Geriatrician

Work Schedule & Location

• Schedule: Full-time split 50% clinic / 50% community • Clinic Location(s): Attleboro, MA • Community Coverage Area: Bristol & Norfolk Counties • Travel: Required for community visits; valid driver's license and reliable transportation • On-call: None / Shared rotation / After-hours phone triage

Key Responsibilities

A. Outpatient Clinic (50%)

Comprehensive Geriatric Assessment

• Conduct multidimensional evaluations including medical complexity, functional status, cognition, mood, fall risk, nutrition, sensory impairment, caregiver support, and social determinants of health. Chronic Disease Management

• Provide evidence-informed management of common geriatric conditions (e.g., frailty, dementia, delirium risk, polypharmacy, osteoporosis, urinary incontinence, heart failure, COPD, diabetes in older adults). Medication Optimization

• Perform structured medication reviews, deprescribing when appropriate, and reconciliation after transitions of care. Cognitive and Behavioral Health Care

• Diagnosing and managing dementia, mild cognitive impairment, delirium risk, depression, anxiety, and behavioral symptoms in partnership with caregivers and community support. Preventive Care & Risk Reduction

• Tailor screening and preventive strategies to life expectancy, function, patient values, and clinical context; address falls prevention and mobility preservation. Care Planning & Advance Care Planning

• Facilitate goals-of-care discussions; document advanced directives/POLST/MOLST where applicable; align treatment plans with patient preferences. Consultation & Co-Management

• Provide geriatric consults for complex older adults and collaborate with PCPs and specialists.

B. Community-Based Care (50%)

Home-Based and Community Geriatrics

• Deliver medical care in patient homes and community settings (e.g., assisted living, adult day programs, supportive housing) for patients with mobility, cognitive, or access barriers. Post-Acute & Facility-Based Rounding (as applicable)

• Provide continuity visits in skilled nursing facilities (SNFs) or other residential settings, coordinate with facility staff on care plans and safety. Transitional Care Management

• Support hospital-to-home (or SNF-to-home) transitions, including timely follow-up, medication reconciliation, symptom monitoring, and coordination with home health and caregivers. Urgent Access & Acute Issue Management (in scope)

• Evaluate and manage subacute changes (e.g., delirium triggers, falls, dehydration, infection risk) while reducing avoidable ED visits/hospitalizations when clinically appropriate. Interdisciplinary Team Collaboration

• Partner with nursing, social work, care management, pharmacy, PT/OT, behavioral health, and community agencies to address medical and social needs. Caregiver Support & Education

• Provide caregiver coaching, anticipatory guidance, and linkage to community resources. Safety & Environmental Assessment

• Identify home safety risks (falls hazards, medication storage, nutrition access, caregiver strain) and implement mitigation strategies.

Cross-Cutting Responsibilities (Both Settings)

• Documentation & Coding • Maintain timely, accurate documentation in the EHR; ensure appropriate billing/coding for clinic and community-based services. • Quality & Population Health • Participate in quality improvement initiatives (e.g., falls, polypharmacy, avoidable utilization, readmissions, dementia care metrics). • Communication • Communicate clearly with patients, families, caregivers, and referring clinicians; provide concise care summaries and follow-up plans. • Compliance & Safety • Adhere to organizational policies, privacy regulations, infection control standards, and community-visit safety protocols. • Teaching/Leadership (optional) • Mentor learners (residents, fellows, students) and contribute to program development in geriatrics/community care models.

Required Qualifications

• MD or DO from an accredited institution • Board Certified/Board Eligible in Geriatric Medicine (or Internal Medicine/Family Medicine with geriatrics expertise), per organizational requirements • Unrestricted medical license (or eligible) in MA • DEA registration (or eligible) • Demonstrated experience with complex older adults, chronic disease management, and interdisciplinary care • Ability to travel for community visits; valid driver's license as applicable

Preferred Qualifications

• Experience in home-based primary care, PACE, SNF/ALF rounding, or complex care management programs • Training/experience in palliative care, dementia care, or transitional care • Comfort with telehealth and remote monitoring tools • Prior quality improvement or program development experience

Core Competencies

• Expertise in geriatrics: frailty, multimorbidity, functional decline, cognitive disorders, polypharmacy, falls • Strong clinical judgment in risk/benefit decision-making for older adults • Patient- and family-centered communication; shared decision-making • Team-based care, care coordination, and systems thinking • Cultural humility and commitment to health equity • Organizational skills for mobile/community practice (time, routing, documentation)

Physical & Environmental Demands

• Ability to work in outpatient clinical environments and community settings (homes/facilities) • May require standing/walking, transport a medical bag/equipment, and navigating variable home environments (stairs, pets, limited space) • Adherence to community-visit safety procedures and situational awareness

Measures of Success (Example Performance Indicators)

• Patient experience and caregiver satisfaction • Timely post-discharge follow-up completion • Reduction in potentially avoidable ED visits/hospitalizations (where appropriate) • Medication safety outcomes (reconciliations completed, deprescribing initiatives) • Falls risk screening/interventions completion rates • Documentation timeliness and coding accuracy

Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.