BMI to NIH: Medicine’s Role in Future of Montefiore
November 3, 2008
by Julia Hess
Image: Dr. Steven Safyer (General Internal Medicine), President and CEO of Montefiore Medical Center
Boosting an academic medical center’s U.S. News and World Report rank from 38 to top 20 and lowering the average South Bronx resident’s BMI are formidable tasks in and of themselves. Both efforts, however, are part of an ambitious vision held by Dr. Steven Safyer, President and CEO of Montefiore Medical Center and Professor of Medicine (General Internal Medicine). Dr. Safyer, who assumed the position in January 2008 to continue a thirty-plus-year career that began as a medical student at Einstein, sees the Department of Medicine as integral to virtually every aspect of his vision for Montefiore to become a premier academic medical center that transforms the health of its community.
Dr. Safyer plans to bolster the centers of excellence in heart, transplantation, cancer, neuroscience, and diabetes. These centers will synergize Montefiore’s core clinical strength with Einstein’s leading research in cancer, liver disease, and diabetes. The Department of Medicine, which includes the Divisions of Cardiology, Hepatology, Oncology, and Endocrinology, is Dr. Safyer’s primary organizational vehicle to expand and develop these centers. “Medicine is so large, important, and embedded in the school’s science and the hospital’s patient care that it provides a natural bridge,” Dr. Safyer said.
The centers’ developments are already underway. Richard Kitsis will become the founding director of the Einstein-Montefiore Center for Cardiovascular Research, stepping down from his current role as Chief of Cardiology at the end of the year. This Center will be a collaborative, integrated enterprise encompassing basic, translational, clinical, and population studies that capitalizes on advancements such as the Weiler Arrhythmia Service lab’s first radiofrequency catheter ablation, performed in June. Montefiore’s first liver transplant was completed on October 10, kicking off a program headed by Paul Gaglio under the divisional leadership of Allan Wolkoff (Hepatology). Plans are also underway to expand clinical programs in cancer and diabetes.
Unlike many of the nation’s premier academic medical centers, whose priorities are limited to innovative scientific research and educating the next generation of physician-scientists, Montefiore maintains a longstanding commitment to its surrounding community. Diabetes is a leading public health crisis in the Bronx, one of the nation’s most populated areas with 1.5 million residents, a third of whom live below the poverty line. Nearly 25% of Montefiore’s hospitalized patients present with diabetes as a comorbidity, and liver disease and cardiovascular issues closely follow as complications. Dr. Safyer’s envisioned centers of excellence will advance a bench-to-bedside-to-community approach, seeking to transform Bronx residents’ health with creative, strategic clinical interventions.
Geriatric medicine and infectious diseases are also priorities, with an aim toward fewer hospitalizations due to diabetes and chronic heart failure, as well as a reduction in communicable illnesses. “The health of our borough will change when we can keep more people in their homes or extended care facilities, and when we see fewer hospitalizations because of our disease management efforts,” said Safyer.
Historically, many of Montefiore’s community-based programs have been created in response to a good idea or pressing need. Dr. Safyer hopes to change the direction of this “bottoms-up” approach with a more strategic use of Montefiore’s resources so that community programs are working together with the rest of the system tackling the big public health threats like obesity, diabetes, HIV, and children and elderly at risk.
Dr. Safyer would like to see an improvement in the integration of each patient’s clinical care. “If you've ever gone to the hospital, even with the best insurance, it's rarely seamless. You're constantly telling the same story over and over again,” he said. “Our system is atypical because it has everything from inpatient beds to ambulatory primary care to home healthcare. It should be easy for our patients to get in, stay in, and get all the care they need from us.”
A stronger unity must also exist between Montefiore and Einstein, Dr. Safyer believes. “Montefiore has been Einstein’s primary academic medical center since the 1980s, yet to this day that relationship isn’t burnt into the public’s mind,” he said. “We are suboptimized because we don't co-invest or co-brand. By building on each other’s strength, one plus one will equal five. Medicine is already unified under Vic [Schuster’s] leadership. It’s my biggest building block.”
Overcoming the historically “siloed” structure of Montefiore’s departments and divisions, while challenging, will render a stronger organization. “An organization this size can’t be managed as an amorphous entity, but each department needs to clearly see its role in the greater enterprise,” Safyer said. “With less propriety, we will have a healthier overall entity and a bigger pie for everyone.”
The measures of his vision are broad and challenging: a top-twenty U.S. News and World Report rank. (“People may not like that publication, but they look at it,” said Dr. Safyer.) Consistently lower hemoglobin A1c (blood glucose) levels throughout the Bronx population. More NIH dollars awarded to investigators, and higher complexity of care provided by clinicians. Fewer phone rings for an appointment and quicker, easier referrals. And interviews with potential house staff and faculty that no longer include the need to explain the medical center-school relationship.
Dr. Safyer’s goals are particularly ambitious in this period of national and global economic turbulence, with the full impact on the healthcare industry and Montefiore yet unknown. His optimism, however, remains undaunted. “We have made smart decisions and executed them well, and we are fortunate to come into this difficult period on a sound footing,” he said. “By working together, identifying opportunities for efficiency, and carefully managing our resources, I am confident we can stay the course. The very best organizations grow stronger in difficult times, and we are no exception.”