For Trevor Barker, a freshman at Albert Einstein College of Medicine in the Bronx, a $1 billion gift from a longtime former professor that will eliminate medical school tuition could very well be life-changing.
Mr. Barker works two jobs on campus and sends money home to his mother in California. He expected to graduate hundreds of thousands of dollars in debt. But the free tuition made him think about new options for his career.
“I hadn’t really gotten around to thinking about family medicine, but I might have wanted to,” he said.
Family medicine doctors do everything from delivering babies to caring for the elderly—usually in underserved communities. Mr. Barker said he might consider practicing medicine in the Bronx, even though doctors there generally earn less.
The billion dollar donation from Dr. Ruth Gottesman made national news last week for her generosity and her life story. He also resonated because he didn’t go to school in Manhattan, where top medical and educational institutions are regularly rewarded with gifts from billionaires.
Instead, her gift went to the only medical school in New York state’s poorest and unhealthiest county: Einstein, a well-regarded medical school with more than 1,000 students affiliated with a major hospital, Montefiore Medical Center. Almost immediately, doctors and health experts began to consider the impact it would have on health care in a municipality with high rates of chronic diseases such as diabetes and asthma and relatively few primary care physicians.
The gift of Dr. Gottesman aims to help Einstein and his medical students and encourage more lower-income students to apply to medical school. It could also encourage students like Mr Barker to practice medicine in the borough. And some health experts and doctors were optimistic that the benefit to Einstein would be felt beyond the campus, with an effect that would ultimately improve health care throughout the Bronx.
“It’s going to have a profound effect throughout the Bronx because some of these students are going to stay in the community,” said Dr. Luisa Perez, an internist in the Bronx. “This is a win-win for everyone to have all this money available in the Bronx.”
But Dr. Vikas Saini, president of the Lown Institute, a health think tank in Massachusetts, said the money would likely have a “marginal impact” on health care in the Bronx.
“Let’s not pretend that these isolated events that might do some good good somewhere are the systemic solution, because they’re not,” he said.
The least healthy municipality
Year after year, the Bronx ranks as the least healthy county in New York, ranking 62nd out of 62, according to the County Health Rankings & Roadmaps, a project of the University of Wisconsin Population Health Institute that compares counties’ health metrics . Instead, Manhattan ranked No. 7, Queens at No. 12, Staten Island at No. 21 and Brooklyn at No. 22.
In New York City, the Bronx has the highest rates of diabetes and the highest rates of childhood asthma. One in three deaths in the Bronx is classified as “premature,” meaning the person died before the age of 65. in the city as a whole, that figure is about one in four.
Access to health care and doctors can play an important role in reducing the number of chronic diseases such as diabetes and hypertension. Diabetes, for example, can lead to lower limb amputations and kidney failure. But the disease can be managed through lifestyle and dietary changes, medication and blood sugar management — all things that primary care doctors try to address with their patients.
“The primary care physician prevents the disease from crippling patients, or so they don’t end up in a wheelchair or on dialysis three times a week,” said Dr. Perez, a member of the SOMOS Care community, a large network of physicians working in underserved New York City neighborhoods.
But even with many more doctors in the Bronx, the prevalence of chronic disease would be difficult to reverse without also addressing the complex factors that contribute to health problems in the first place.
Many chronic diseases are rooted in socioeconomic conditions. The high toll of asthma in the South Bronx is linked to air pollution, diesel exhaust from truck traffic, cockroach particles, mold and other factors related to environmental and housing conditions.
Diabetes can often be prevented by eating healthy, staying physically active and keeping weight under control. But this can be difficult for people who work multiple jobs or have long commutes and limited meal options.
“The vast majority of these disparities have their origins in living and social conditions that long predate the onset of the disease,” said Dr. Saini of the Lown Institute.
However, the messages coming from doctors can make a difference. They can encourage patients to exercise more and make healthier choices where possible, such as drinking less juice, eating less rice, or washing canned vegetables to reduce sodium.
From 2015 to 2021, there was a significant improvement in the Bronx’s ranking of “health behaviors” — which includes smoking rates, physical activity and diet, according to Charmaine Ruddock, project director at Bronx Health REACH, a community program that seeks to reduce health inequalities. . Ms Ruddock said the improvements were a result of the efforts of community groups as well as doctors and other health care providers.
Lack of doctors
The Bronx has the fewest primary care physicians per capita of any borough. Asked if they have a doctor, Bronx adults are more likely to say no than those living elsewhere in the city.
One factor is that the Bronx has a higher percentage of residents on Medicaid, which reimburses doctors at lower rates than private insurance. This translates into lower salaries for doctors. The number of primary care physicians per capita in the Bronx has increased significantly, however, over the past 15 years. Now it’s just below that of Queens.
Yuliana Dominguez Paez, 24, a first-year medical student at Einstein, wants to do her part to change those statistics.
“I live in the Bronx,” he said. As far as she knows, she is the only one of the 183 medical students in her class who has grown up in the township. (About half the students in the class are from New York.) “I’d like to stay here and really serve the community that raised me.”
The question is whether others will follow.
Dr. Rikhil Kochhar, an internist in the Bronx, believes the donation could lead to more primary care physicians and pediatricians working in the Bronx. “I think if you take away those financial pressures of medical education, you will encourage doctors to stay in those fields,” he said.
Others weren’t so sure. Dr Saini from the Lown Institute said the donation would help those “who already want to become primary care doctors”.
But he doubted that providing medical school for free would persuade many students to reconsider pursuing more lucrative career paths or keep them around once they graduate. “It won’t change the incentive structure,” he said.
