A Founding Father Reflects

WILLIAM HAZZARD, MD, HAS SHAPED NOT ONLY WAKE FOREST BAPTIST’S WORK IN HEALTHY AGING BUT THE FIELD OF GERIATRICS ITSELF

The man widely regarded as “a founding father of geriatric medicine in the U.S.” is quick to point out an odd fact.

“I’m not a geriatrician,” says William Hazzard, MD, who earned the “founding father” label from the American Geriatrics Society when it presented him with its prestigious Nascher/Manning Award for lifetime achievement in clinical geriatrics in 2016.

“I never trained as a geriatrician and have never worked as one.”

Yet, Wake Forest Baptist is one of three academic medical centers in America, alongside the University of Washington (UW) in Seattle and Johns Hopkins, that traces to Hazzard its lineage in geriatrics and gerontology, spanning research, education and care.

Now an octogenarian, Hazzard remembers when geriatrics was considered a career-ender in academic medicine.

“At most other places, people would say, ‘Why waste your time on aging? Why not work in cardiology or some other area?’”

Where others saw a dead end, Hazzard saw opportunity where medicine could better serve people. What he did with this opportunity changed the course of Wake Forest Baptist and the field of geriatrics and gerontology.

A National Leader

Wake Forest Baptist has a number of assets in healthy aging that makes it a big fish in the relatively small pond of geriatrics and gerontology, as Hazzard sees it.

The program in aging includes one of only 31 Alzheimer’s Disease Core Centers (ADCC) for research in the nation. It received the designation and nearly $9 million in funding from the National Institute on Aging (NIA), part of the National Institutes of Health.

Wake Forest Baptist is one of 15 Claude D. Pepper Older Americans Independence Centers in the country. The NIA supports Pepper Centers to develop and enhance research and education at selected academic medical centers. Wake Forest Baptist is the Pepper program’s national coordinating center.

Other assets include:

  • The Sticht Center for Healthy Aging and Alzheimer’s Prevention, focused on research
  • The J. Paul Sticht Center for Aging and Rehabilitation, a building which was the first site in the world to house geriatric acute care, transitional care, psychiatry, rehabilitation and clinical research under one roof, and
  • The Roena B. Kulynych Center for Memory and Cognition Research, founded by the Kulynych family of North Carolina and dedicated to studying dementia and age-related cognitive impairment.

Much of what’s in place might not exist here if Hazzard had not joined the Medical Center in 1986.

Early Career

Hazzard earned his medical degree at Cornell University Medical College (now Weill Cornell Medical Center) in Manhattan and started his academic career in internal medicine.

“Birth control pills were brand new, and concerns about their metabolic side effects set the table for my research,” he says. Because most of his patients were women, Hazzard eventually became intrigued about why they live longer than men.

In 1965, he joined the UW School of Medicine in Seattle, where he completed his residency and fellowships in endocrinology and metabolism, and became an instructor.

In 1975, school leadership asked him to start a division of gerontology and geriatric medicine.

Choosing to accept the assignment was “the best professional decision I ever made.” The challenge: to do what no one else had done.

“At that time, I found no geriatrics training programs in this country to learn from,” he says. So, he sought advice from Paul B. Beeson, MD, one of his mentors, an expert in infectious diseases, and an influential medical editor and administrator at Yale and Oxford universities.

On Beeson’s advice, Hazzard spent a year on sabbatical in Oxford and London learning the British approach to caring for older people. Geriatrics essentially had started there in 1947 as part of the UK’s National Health Service.

The Sticht Center is a highly visible reminder of Wake Forest Baptist’s distinctive work in healthy aging

That experience helped him launch UW’s aging program. Four years later, Johns Hopkins School of Medicine recruited him to lead its new geriatrics program. After getting that effort off the ground, he was approached by Richard Janeway, MD, vice president of health affairs for Wake Forest Baptist, but it wasn’t necessarily to build a program in aging.

Imbed and Infiltrate

Janeway recruited Hazzard to be chairman of internal medicine. Hazzard took 13 trips to Winston-Salem while negotiating for his position before he accepted, cultivating support from key people that he believed he needed to succeed.

“From the beginning, my strategy was to use the position as a platform on which to build a program in aging that would infiltrate the entire institution, and ultimately the community,” he says.

His plan was twofold. Within the Medical Center, he wanted to imbed geriatrics in internal medicine and other disciplines, and not assign it to neurology, surgery or any single area. Within the field, he sought to share academic geriatrics research nationally, build a strong reputation and begin to “gerontologize” medicine across the country.

He saw it as “an opportunity to build a prototype,” and he framed it in aspirational terms.

“I spoke with the faculty about how this was a dream,” he says. “I told them we needed to stretch, to raise ourselves to a higher level of respect nationally and to raise our self-respect, too.”

Sowing Seeds of Success

Over time, with internal medicine as the base, the plan began to work.

He convinced colleagues in cardiology, nephrology and other areas to add aspects of aging to their research projects.

He recruited a cadre of physicians trained in aging, chose to focus on research from the beginning and began competing nationally for research funding. He also established a career development program to attract the best young physicians to geriatrics. Since 1995, the John A. Hartford Foundation and the NIA have supported Paul B. Beeson Scholars in Aging, named for Hazzard’s mentor.

As chair of internal medicine, he connected with medical students by making rounds with them every day. “It was important that they see the chairman not as an administrator who works in an office,” he says, but it also let him encourage students to pursue interests in geriatrics and gerontology.

Growth in His Absence

By 1999, Hazzard had decided to return to Seattle and rejoin UW as chief of geriatrics and extended care at VA Puget Sound Health Care System. Meanwhile, Wake Forest Baptist embarked on a new phase of growth.

From roughly 2001 through 2016, the program built a reputation for taking leading roles in national population research studies and clinical research trials, led by professors Stephen Kritchevsky, PhD, and Jeff Williamson, MD, among others.

Hazzard returned to Winston-Salem in 2012 at Williamson’s encouragement. “They are an unbeatable pair,” Hazzard says of Kritchevsky and Williamson. “There’s no place in the country that has an integrated team that is any stronger than what we have at Wake Forest Baptist.

“It’s rewarding to be back at this Medical Center. It’s the kind of place that’s hard to reproduce. There’s a sort of magic here that’s very powerful, maybe more powerful than anywhere in the country.”

Into the Future

The growth that took place during his absence makes Hazzard optimistic about future work in healthy aging. “It was very gratifying to see how much progress had been made and how dynamic the aging program has become, Hazzard says. “I credit that to leadership that extends to the very top of our new regional health system.”

He praised the Medical Center’s 2012 recruitment of Suzanne Craft, PhD, and her Alzheimer’s disease research team from UW as a pillar for continued success. Her recruitment set in motion a series of developments that culminated in the NIA’s 2016 announcement of the ADCC at Wake Forest Baptist. He believes the ADCC’s triad approach—physical function, mental function and end-of-life palliative care—will be emulated elsewhere.

He calls the overall effort in aging, though, a work in progress. It’s still a challenge to convince leaders across
the medical field that people are best served when geriatrics and gerontology are imbedded across disciplines.

Grateful for the role that he has seen philanthropy play during his career, he also foresees funding challenges. That includes support from public and government sources, which continually face potential cuts, and from private foundations whose funding may not remain at the same levels as the past.

He also hopes more talented people will come to the Medical Center, learn the value of what his prototype has produced and eventually go elsewhere.

“I learned from my family that you grow up, you take the good things you’ve learned and you leave,” he says, still working to “gerontologize” medicine from coast to coast. “You don’t grow by staying in one place.”