Geriatrician

The Geriatrician is responsible for delivering thorough, patient-focused medical care to elderly individuals in two main environments: (1) outpatient clinics and (2) community settings. This position is designed to allocate 50% of the time to in-clinic activities (such as evaluations, ongoing management, and consultations) and 50% to community-based care (including home visits, assisted living facilities, skilled nursing facility visits, transitional care, and outreach efforts). The clinician will prioritize functional ability, quality of life, medication safety, alignment of care goals, and seamless coordination throughout the healthcare continuum.

Work Schedule & Location

• Schedule: Full-time, with a 50% clinic / 50% community split.

• Clinic Location(s): Attleboro, MA

• Community Coverage Area: Bristol & Norfolk Counties

• Travel: Required for community visits; must possess a valid driver’s license and reliable transportation.

• On-call: None / Shared rotation / After-hours phone triage

Key ResponsibilitiesA. Outpatient Clinic (50%)

Comprehensive Geriatric Assessment

• Conduct thorough evaluations that encompass medical complexity, functional status, cognitive abilities, mood, fall risk, nutritional needs, sensory impairments, caregiver support, and social determinants of health.

Chronic Disease Management

• Implement evidence-based management strategies for prevalent geriatric conditions such as frailty, dementia, delirium risk, polypharmacy, osteoporosis, urinary incontinence, heart failure, COPD, and diabetes in older adults.

Medication Optimization

• Conduct structured medication reviews, deprescribing when necessary, and ensure reconciliation following transitions of care.

Cognitive and Behavioral Health Care

• Diagnose and manage conditions such as dementia, mild cognitive impairment, delirium risk, depression, anxiety, and behavioral symptoms in collaboration with caregivers and community resources.

Preventive Care & Risk Reduction

• Customize screening and preventive measures based on life expectancy, functional status, patient values, and clinical context; focus on fall prevention and mobility maintenance.

Care Planning & Advance Care Planning

• Facilitate discussions regarding care goals; document advanced directives/POLST/MOLST as needed; ensure treatment plans reflect patient preferences.

Consultation & Co-Management

• Provide geriatric consultations for complex cases and collaborate with primary care providers and specialists.

B. Community-Based Care (50%)

Home-Based and Community Geriatrics

• Deliver medical services in patients' homes and community settings (e.g., assisted living, adult day programs, supportive housing) for those facing mobility, cognitive, or access challenges.

Post-Acute & Facility-Based Rounding (as applicable)

• Conduct continuity visits in skilled nursing facilities (SNFs) or other residential environments, coordinating with facility staff on care plans and safety measures.

Transitional Care Management

• Assist with transitions from hospital to home (or SNF to home), ensuring timely follow-ups, medication reconciliation, symptom monitoring, and coordination with home health services and caregivers.

Urgent Access & Acute Issue Management (in scope)

• Assess and manage subacute changes (e.g., triggers for delirium, falls, dehydration, infection risks) while minimizing unnecessary emergency department visits and hospitalizations when clinically appropriate.

Interdisciplinary Team Collaboration

• Work alongside nursing, social work, care management, pharmacy, physical/occupational therapy, behavioral health, and community organizations to address both medical and social needs.

Caregiver Support & Education

• Offer coaching for caregivers, anticipatory guidance, and connections to community resources.

Safety & Environmental Assessment

• Identify potential home safety risks (such as fall hazards, medication storage issues, nutrition access, and caregiver strain) and implement strategies to mitigate these risks.

Cross-Cutting Responsibilities (Both Settings)

• Documentation & Coding

  • Ensure timely and accurate documentation in the electronic health record (EHR); maintain appropriate billing and coding for both clinic and community services.

• Quality & Population Health

  • Engage in quality improvement initiatives (e.g., falls prevention, polypharmacy management, reducing avoidable utilization, readmissions, and dementia care metrics).

• Communication

  • Maintain clear communication with patients, families, caregivers, and referring clinicians; provide concise summaries of care and follow-up plans.

• Compliance & Safety

  • Follow organizational policies, privacy regulations, infection control standards, and safety protocols for community visits.

• Teaching/Leadership (optional)

  • Mentor learners (residents, fellows, students) and contribute to the development of geriatrics and community care programs.

Required Qualifications

• MD or DO from an accredited institution.

• Board Certified/Board Eligible in Geriatric Medicine (or Internal Medicine/Family Medicine with geriatrics expertise), as per organizational standards.

• Unrestricted medical license (or eligibility) in MA.

• DEA registration (or eligibility).

• Proven experience with complex older adults, chronic disease management, and interdisciplinary care.

• Willingness to travel for community visits; valid driver’s license required.

Preferred Qualifications

• Experience in home-based primary care, PACE, SNF/ALF rounding, or complex care management programs.

• Training or experience in palliative care, dementia care, or transitional care.

• Familiarity with telehealth and remote monitoring technologies.

• Previous involvement in quality improvement or program development.

Core Competencies

• Expertise in geriatrics, including frailty, multimorbidity, functional decline, cognitive disorders, and polypharmacy.

• Strong clinical judgment in making risk/benefit decisions for older adults.

• Effective communication with patients and families, emphasizing shared decision-making.

• Ability to work collaboratively in team-based care, ensuring care coordination and systems thinking.

• Commitment to cultural humility and health equity.

• Strong organizational skills for managing mobile/community practice (time management, routing, documentation).

Physical & Environmental Demands

• Capability to work in outpatient clinical settings and community environments (homes/facilities).

• May require standing or walking, transporting medical equipment, and navigating various home environments (including stairs, pets, and limited space).

Salary Range: $196,992.72 - $313,150.49

Our organization is an equal opportunity employer. We do not discriminate based on race, color, creed, age, gender, sexual orientation, national origin, veteran status, or disability.