10 Questions: Terry Fulmer, PhD, RN
Terry Fulmer, PhD, RN, believes in the importance of creating age-friendly health systems and fostering open communication between healthcare professionals and patients.

Terry Fulmer, PhD, RN, believes in the importance of creating age-friendly health systems and fostering open communication between healthcare professionals and patients. Since receiving her master's and doctoral degrees in nursing from Boston College, followed by her Geriatric Nurse Practitioner Post-Master's Certificate from New York University in 2001, Fulmer has dedicated her career to the advancement of intra-professional science, education, and practice in order to improve the care of older adults.

She currently serves as president of The John A. Hartford Foundation, a New York-based organization which promotes high-value, evidence-based healthcare for the elderly, and was recently recognized for her leadership as one of the top 50 Influencers in Aging by PBS's Next Avenue.

Her resume also includes trusteeships for the Josiah Macy Jr. Foundation and the Bassett Healthcare System, and she is co-chair of the National Academy of Medicine's Forum on Aging, Disability, and Independence.

1. What's the biggest barrier to practicing medicine today?

Competing demands and priorities with finite time. Clinicians are working hard to meet the strident demands required to provide evidence-based, value-driven care while at the same time struggling with complex governmental requirements for reimbursement and challenging electronic health record systems. Sometimes it can feel like the personal connection with the patient is diluted.

2. What's the most important healthcare issue that nobody is talking about?

The healthcare system as it currently operates does not always meet the needs of older adults or support vibrancy as people age. This is an important issue because of the demographic changes that will transform our nation over the next 20 years. Few hospitals and health systems are consistently age-friendly, even though older adults are, and will continue to be, their largest customer base. It's important to create age-friendly health systems that seamlessly provide care across the multiple settings and systems of care, with minimal redundancy and a keen eye for the reduction of unnecessary and unwanted care.

3. What changes, if any, will the Trump administration impose on medical practice?

Right now it's hard to determine how Congress will move forward with the revisions required to adjust the Affordable Care Act in a way that addresses bipartisan concerns. The recent vote that rejected repeal and replace and instead calls for addressing improvement in our current Obamacare will require excellent communication and coordination. Foundations like ours stand ready to help provide the evidence needed to improve care of older adults and all patients in our healthcare system.

4. What country do you think has a better healthcare system than the United States?

The recent work by the Columbia University School of Public Health under the direction of Jack Rowe with the Research Network on an Aging Society is moving forward with a global aging index to help us better understand the answer to this question. According to their data, Norway and Sweden are ranked more highly for health and well-being of aging populations then the United States. This work is critical given the growing number of older people across the globe.

5. How often do patients ask you about some medical finding they heard discussed by a celebrity doctor?

This happens all the time and is a perfect opportunity to educate the public more broadly. Usually people are looking for a magic bullet that can help them stave off aging and remain highly functional into late life.

6. Have you ever been afraid of a patient? (If so, can you briefly describe the situation?)

I have had moments where I was afraid, but they always took place when the patient was cognitively impaired and it was my job to figure out how to get out of harm's way. Sometimes the patients were chemically impaired and other times they had severe dementia. Most of us have been there, and the goal in that moment is safety for all.

7. Do you discuss drug costs with patients?

I do – usually the issue is pricing, not cost!

8. What do you consider the best advice you could offer patients (medical or otherwise)?

When you have a doctor's appointment, bring a list of questions and don't be afraid to offend nurses and doctors by asking them. Challenge their answers, and please feel confident that this is a partnership that can only work when both sides are forthcoming.

9. If you weren't a nurse, what do you think you would be doing today?

I can't imagine any other career for me. My PhD has certainly been essential to the advancement of my research career and practice.

10. What is the biggest difference between your expectations of medical practice when you graduated from nursing school and the reality?

I could not have imagined the dramatic advancement in genomics and technology. It has been fascinating and will change the nature of care for the future.

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