History of the Division
Thanks to Dr. Edwin Bierman, the development of geriatric medicine at the University of Washington closely parallels the development of geriatric medicine in the United States.
Our history starts with the creation of the National Institute of Child Health and Human Development (NICHD) by congressional mandate early in the Kennedy Administration. Dr. Robert Aldrich, Head of the Department of Pediatrics at the University of Washington, was enlisted to become the first director of the NICHD. Part of the mandate of the Institute was human development from birth to old age and a branch was created to generate research in this area. Dr. Aldrich thought the University of Washington could profitably be in the forefront of this effort, and as a result of his urging, the University formed a committee of gerontology with Dr. Robert G Petersdorf as its chairman. The committee was impressed with the opportunity to develop a strong research and teaching program in gerontology. They recommended an interdisciplinary, interdepartmental gerontology research center program, which then was established in the Department of Medicine.
Dr. Bierman was recruited to head this effort and Dr. Petersdorf placed its development within the Division of Metabolism at the VA hospital, which became the Division of Metabolism and Gerontology. The "Gerontology Research Center" concept began as a program project grant. The existence of this multidisciplinary program was an important factor in the recruitment of Dr. Carl Eisdorfer as Chairman of the Department of Psychiatry in the early 1970’s. He set up a Division of Psychogerontology in the Department and, thus, began a close collaboration for the development of an aging center at the University of Washington and interdigitation between the two departments. This culminated in the successful competition and award of one of the first Geriatric Research, Education and Clinical Centers (GRECCs) to the Seattle and American Lake VA Medical Centers, and the establishment of the Institute on Aging at the University.
In the mid to late 1970’s, consideration was given toward development of the clinical side of the program for the University, i.e., geriatric medicine. The Division of Gerontology and Geriatric Medicine was formally established in 1977, separating out of Metabolism and Endocrinology. Dr. William Hazzard was appointed the first Division Head, coincident with the decision to base the Division at Harborview Medical Center.
The Geriatric Medicine Clinic at UW
Dr. Hazzard continued the strong research tradition of the program while initiating the clinical and training components of the Division. An inpatient geriatric assessment unit was established, which today continues to be one of very few non-VA-based units. The clinical program also included a consultation service, ambulatory care clinic, and nursing home follow-up program. The geriatric medicine fellowship program, one of the first in the country, began as one year of clinical geriatrics. Additionally, medicine residents had one month rotations on the service, and a medical student elective was established. The program at the VA continued to focus mostly on research. The national demand for academic leaders in geriatrics was growing, so several individuals, first Marsha Fretwell (‘81), then Bill Hazzard (‘82), and then Jeff Halter (‘84), were recruited to establish new programs at other institutions (Rhode Island, Johns Hopkins, and Michigan, respectively).
After interim stewardship by Dr. James LoGerfo, Dr. Itamar B. Abrass was recruited to head the Division in 1984. Since Dr. Abrass’ arrival, the geriatrics program has grown at all of its sites: Harborview Medical Center, the Seattle and American Lake sites of the VA Puget Sound Health Care System (VAPSHCS), and the Boise VAMC. The faculty has grown to over 20 full-time faculty members with research spanning the broad spectrum of geriatrics and gerontology, including ethics, health services, epidemiology, and clinical, animal, and cell and molecular biology research. This has been accomplished at these multiple sites, in no small part, by the leadership of several individuals, including in the past Dr. Robert Schwartz and Dr. Dan Dorsa at the Seattle VA and Dr. Bernard Roos at the American Lake VA, and presently by Dr. Alvin Matsumoto and Dr. Gerard Schellenberg at the VAPSHCS/Seattle, Dr. Stephen Plymate at the VAPSHCS/American Lake, and Dr. Barry Cusack and Dr. Robert Vestal at the Boise VAMC. Of particular note is the strong biomedical research program established at the Boise VA under Dr. Vestal’s leadership, with national and international recognition in multiple disciplines including gerontology, despite the distance of their program from the University.
The program continues to expand clinically. The Harborview inpatient unit has continued but the case mix acuity has increased while the length of stay has shortened. The consultation and ambulatory services have also expanded. More recently, the Long Term Care Service has expanded under the direction of Dr. Wayne McCormick. A formal affiliation has been established with six traditional nursing homes, one AIDS long-term care facility, two assisted living facilities, and two home-care agencies with Division faculty as physicians of record so that the full continuum of care is available to HMC, UWMC, and VA patients. The average daily census of the long-term care program has grown to over 800. Ambulatory care clinics staffed by nurse practitioners have been established in multiple community housing settings. These sites have not only improved patient care, but have also become the base for research and training in long-term care. Similar programs, including an assessment and treatment unit, ambulatory care, consultations, home-based primary care, and nursing home care have been established at the VAPSHCS/Seattle.
Changes in Geriatric Medicine Training
The training program has changed over time. In 1984 the fellowship was expanded to a two- to three-year program with up to three candidates entering each year. Graduates of the fellowship program have continued in geriatrics and a majority have chosen academic careers. Internal medicine residents have regular rotations on the geriatrics services, and the student elective is often over-subscribed.
On July 1, 1990, we became an accredited program with the American Board of Medical Specilties - Accreditation Council for Graduate Medical Education (ACGME).
In 2009, the Division began a Palliative Medicine Fellowship under the leadership of Dr. Wayne McCormick. The fellowship was developed to further meet the health care needs of an aging population and address severe and chronic illness affecting individuals of all ages.
The future brings great challenges to the Division with a growing older adult population, changing health care system, and the rapid evolution of graduate medical education. However, with the strengths of the individuals in the program, and the structure we have developed, we believe we can meet these challenges and look forward to them.