specific person, no one is an island and sharing success across all missions is part of the fabric of our program. You might call it ‘translational fundraising!’ ”

Resources

For more about coverage of aging issues in the media, see The New Old Age Blog of the New York Times: http://newoldage.blogs.nytimes.com

See also the American Geriatrics Society’s Press Room on its web site: http://www.americangeriatrics.org/news/

For resources on fundraising for health, see the Getting Started: Fundraising for Health resource list at the Foundation Center web site: http://foundationcenter.org/getstarted/topical/health.html

See also a book from two development specialists: Fitzpatrick JJ and Deller SS. Fundraising Skills for Health Care Executives. New York, NY: Springer Publishing Company, Inc.; 2000.


Continue to Section 4, Using Consultants ⇒


Chapter I: Expanding Academic Geriatrics Programs

2. Building Clinical Revenue

The challenge: To explain the longer-term financial benefits of geriatrics to hospitals and outpatient clinical services

Summary

Mastering and communicating the financial side of clinical services is an increasingly prominent aspect of being an academic geriatrics manager. Some geriatrics leaders successfully make the case that a strong geriatrics program has long-term benefits for a hospital and the larger institution (for example, lower rates of re-hospitalization). This has created a stronger bargaining position for geriatrics. Some leaders have conducted formal reviews of their clinical services and have refocused them so they are better linked to academic and institutional missions and priorities, such as the competitiveness of the local market or the value of downstream revenues generated by geriatric primary care services. Geriatrics leaders are developing or expanding new venues for clinical care, adding contracts with continuing care communities, hospices, home medical care services, and inpatient assessment units.

As opportunities grow for geriatricians to blend their expertise with subspecialty colleagues in the care of sick older patients, leaders may seek to change longstanding institutional arrangements in order to make geriatric care financially viable. For example, at one medical center, a geriatrician with expertise in oncology persevered in his goal of joining an oncology clinic. At another medical center, the geriatrics program embarked on a new clinical program focusing on dually eligible patients. As a result, clinical revenues grew substantially. Palliative care services are another example. Many leaders have already established such services in hospitals and some are working to expand them into outpatient settings.

New clinical initiatives often meet with resistance from hospital and institutional administrators. To strengthen their case, geriatrics leaders are adding clinical budgeting and financial and clinical data tracking to their management skills. In addition, they are seeking assistance from consultants and other outside experts to enrich their strategies and develop more sophisticated business plans. Start-up funding is necessary because gathering crucial information to demonstrate value and viability depends on initiating services. At institutions where clinical administrators have balked at providing that initial support, leaders have acquired seed money from their chairs, foundations, or other sources.

Regardless of the clinical setting or type of services, leaders stressed that generating clinical revenue must never take priority over the quality of care provided. Clinical faculty should not be stretched so thin that they cannot do a good job of taking care of patients.

Strategies

Pay attention to the bigger bottom line. When reporting on costs and benefits of geriatrics services, don’t just look at immediate financial data—seek information that addresses the impact of geriatric clinical services on the institution over time. Take into account bigger picture issues that may be of particular interest to institutional leaders. Examine a variety of variables, such as lower re-admissions of patients cared for by geriatricians, and increased patient satisfaction. And, consider cost-saving strategies such as:

  • improving discharge planning to reduce the likelihood of readmission within 30 days
  • reducing the number and cost of medications used during the hospital stay
  • reducing duplication of services such as laboratory tests and radiology through better coordination of information across inpatient and outpatient settings.

Enhance geriatrics’ visibility in the hospital setting. Geriatrics in-service programs and clinical revenue can be enhanced by increasing the visibility of senior faculty throughout the hospital so they can interact directly with other specialists. Don’t rely solely on geriatrics fellows to provide in-patient care, with senior faculty involved only behind-the-scenes. Opportunities for closer contact between senior faculty and other specialists can help to increase geriatrics consults, particularly in relation to discharge planning. A senior faculty member can make the case to peers that geriatricians have the most knowledge and experience with care transitions, and understand what is possible (after discharge) in home care, nursing homes, and other long-term care settings.

Control of your money is extremely important, so negotiate. At one institution the geriatrics leader negotiated the clinical budget with administration. This allowed him to create an account that could be used in any way within legal limits. He discontinued the practice of supplementing clinical losses with medical administrative fees. Instead, he arranged to allocate contracts separately within the clinical budget by establishing three distinct funds:

  • a university account for dollars from outside entities, such as grants and other sources
  • money for the clinical budget, such as medical director fees that include overhead costs
  • revenue generated from seeing patients.

The healthcare system supplemented outpatient care activities. One benefit of such an approach is that when you are applying for a matching grant, you can use some of your administrative support as your share of the match.

Whether division, department, or interdisciplinary center, ensure that geriatrics has a place at the leadership table. The structure of a geriatrics program may vary depending on institutional history, resources, and other factors. Gregg Warshaw, MD, director of geriatrics at the University of Cincinnati College of Medicine, emphasized that no matter what the structure, the geriatrics program director’s status needs to be equivalent to a department chair, in a setting where he is recognized as a program leader and is included at the table with cancer center directors, chairs, and others. Dr. Warshaw noted that the Hartford CoE and Donald W. Reynolds Foundation Aging and Quality of Life grants have been very helpful in positioning geriatrics at this level in the medical school administrative structure. This support has enabled deans to accord geriatrics this stature.

Conduct a strategic review of your clinical services. Having a huge clinical program can detract from the basic missions of teaching and research. Some leaders have purposely limited clinical services to better meet geriatrics program and institutional missions as well as local market factors. An in-depth review can generate stronger, smarter programs by: (1) tapping the experiences of faculty, trainees, colleagues, and administrators; and (2) gathering strategic data focused on efficiencies, quality, and revenues. A review at one institution led to changes including greater integration of clinical services with training and research; more efficient use of faculty time; improved care quality; heightened visibility of clinical services, research, and senior faculty; and enhanced revenue generation. Be sure to incorporate your institution’s mission, priorities, and activities into your review. In situations where high-level administrators value “downstream” revenues generated by geriatrics clinical services, where a highly competitive market exists, or where there is a high penetration of managed care, there is the potential for enhanced institutional support for expanded geriatrics clinical services. Therefore, make the case for how your program can provide value through more efficient and high quality care.

Put quality first.

"When you are starting a new clinical service, be sure it is a top quality service, and that will build momentum for you. Quality is much more important up front. Then you can work on the efficiencies."

Steven Counsell, MD, Indiana University

Build on your own prior experiences and the successes of others. Leaders who have begun clinical programs at other institutions take their best ideas with them to new positions. This could include outpatient or inpatient consultation services, an Acute Care of Elders (ACE) unit, a post-hospitalization medical house calls program, or a geriatrics medical home program. If yours is a new program, review the literature, but also visit model programs for each of the service areas you are contemplating. Learn first-hand from others who have worked out the kinks so you can avoid unnecessary steps while identifying best practices and putting them in place. One leader who had started an ACE unit recommended visiting several model programs, identifying the best ones, and asking their leaders to come to your hospital to help you implement yours. Sometimes doctors don’t ask for help, he noted, but it can save a lot of time, such as when his program adopted a strategy used successfully by another program—initiating team rounds for complicated cases.

Explore new clinical opportunities in long-term care. The expansion of Continuing Care Retirement Communities (CCRCs) across the country offers academic geriatrics advantages over freestanding nursing homes. CCRCs can:

  • support an outpatient as well as a nursing home practice
  • generate more substantial revenue for geriatrics through significant medical director contracts
  • offer expanded opportunities for training and faculty involvement
  • reduce clinical overhead compared to office-based outpatient geriatrics (One leader estimated the overhead costs for office-based outpatient geriatric primary care at about 60 percent.).

Keys to success include identifying the right kinds of CCRCs and addressing competition with community physicians. Generally, nonprofit CCRCs recognize the value of a link to an academic geriatrics program. Such relationships are often more stable and fruitful.

Another opportunity: Providing caring for nursing home patients in sub-acute units (following hospitalization), as you can see the patient and bill more frequently. One area to pay close attention to is faculty supervision in long-term care settings. While geriatric medicine fellows at some programs operate more independently, some leaders have been told by their risk management staff that faculty need to be on site. Moreover, faculty involvement is required for billing. Many programs have structured clinical time so faculty and clinical learners are there at the same time. Despite scheduling challenges within a substantial clinical practice, fellows, residents, and students can learn a lot and have the added benefit of interactions with the rehabilitation team.

Consider other opportunities, including an outpatient “medical home” model, home-based medical care, and medical directorships of hospices. Many programs have initiated or revitalized home medical programs. One university has established a highly structured home follow-up program post-hospitalization. A business model is crucial for these programs. Engaging nurse practitioners and physician assistants is an important part of the model. These programs can work without hospital support because of low overhead, but they have to be run efficiently. Some academic geriatrics programs that offer outpatient services (often considered “loss leaders”) have begun to develop medical home models, which are particularly attractive for patients with chronic illnesses. Such programs are in the early stages. However, medical practices that are willing to develop electronic medical records and incorporate social workers and patient educators (if rewarded through extra reimbursement), can have a positive effect on quality of care as well as on the bottom line, by making outpatient practice more viable. Medical directorships of hospices are another option.

For new clinical services, use all available resources to create a strong business case. Present your information in a business-like manner. Understand how budgeting works at your particular institution. Understand the essentials of facility and professional fees. Back up your budgeting with strong presentations to the individuals who can either support or block the initiative. At one institution, a geriatrics leader who was looking for hospital support for a new palliative care medicine program made his case with new services and a written business plan. The plan identified staff by name, their relevant experience and specialized training (the program leader was a hospice-trained geriatrician), and made the business case for the initiative for the hospital and the larger institution. Many leaders use the Center to Advance Palliative Care (CAPC) for management and business planning as well as for extensive clinical training and support. One leader, for example, learned specific strategies for making the case to hospital leadership, including some of the more difficult arguments for cost-savings. (See Resources below.)

When the hospital won’t provide start-up support, find it elsewhere. Hospitals are often reluctant to take a chance on important new clinical services that don’t have a proven track record of generating revenue. Begin a pilot project with alternative funding, such as a foundation grant or support from a chair. It can be an essential strategy for demonstrating value. At one medical center, leaders in geriatrics and oncology who proposed a new palliative care service were able to secure a foundation grant to start a consulting service. At another institution, the department of medicine viewed the proposed palliative care program as crucial to its institution, which the leaders saw as falling behind comparable institutions nationally. They made the argument that the palliative care service would save in-house costs. Midway through the initial funding period, the program had already improved the institution’s national standing, high quality clinical leadership had been secured, and the program was on its way to demonstrating its benefit to the hospital.

Don’t stop thinking about tomorrow: Continue to make the business case. Pilot projects lay the foundation for new clinical services. However, leaders in both of the above examples have had to continue demonstrating the growth and success of the program over time to hospital administration. The initial investment of time and effort to prepare the business case will pay off again and again for new initiatives.

Spread the word about good outcomes.

“We brought our information about positive outcomes for geriatric patients into the board room. Once the board can see the quality and cost data from its own institution, it’s much easier to make the case that geriatrics should be a major player rather than a luxury.”

Neil Resnick, MD, University of Pittsburgh

Focus on quality in patient care. Leaders emphasized repeatedly that the quality of patient care must come first. “Train higher” and train the right people; make the effort to put policies and procedures in place that reinforce quality. One leader emphasized the importance of instilling a culture of quality first. But to do that you need well-trained doctors, nurse practitioners, physician assistants, and other providers.

Share positive results. Take your good news to deans, chairs, and higher-level administrators. Consider a request to speak to board members of the hospital.

Close-ups

Make an end-run around clinic deficits. Dr. Neil Resnick, CoE director at the University of Pittsburgh, reported that he changed the framework for making the case for geriatrics with hospital CEOs. While losing money is inevitable when providing care in the clinic for the frailest patients, he avoided using an older strategy that highlighted “downstream revenue” (for example, saying that geriatrics opens the door to elderly inpatient revenues.) “Elderly patients will come to the system whether or not we are here,” he said. Instead, he focused on outcomes, without waiting to hear that geriatrics generated a deficit. He looked at every patient over age 65 who was discharged, and compared cost and performance. He found that for hospital discharges, the geriatrics program generated better results than other departments. “We were better per patient than other areas. Thirty-day mortality was the same, but patients of the geriatrics program had reduced readmission and shorter lengths of stay by a third.” Geriatric medicine had a “lower complication rate and highest patient satisfaction, best quality, and lowest cost, of any other group,” he said.

Persevere, line up supporters, and don’t forget billing! William Dale, MD, PhD, CoE co-director and section chief at the University of Chicago, persevered in his efforts to provide outpatient care to older cancer patients in the university oncology clinic because, “being there and being a part of the oncology team is five times as valuable as seeing the same patients in an off-site clinic,” Dr. Dale said. However, he faced significant challenges with billing and setting up this clinic. “This was considered valuable space, and hematology/oncology was initially reluctant to allow a geriatrician to use it.” He spent six months learning about billing to create a “revenue neutral” clinic and to avoid losing revenue for geriatrics, without upsetting hematology/oncology. “I had to work out facilities fees and professional fees, which I had never paid much attention to, and I asked for one room on Fridays when no one else wanted to work, so the space was underutilized.” When nothing further happened, he gave a research talk to hematology/oncology and emphasized complicated technical details and his Beeson funding. “The hematology/oncology section chief attended the talk and loved it. I was offered clinical space and time within a week. Suddenly they decided I was a good bet—a funded researcher with interesting ideas,” Dr. Dale said. By then he had already worked out the billing and had a collaborator in hematology/oncology to advocate for the clinic to his chief. As a result Dr. Dale was able to establish the Specialized Oncology Care and Research in the Elderly (SOCARE) clinic. “If the section chiefs are neutral on a proposal, they ignore it and most of the time it will go away. You have to persevere and do high quality work until the timing is right. My advice is to stick with it and assume the burden of proof that what you do matters! Eventually it will be recognized.”

Rightsizing and refocusing clinical services. The geriatrics program at Indiana University School of Medicine has significant scope. It provides clinical services at Wishard Health Services, Clarian Health, and the Roudebush Veterans Administration Medical Center; conducts extensive health services and aging research; and does all the geriatrics education for the state. Program director, Dr. Steven Counsell, knew that faculty was spread thin. “At one point, as we were not going to hire more people, we needed to realign clinical activities with our education and research missions.” He and faculty undertook a year-long intensive internal review and refocusing to address questions such as: “How could we attract more key stakeholders to support clinical geriatrics? How could we better train people and attract people to careers in geriatrics?” During the first three months they conducted focus groups with trainees, faculty, and others, examined data, and held a faculty retreat. The next three months were spent planning changes, which laid the groundwork for a six-month period of implementing them. They also evaluated changes one year later.

Among their findings were that half of faculty’s clinical time was spent following nursing home patients, spread across approximately two-dozen nursing homes, some with only a few patients. None of their students or residents participated in those services, which were not part of the teaching program. Nursing home services were subsequently reduced by 50 percent to concentrate on homes with the largest number of patients.

On the inpatient side, “we increased the ACE program and made it more attractive,” he said. Previously nurses followed up on patients along with residents and fellows, while senior geriatricians participated mainly in team conferences, seeing patients only briefly. “We found it would be better to have face-to-face contact with colleagues and trainees—giving geriatrics faculty more visibility.” So faculty began “better tailoring of recommendations [about patients] and increased talking with doctors,” he said. This established early, positive doctor-to-doctor experiences, and increased exposure to faculty and research opportunities.

They also beefed up their home medical care service, which has about 200 people on its rolls. “We got good reviews for house calls, which have met the needs of homebound seniors and decreased unnecessary hospitalizations, length of stay, and emergency department visits. Indirectly there are a lot of benefits.” In terms of the geriatrics research group: “No one knew we had one—so as part of a rotation, residents are going to the Indiana University Center for Aging Research, getting more of a sense of what we do,” he said.

For others contemplating such a review, Dr. Counsell emphasized: “It is tough! Be open to findings, because some things really surprised us, and it is hard to implement certain changes. We thought nursing homes were favorites of the hospitals, but we found that administrators believed hospital admissions from these institutions would happen anyway, and we could partner with private practice groups working in nursing homes that send those patients to our hospital. It was painful for us to hear that we weren’t that visible, and no one had heard of our research group, but sometimes you have your head in the sand. We tried to evaluate excellence of clinical services, and how they were perceived. Our first goals were getting high patient satisfaction, providing excellent quality of care, and being viewed positively by physician colleagues.”


Resources

For more information about the impact of geriatrics services on the bottom line, see the Hartford Foundation action brief, A Shared Bottom Line: Effective Geriatrics Services Improve Patient Care, Hospital Finances. http://www.jhartfound.org/pdf%20files/Business%20Case.pdf

For information about developing a business plan, see: Goodwin, JS. Developing a geriatric business plan for an academic medical center. Journal of the American Geriatrics Society 2002;50(4):755-760.

For information about making the business case for palliative care services, and for other palliative care resources, see the Center to Advance Palliative Care (CAPC) web site: http://www.capc.org/

For information on cost savings of palliative care consultation, see Morrison RS, Penrod JD, Cassel JB, et al. Cost savings associated with U.S. hospital palliative care consultation programs. Archives of Internal Medicine 2008;168(16):1783-1790. http://archinte.ama-assn.org/cgi/content/abstract/168/16/1783

For information about geriatrics clinical services in an urban public health system, see Callahan CM, Weiner M, Counsell SR. Defining the domain of geriatric medicine in an urban public health system affiliated with an academic medical center. Journal of the American Geriatrics Society 2008;56(10):1802-1806.

For information about ACE implementation, see Palmer RM, Counsell SR, Landefeld CS. Acute Care for Elders (ACE) units: Practical considerations for optimizing health outcomes. Disease Management and Health Outcomes 2003;11(8):507-517.

Continue to Section 3, Funding Strategies ⇒


Manual Two: Approaches to Recruitment to Advanced Fellowship Training and Faculty Positions in Academic Geriatrics


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An Introduction to Academic Geriatrics Recruitment and Career Development

Pre-Fellowship Decision Recruitment Strategies - Expose Residents to Geriatrics Fellowship and Career Opportunities
- Geriatrics Is Your Future: A Regional Resident Recruitment Program at Baylor College of Medicine
- Annual Resident Award Summit at the Southeast Center of Excellence in Geriatric Medicine (Emory University and the University of Alabama at Birmingham Schools of Medicine)
- Using Resident Applications to Identify and Engage Geriatrics Trainees at the University of Texas Health Science Center at San Antonio

Support Resident Research and Scholarly Projects in Geriatrics
- Scholarly Projects for First-Year Internal Medicine Residents at the University of Rochester School of Medicine
- Establishing an American Geriatrics Society Resident Chapter

Post-Fellowship Decision Recruitment Strategies - Provide Faculty and Peer Mentoring on Academic Careers
- Collaborative Grant Review and Mentoring for Clinician-Researcher and Clinician-Educator Trainees at Emory University/University of Alabama at Birmingham (Southeast Center of Excellence in Geriatric Medicine)
- Junior Faculty Mentoring in Aging Research at the Indiana University School of Medicine Center for Aging Research
- Aging-Related Research Career Development Core for Junior Investigators at the University of Michigan

Implement Programs that Promote Academic Career Preparedness
- One-day Career Development Retreat for First-year Medicine Subspecialty Fellows at the University of California, San Francisco School of Medicine
- Fellows’ One-Year Academic Career Development Course at the University of Rochester Medical Center

Approaches to Advancing Clinician-Educator Careers
- Academic Faculty Scholars Program in Geriatrics for Non-Geriatricians at Boston University
- Geriatrics Excellence in Teaching Series for Faculty and Fellows at Duke University School of Medicine
- Faculty Enrichment and Educational Development Program at the Indiana University School of Medicine
- Year-long Master Clinician-Educator Program in Geriatrics at Mount Sinai School of Medicine
- Area of Concentration for Clinician-Educators at the University of Chicago
- Knowledge and Skills in Cultural Competence and Minority Health Issues at the University of Pennsylvania

Approaches to Advancing Research Careers
- One-Year Course in Research Methods and Design for Geriatrics Fellows and Junior Faculty at Weill Medical College of Cornell University
- Grant Writing Seminar for Geriatrics Fellows and
Junior Faculty at Weill Medical College of Cornell University
- Advanced Aging Research Training Seminar Series at Harvard Medical School
- Clinical Investigator Training Enhancement Program at the Indiana University School of Medicine
- Scholarly Activities Clinic for Clinician-Educator Junior Faculty in Geriatrics at the Indiana University School of Medicine
- Interdisciplinary Academic Advancement Seminar for Junior Faculty Interested in Aging Research at the David Geffen School of Medicine at the University of California, Los Angeles
- Portfolio Structure for Fellows and Junior Faculty in the Academic Geriatrics Research Track at the University of Pittsburgh School of Medicine

Manual One: Approaches to Recruiting Premedical and Medical Students and Residents to Careers in Geriatric Medicine


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Introduction to Geriatrics Recruitment: Opportunities and Challenges

CoE-Affiliated Programs Targeted to Middle School, High School and Undergraduate Students
- The Pennsylvania Governor’s School for Health Care Geriatrics Concentration for High School Students at the University of Pittsburgh School of Medicine
- Year-long Freshman Course on Frontiers in Human Aging: Biomedical, Social, and Policy Perspectives at the University of California, Los Angeles
- Positively Aging® Curriculum for Middle School Students and High School Students at the University of Texas Health Science Center at San Antonio

CoE Recruitment Approaches Targeted to Medical Students
- Integrated Four-Year Elective Geriatrics Track for Medical Students at Baylor College of Medicine
- Medical Student Summer Institute in Geriatric Medicine at Boston University Medical Center
- Increasing Aging-related Content in the Mandatory Medical Student Curriculum at the Warren Alpert Medical School of Brown University
- Medical Student Four-Year Scholarly Concentration in Aging at the Warren Alpert Medical School of Brown University
- Introduction to Geriatrics for First-Year Medical Students at Emory University School of Medicine
- Incorporating Geriatrics into the History and Physical Exam for Second-Year Medical Students at Harvard Medical School
- One-Month Chronic Disease Disability: Improving Quality of Life Rotation for Medical Students at the Johns Hopkins University School of Medicine
- Seniors as Mentors Program at Mount Sinai School of Medicine
- Integrated Medical Student Curriculum in Geriatrics at the University of California, Los Angeles
- Mandatory Rotation in Geriatric and Palliative Medicine for Fourth-Year Medical Students at the John A. Burns School of Medicine at the University of Hawaii
- Area of Concentration and Geriatrics Certificate Program for Medical Students at the University of Pittsburgh School of Medicine
- Year-end Professional Skills Assessment Geriatrics Case at the University of Wisconsin-Madison School of Medicine and Public Health
- Aging Organ Systems Curriculum for Second-Year Medical Students at Wake Forest University School of Medicine
- Ambulatory Geriatric Care Rotation for Third-year Medical Students and Internal Medicine Interns at the Wake Forest University School of Medicine

CoE Recruitment Approaches Targeted to Interns and Residents
- Geriatrics Is Your Future: A Regional Resident Recruitment Program at Baylor College of Medicine
- Annual Resident Award Summit at the Southeast Center of Excellence in Geriatric Medicine (Emory University and the University of Alabama at Birmingham Schools of Medicine)
- Chief Resident Immersion Training in the Care of Older Adults at Boston University School of Medicine
- One-month Rotation in Acute-care Geriatric Medicine for Senior Residents at the David Geffen School of Medicine at the University of California, Los Angeles
- First-Year Internal Medicine Resident Training in Transitions of Care from Hospital to Home at the University of Rochester School of Medicine and Dentistry
- Using Resident Applications to Identify and Engage Geriatrics Trainees at the University of Texas Health Science Center at San Antonio
- Four-Week Elective in Geriatrics for Internal Medicine Residents at Yale University

The John A. Hartford Foundation Centers of Excellence Network Resource Center

About this Site
Acknowledgements
John A. Hartford Foundation Centers of Excellence in Geriatric Medicine and Training
CoE Network Resource Center Advisory Group and Network Resource Center Project Team
About the American Federation for Aging Research
About the John A. Hartford Foundation

About this Site
The John A. Hartford Foundation Centers of Excellence in Geriatric Medicine and Training were initiated in 1988 to address the critical shortage of geriatrics faculty at medical schools across the country. Currently, 28 Centers of Excellence (CoEs) are training scientists, teachers and clinicians in the special knowledge and skills needed to ensure quality healthcare for older adults.

The impetus for creating the CoE Network Resource Center was the recognition that there were no formal mechanisms among the CoEs to share their expertise with colleagues throughout the CoE network and with other geriatric academic programs. With a grant from the Hartford Foundation, the American Federation for Aging Research (AFAR) established the Hartford CoE Network Resource Center to collect and disseminate successful approaches to geriatrics recruitment and career development.

Based on an Inventory of CoE Geriatrics Career Development Initiatives, a literature review on recruitment and academic program development in geriatrics and related disciplines, and interviews with CoE directors, faculty, and staff, a comprehensive list of recruitment and career development strategies was developed and distributed to the CoE directors.

After reviewing these strategies, the CoE directors identified three key issues as the highest priorities in supporting efforts to enhance geriatric academic career development:

  1. The recruitment of premedical and medical students and residents to careers in geriatric medicine
  2. The recruitment of candidates to advanced fellowship training and faculty positions in academic geriatrics
  3. The management of programmatic growth and development in academic geriatrics.

Based on the CoE Inventory findings, descriptions of CoE approaches to the above topics were compiled for this Web site. These program descriptions (available as downloadable .pdf files) can be used as models for new program development and as examples for medical school administrators and potential funders of how other institutions have met the vital need for recruiting and training a new cadre of academic geriatricians.

Acknowledgements
The John A. Hartford Foundation and the American Federation for Aging Research gratefully acknowledge the assistance of the many Hartford CoE directors, faculty and staff who provided much of the information contained on this site; the CoE Network Resource Center Advisory Group; and the consultants who served as the primary authors for the three topical areas:

Manual One: Recruitment of Students and Residents to Careers in Geriatric Medicine
Crystal Simpson, MD, MHS
Center for Medicare and Medicaid Services

Manual Two: Recruitment of Candidates to Geriatrics Fellowships and Faculty Positions
Annette Medina-Walpole, MD
University of Rochester Medical Center

Manual Three: Programmatic Growth and Development
Susan Shampaine Hopper, PhD

John A. Hartford Foundation Centers of Excellence in
Geriatric Medicine and Training
Baylor College of Medicine
Boston University
Brown University
Cornell University
Duke University
Emory University (Southeast CoE)
Harvard University
Indiana University
Johns Hopkins University
Mount Sinai School of Medicine
University of Alabama at Birmingham (Southeast CoE)
University of California, Los Angeles
University of California, San Diego (Geriatric Psychiatry)
University of California, San Francisco
University of Chicago
University of Colorado at Denver
University of Hawaii
University of Michigan
University of North Carolina at Chapel Hill
University of Pennsylvania
University of Pittsburgh
University of Rochester
University of Pittsburgh
University of Pittsburgh (Geriatric Psychiatry)
University of Texas Health Science Center at San Antonio
University of Washington
University of Wisconsin-Madison
Wake Forest University
Yale University

CoE Network Resource Center Advisory Group
Stephanie Studenski, MD, MPH, Chairperson
University of Pittsburgh School of Medicine

Steven R. Counsell, MD
Indiana University School of Medicine

F. Daniel Duffy, MD
University of Oklahoma School of Community Medicine

Joseph G. Ouslander, MD
Institute for Quality Aging, Boca Raton Community Hospital

Jane F. Potter, MD
University of Nebraska Medical Center

Judith A. Salerno, MD
Institute of Medicine

Rebecca A. Silliman, MD, PhD
Boston Medical Center

George E. Taffet, MD
Baylor College of Medicine

Mary E. Tinetti, MD
Yale University School of Medicine

Gregg Warshaw, MD
University of Cincinnati School of Medicine

CoE Network Resource Center Project Team
Odette van der Willik, AFAR Director of Grant Programs
Veronica Smith, AFAR Program Associate
Carol Goodwin, AFAR Special Projects Consultant
Gavin W. Hougham, PhD, Senior Program Officer, John A. Hartford Foundation
James O’Sullivan, MPH, Senior Program Officer, John A. Hartford Foundation (former)

Editorial Services
Toby H. Brener, EdD
Elizabeth C. Segal

About The American Federation for Aging Research
The American Federation for Aging Research is a nonprofit organization whose mission is to support biomedical research on aging. It is devoted to creating the knowledge that all of us need to live healthy, productive, and independent lives. Since 1981, AFAR has awarded more than $100 million to nearly 2,500 talented scientists as part of its broad-based series of grant programs. Its work has led to significant advances in our understanding of the aging process, age-related diseases, and healthy aging practices.

About the John A. Hartford Foundation
Founded in 1929, the John A. Hartford Foundation is a committed champion of health care training, research and service system innovations that will ensure the well-being and vitality of older adults. Its overall goal is to increase the nation’s capacity to provide effective, affordable care to its rapidly increasing older population. Today, the Foundation is America’s leading philanthropy with a sustained interest in aging and health.

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