Spring 2016 Volume 5 Issue 1

Brown Family Medicine Alumni Association News about your residency...

Dear Colleagues, Brown Family Medicine is moving from a single academic com-munity hospital focus to a system-wide and state-wide depart-ment...with a combination of sadness for what is being lost and hope for the future. I don’t need to tell you that we are in a period of incredible healthcare system transition that has repercussions for all us, including our patients, families, and communities. Brown Family Medicine is expe-riencing the significant down-sizing of its academic community hospital (Memorial Hospital of RI) that has been the beloved home to two gener-ations of family physicians trainees and faculty since the first hardy class

of pioneers started in 1975. After 116 years, the birthing center at Memorial is moving 6.8 miles down the road to the largest maternal and child health hospital in the region. Memorial’s ICU and med-surg units are downsizing significantly. This will necessitate setting up new Family Medicine inpatient units at local area hospitals (the closest being 2 miles away). The timing of these moves is still being discussed and some of this depends of regulatory bodies, but we are in the “few weeks to few months” phase for all elements. What is staying? The Family Care Center and Family Medicine Residency; all the ambulatory clinics (including Primary Care Internal Medicine, Cardiology, Cancer Center, Pediatric Neurodevelop-ment, Nutrition, Geriatrics, Dermatology, Rheumatology, and GI); the Emergency Department; Rehab; Endoscopy Center; and operating rooms for Orthopedics and General Surgery, among others. The old “everything within 100 yards of one another” model that was comfortable and convenient for Family Medicine is being changed forever. We are moving to a more distributive model where inpatient services are off–site – and at larger and more bio-medically accomplished centers. Why is this happening? There are many reasons but the bottom line is that the academic com-munity hospital model is no longer viable or sustainable, especially in urban settings where larger hospital units are competing. In fact, the Memorial model has not been sustainable for several years, as evidenced by significant operational losses and marked decreases in volume for the past 8-10 years. We have always provided care to an underserved community and were proud of it. However, over the past decade, Me-morial has seen an erosion in its reimbursement as RI Medicaid markedly reduced payments; as the Af-fordable Care Act (which we supported) brought in insurance coverage that paid little; and as care has shifted to the outpatient arenas. Technology and labor costs have increased; the primary care base did not sufficiently expand, and even our successes have led to Memorial’s downfall -- successful patient cen-tered medical home (PCMH) and accountable care organizational (ACO) efforts have reduced hospitali-zations, lab, imaging, and readmissions. In addition, all hospitals in RI are suffering in the new healthcare environment and as profit margins have eroded, cross-subsidizations are no longer possible. Though there is significant anguish and a palpable sense of loss at the changes (particularly from areas in the hos-pital that are being downsized), this day was long ago predicted as healthcare around the US and the world has undergone rapid transformation. What has happened is not unique to Memorial or to Rhode Island. It has been occurring around the country and across the globe – e.g., Denmark has gone from over 50 hospitals to just 18. This does not make it easier; it only explains why it is happening. The Department of Family Medicine realized several years ago that having “all its eggs in one bas-ket” was not reasonable stewardship. We were advocates for joining Care New England 3 years ago since we felt that we could expand across their system and could utilize their excellent training and practice set-tings for our trainees and patients. Although it has not always been a smooth (cont’d on back cover)

WELCOME CLASS OF 2019 Laura Anthony, MD University of Massachusetts Medical School Undergraduate: UMass Amherst BS Biology & Kinesiology Grew up on Cape Cod Volunteered at Worcester Free Clinic Coalition and Mustard Seed Soup Kitchen FM Interests: Nutrition, Preventive Medicine, developing trusting relationships and motivating patients to set reasona-ble health goals. Outside Interests: staying active through swimming and running; eating healthfully and trying new unique recipes; mu-

sic; traveling and spending time with family – and capturing these moments in homemade scrapbooks to remember.

William Blair, DO Edward Via Virginia College of Osteopathic Medicine Undergraduate: Vassar, BS Psychology/Religion Worked as a research coordinator at Mt Sinai in the Division of Traumatic Stress Studies FM Interests: Social Determinants of Health, Underserved Care Outside Interests: Camping with his wife and black lab, Indiana; travel – has visited over 20 countries; golf; and cook-ing.

Robert Fruggiero, MD New York Medical College Undergraduate: URI, BS Biological Sciences Robert was born in RI and grew-up in Cranston Prior to medical school, worked as a full-time medical scribe at RIH ED and tutor for inner city kids FM Interests: Academic Medicine Outside Interests: Music, including playing classical and jazz piano, playing guitar, singing in chamber choir, chorus, a cappella, and barbershop quartets; amateur astronomy with home telescope; strategy, trivia, and party board games; video games; watching football; science fiction, both new and classic, including books, TV shows, and movies; cooking, especially Italian food.

Dana Kaufman, MD Tufts University School of Medicine Undergrad: Barnard College, BA, Biochemistry Designed group prenatal care program for underserved adolescents Participated in the “Bridge over Troubled Water” mobile medical van for homeless youth Speaks Hebrew FM interests: Underserved populations, reproductive health Other interests: Guitar and vocal performance, rollerblading, kayaking and travel

Amanda Kelvey, DO New York Institute of Technology College of Osteopathic Medicine Undergraduate: Salve Regina, BS Chemistry & Biology; MPH, Brown University Born in Providence Speaks Spanish and Portuguese FM Interests: Public Health, Preventive Medicine Outside Interests: Reading; Painting/Drawing; Figure skating/ Synchronized Figure Skating; Major League Soccer

Amy Kwok, MD University of Massachusetts Medical School Undergraduate: Simmons College, BS Biochemistry; MS, Tufts, Biomedical Sciences Prior to medical school, worked as a research assistant at Beth Israel Deaconess Medical Center constructing DNA reporter systems Speaks advanced Chinese FM Interests: Women’s Health, Adolescent Health, Behavioral Health Outside Interests: Acoustic guitar, piano, drums, and dulcimer player; backup singer for a cover band; healthy baking; promoting oral health; spending time with my nieces and nephew

Ye Li, MD University of Massachusetts Medical School Undergraduate: Boston University, BA Biology Has a master’s in Acupuncture and worked as an interpreter at the New England School of Acupuncture At UMass, participated in the Complementary and Integrative Medicine elective Speaks advanced Chinese and native Japanese FM Interests: Preventive Medicine, Nutrition Outside Interests: Yoga, taekwondo, disc golf, food as medicine, reading and writing Japanese novels

Claire Lyons, MD University of Rochester School of Medicine and Dentistry Undergraduate: Cornell, BS Human Development During medical school, participated in the longitudinal Med Ed Pathway and spent a summer teaching health education to HIV+ children in Ethiopia FM Interests: Teaching, Community Health, Longitudinal Care Outside Interests: Outdoor activities (hiking, biking, cross-country skiing), dance, art, cooking

Angelina Palombo, MD University of Vermont School of Medicine Undergraduate: Loyola, BA Sociology, Minor – Spanish Served in the Peace Corps, teaching English in Mozambique During medical school, served as president of the Wilderness Medicine Interest Group, as well as an organizer and instructor for AMWA Speaks advances Portuguese and Spanish FM Interests: Rural Medicine Outside Interests: Hiking, running, clay sculpting, skiing, kayaking, board games, spending time with friends

Payal Patel, MD University of Maryland Medical School Undergraduate: UMD, BS General Biology & Psychology During medical school, was a member of the Combined Accelerated Program in Psychiatry and volunteered with Healthy Choices Baltimore FM Interests: Family Planning Outside Interests: Spinning, Yoga, Tennis, trying new restaurants/recipes, and exploring farmers' markets/outdoor markets

Congratulations!

Congratulations, Dr. Susanna Magee for being named Top Doc in RI Monthly and Doctor of the Year from RIAFP. Dr. Magee be-gan her career here at Memorial after finishing the Brown Family Medicine Residency. She is best known for her Family Medicine Maternal Child Health model, the Maternal Child Health Fellow-ship and her skin-to-skin style of caesarean deliv-ery.

She got front cover status and is a star in every sense of the word!

BFMAA Networking Event

Thank you all who came out to participate in the BFMAA very first silent auction. We raised some funds and had a great time. Thank you to all who donated!

Phil Salko with his mom. Jeff Syme and Jason Salter.

Dr. Cristy Pacheo ‘07 and Dr. Phil Salko ’11 both partictipated in

the 2016 Dancing with the Doctors. Phil won most technical - congratulations!

Brown Family Medicine Class Notes

Kristina Connor ‘15 reports, “ I got engaged to Maxwell Afari (MHRI Internal medicine class of 2015!) just before Christmas :) as you can tell from the picture it was a complete surprise!” Daria Szkwarko ‘15 led a research workshop for the Moi University Department of Family Medicine in Webuye, Kenya in February 2016 with Dr. Fadya El Rayess and Katya Jarrell (PGY-3)

Cameron Nienaber ’13 reports, “My husband, Dan Kay, and I were married on August 29th, 2015 in Chatham, MA. Lots of Brown folks were there - Ashley Lakin and

Liz Brown were bridesmaids, Ashley's husband Ruarri, Ben Bauer, Carmen Goojha, Cortney Haynes and her husband Michael, Chris Furey and his wife Marissa and Mary Lajoy were all there! Dan and I are still living in Brooklyn. I'm still working at Jamaica Hospital in Queens as faculty of the family med residency program.”

Sean Uiterwyk ’05 reports that he is Moving back "South" after 8 years in Ver-mont at White River Family Practice. Took a position in Newton, MA at Atrius Health as the Senior Medical Director for Performance Excellence (Quality, Safety,

Patient Experience, and Medical Management.) I'll be seeing patients at the Wellesley practice site as well. We are in the process of house hunting in the area. Lisa, Reilly, Claire and I are looking forward to the next adventure.”

Margaret Coughlan ‘97 reports, “Attached is a photo of some of my 1997 classmates: Jessica Harrington, Cheri Hardenbrook, Elaine Wu, Barry Kottler, Scott Cullen.”

Laszlo Madaras ‘96 reports, “I work in southern PA. I will always be grateful to my family medicine collegues who hastily altered their residency schedules to suit my schedule for me to be able to work in Rwanda in the aftermath of the 1994 genocide, in the geo-graphic area where I once worked as a Peace Corps volunteer. I became a Senior Fellow of Hospital Medicine during an award ceremony in San Diego, CA in March 2016. I have been both a family doctor for 20 years (20 years!) and a hospitalist for 11. Senior Fellows have worked in hospital medicine for a least 10 years, published, taught, and generally advanced the field over their careers. It was a great honor to be in the class of 2016 Senior Fellows. I miss everyone, and hope to see some friends when I come north to New England to visit my parents.”

Allan Raskin ’85 reports, “I am still plugging away in the Sturdy Memorial ER, now 30 years and counting. Was so sad to learn of the death last year of Bill Jenkins. Bill was north of 40 when he started residency, which is of course tough at any age. He had dry sense of humor and use to “brag” that it took him 10 years to get accepted at medical school – don’t know if that was true or not. He worked incredibly hard and was known to to be seen leaving the hospital at 9 pm even after the previous overnight. No surprise that he was a “doc of the year” up in Maine. I still play tennis with Jeff Syme regularly, and he and I and Mark Ringiewicz skied together as we do almost every year. I also skied this year with Karl Machata in Utah, but didn’t ski with Alphonse Cardenas this year, though we usually do. Karl and I also surf together, though unlike him, I only go when it is warm. Am also in touch periodically with Susie Spitz who is still in Boston. Bob Weinstein has moved back to RI, so I see him more than before.”

x� Visit the Brown Alumni Association at http://gifts.brown.edu and go to Give Now

x� Once there: Scroll down to the heading "Other Current-Use Prior-ities"

x� Check the box "Other" and type in "Family Medicine Alumni As-sociation"

Give generously to the Brown Family Medicine

Alumni Association 100 % of the proceeds support our

Family Medicine residents.

Thanks to the generous donations of the Brown Family Medicine Alumni Association, the Brown Family Medicine Residents enjoyed a night out at the Breaktime Bowl and Bar in Pawtuck-et. Please continue to give, so we can sponsor events like this! The link to donate is below!

Resident Bowling

(cont’d from front page) ride, we now have two residencies, two ACOs – both with family medicine physicians in the top leadership positions, and will have family medicine OB units at two hospitals and, very likely, family medicine inpatient services at two additional hospitals. More family physicians are employed in CNE and in RI than ever before and nearly all primary care groups and health centers have moved to a family medicine-friendly model and have attracted large numbers of our graduates and those from out of state. There are also more suc-cesses in several of the Family Medicine efforts across– from Sports Medicine (and the new fellowship), to part-nerships with health centers (we received an award from Thundermist Health Centers for our residency efforts this week), to integrated behavioral health in primary care, to global health, to Pre-Doc, to research, and on and on. Family Physicians are the largest group by far in our ACO (Integra) and have a voice across the State. There are still many issues and the intensity of effort is currently at fever pitch. The changes are generally perceived as a loss for the community we serve, and a loss for all of us who have seen Memorial as scrappy, devot-ed community of providers and staff who were dedicated to the core – sometimes beyond reason. It is affecting the personal, professional, and group identity of all 1000 employees, including the nearly 100 in our Department here and the hundreds around RI and the region. Though the reality of the healthcare in the future will likely be better than the current situation, there is much more to do on several levels. We are moving to a system-wide, state-wide, and even region-wide department. We will have to mourn for what is lost, but recognize that change was inevitable and is sweeping the country. We will, as family doctors, with our patients and community interest uppermost, help create a future that meets the triple and quadruple aim. Thanks, Jeff