“You know, children are not small adults,” a preceptor once told me during an early pharmacy practice rotation. Nearly 10 years later, I sometimes still hear her voice in my head. However, my patient population falls on the opposite end of the life spectrum: They are members of the geriatric community.
Like children, advanced members of our community require special considerations. Some disease states affect elderly patients differently than younger individuals. Liver function changes with age, resulting in altered drug metabolism. Physiological changes such as thinning of the skin and increased body fat can greatly alter drug metabolism and affect how medications behave outside and inside the body. A prudent clinician may initiate therapy at a lower-than-normal starting dose and slowly titrate accordingly.
Pharmacy school alludes to some of the many differences seen in patients of advanced age. But providing a comprehensive overview of the circumstances that distinguish geriatric patients from younger patient populations is both arduous and impractical. Certification offers a solution.
One may have many motives for specializing in geriatrics—just as with any other therapeutic area. As with residencies and fellowships, many pharmacists choose to pursue board certification to deepen their clinical skills while gaining a leg up on the competition in the ever-tightening job market.
While these factors influenced my decision to become a board-certified geriatric pharmacist (BCGP), I ultimately chose geriatrics as a specialty because of my love for the elderly. I come from a culture in which its oldest members head the entire family, and caring for them is considered a community effort. I willingly forfeited sleeping late my senior year of high school to act as my grandfather’s morning chauffer, administer his medications, and take him to the barbershop every Saturday. I guess you could say the seed was planted early.
In my first role as a licensed pharmacist, I served a predominantly older population. Almost immediately, I recognized that successfully managing these patients required a higher skill set than pharmacy school offered. Providing medication therapy management consultations further highlighted what I felt were deficiencies in my skill set that additional experience alone could not address. It was during this time I first began considering certifying in geriatrics. However, with no residency under my belt, I needed several years of practical experience before sitting for the exam.
By the time I moved into managed care, I had become eligible to test. I was still consulting, but my patient population had become even more complex. I went from working with elderly populations in rural East Texas communities to serving a hybrid middle-aged/geriatric community that encompassed the gamut of cultural, racial, and ethnic diversity of New York City and surrounding areas. Special considerations required to manage this highly diverse demographic further amplified the need to upgrade my skill set.
My advice to pharmacists considering certifying in geriatrics: Don’t do it just to add extra letters to the alphabet soup of credentials after your name. Do it because you want to make a difference and build confidence in your ability to provide optimal patient experiences. In that lies the true reward.