People work with older adults for many reasons, some due to an influential grandparent, others a school role model. For Dr. Freddi Segal-Gidan, it’s because she loved her first job as a nurse’s aide in a nursing home. Using a less than delicate term, she said “it was sh-- work, some would even say demeaning, but I found it inspiring. Hard work, but very satisfying. The people I worked with were amazing. … Yes, I saw horrible things, but I also saw that you could make a real difference doing these basic things.”
She has loftier but similarly solid reasons for the work she does decades later, too, as a Physician Associate (PA) and gerontologist. Such as time travel. Or as Segal-Gidan explains it, “The patients I care for have all had such interesting lives, in trajectories I’ve never experienced. I once had two patients [originally from China] who had bound feet. I’ve taken care of people on all sides of WWII, people from Japan, American GIs who fought in Asia and in Germany, Holocaust survivors, and others who wouldn’t tell me what their family did in Germany.
“These are life experiences I’ll never have that I get to learn about,” she added, almost giddy thinking about her patients. Now caring for a large number of older, low-income Latino people, she loves talking with her patients about their life trajectories that led them to Los Angeles.
Segal-Gidan did her clinical training at the Johns Hopkins’ Health Associate Program and completed the first PA Fellowship in geriatric medicine in the country; then proceeded to get her doctorate in gerontology.
She directs the USC Rancho California Alzheimer’s Disease Center at the Rancho Los Amigos National Rehabilitation Center in Downey, Calif., and holds appointments as an associate professor of clinical medicine in Neurology and Family Medicine at the Keck School of Medicine of USC and the USC Leonard Davis School of Gerontology. Segal-Gidan is a member of the clinical and research staff with the National Institutes of Health–funded USC Alzheimer’s Disease Research Center.
‘I applied to PA school because I was too impatient to go to med school, and it was the best thing I ever did.’
Her research focuses on improving research participation from the Latino community and interdisciplinary health professional training to foster the future geriatric workforce. In 2021 alone she co-authored five papers but credits her colleagues from seven disciplines with whom she collaborates in an interprofessional program for that feat.
The longtime geriatric clinician and gerontologist was raised with four grandparents, including a grandmother who with her parents fled the pogroms in her native Ukraine by walking at age 4 out of the country, eventually ending up in New Jersey, where Segal-Gidan was born. When the family moved to the West Coast, so did the grandmother, who never learned to drive, despite living in Los Angeles, and lived to 101.
“It wasn’t really her that fostered my love of aging, but I was raised with positive role models,” said Segal-Gidan.
Winding Route to Being a PA
The nurses’ aide job inspired Segal-Gidan to go to med school, so she studied premed in undergrad, but became enamored of dance instead and took a leave to work for a semi-professional dance company. Realizing she lacked the proper temperament for that endeavor, she took the money she had earned and traveled to South Africa where she had a friend, turned in her open-ended air ticket to join an overland expedition and travel by truck from Johannesburg to London.
During those five months of travel across the African continent Segal-Gidan witnessed basic medicine saving lives. “Everyone on the trip got sick, with basic stuff like diarrhea, dehydration, etc., and I realized you didn’t really need technology and all that equipment to make things different,” she noted.
Upon her return she “did all the things you needed to do to go to med school” (taking the MCAT, etc.), but the idea that she would have to spend eight years to pursue what she wanted to do now was disillusioning, so when she came across the concept of a PA degree, she tacked in that direction.
This was 1976 and when Segal-Gidan informed her parents of her choice, her dad suggested she first speak with his friend, a cardiologist. “He said, this is the stupidest thing I have ever heard, this profession [PAs] is going nowhere!”
Segal-Gidan didn’t let that stop her in her determination to head overseas and practice medicine. “I applied to PA school because I was too impatient to go to med school, and it was the best thing I ever did.”
Alas neither the Peace Corps nor Medicines Sans Frontiers were hiring PAs at that time, so she “took the most exotic option and went to work at a rural health center in Hawaii.” Since then, Segal-Gidan has gone on multiple medical missions overseas.
Due to the nature of what Segal-Gidan calls the “curved course life takes” she met a young neurologist during her geriatrics fellowship and the woman offered her a job and Segal-Gidan joined her for what was to be “a couple years” (now going on 35) in a budding dementia-care practice. That job set the course for the rest of her career.
On Career Pipelines and Other Issues
After more than four decades working in it, Segal-Gidan has thoughts about how our healthcare system might evolve. “If you want to improve healthcare, particularly the leadership, you should require everyone to do a year as an orderly or a nurse’s aide before they go to med school, tie it to the loans—a one year requirement of doing menial work.
‘No one thinks they’ll be taking care of older adults, but all of them will, regardless of specialty.’
“That will improve healthcare and as they go up the chain they will understand what it’s like for people at the bottom,” she said. Her first job “was such a meaningful experience, instead of turning me off to medicine; it turned me on.”
Not a rose-colored glasses wearer, Segal-Gidan is more than aware of the challenges PAs and other healthcare professionals face, one of the biggest being ageism. “We live in an ageist society, it’s so pervasive. We all want to get old, so it’s the place we all should want to be, but no one sees themselves as wanting to be old,” she said.
She knows of 80-year-olds who are reluctant to go to the senior center because it’s full of “old people,” and she knows providers can be just as ageist, which impacts older adults’ care.
Very few hands are raised when she asks her students how many of them plan to take care of older adults, despite a rising percentage of those students having personally known 80, 90 or 100-year-olds.
Her follow-up question: “But who do you think you’ll be seeing?”
“No one thinks they’ll be taking care of older adults, but all of them will, regardless of specialty,” she said. “And as I approach that age, it’s very scary to think that there won’t be people out there who will know how to take care of me.”
Segal-Gidan also has ideas for solving the workforce crisis, and one of them is to foster a pipeline of people who are nurse’s aides, pharmacy techs and any other professionals who want to rise to the next level to become PAs and work with older adults, or to get a gerontology degree and work in a non-clinical setting such as adult daycare or in meals or transportation. “There are lots of opportunities for people to move up, depending upon what sort of role they want,” she said.
There are few other jobs that leave one with the same sense of accomplishment. “If you want to feel appreciated for what you do, older adults are very appreciative. And if you want to make a difference, it’s a place where you can really make a difference and it doesn’t take a lot—just caring and listening.”
Alison Biggar is ASA’s editorial director.
Photo caption: Dr. Freddi Segal-Gidan enjoying travels to Cape Town, South Africa.
Photo credit: Courtesy Freddi Segal-Gidan