Will a $1 Billion Donation to the Medical School Make the Bronx Healthier?
For Trevor Barker, a freshman at Albert Einstein College of Medicine in the Bronx, a former professor’s $1 billion gift that will eliminate medical school tuition could be life-changing.
Mr. Barker works two jobs on campus and sends money to his mother in California. He had expected to pay off hundreds of thousands of dollars in debt. But the free tuition has made him think about new options for his career.
“I hadn’t really thought about family medicine before, but maybe I would like to,” he said.
Family 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 by Dr. Ruth Gottesman made national news last week for her generosity and for her life story. It also resonated because it didn’t go to a school in Manhattan, where top medical and educational institutions are regularly showered with gifts from billionaires.
Instead, her gift went to the only medical school in New York State’s poorest and unhealthiest county: Einstein, a highly ranked medical school with more than 1,000 students affiliated with a major hospital, Montefiore Medical Center. Almost immediately, doctors and health experts began wondering what effect this would have on health care in a city with high rates of chronic diseases such as diabetes and asthma, and relatively few primary care physicians.
Dr.’s gift 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 district. And some health care experts and physicians were optimistic that the boon for Einstein would be felt beyond campus, with a trickle-down effect that would ultimately improve health care throughout the Bronx.
“It will have a profound effect on the entire Bronx because some of those students will remain in the community,” says Dr. Luisa Perez, an internist in the Bronx. “It’s a win-win for everyone to have all that money allocated to the Bronx.”
But Dr. Vikas Saini, president of the Lown Institute, a health care think tank in Massachusetts, said the money would likely have at best “a marginal impact” on health care in the Bronx.
“Let’s not pretend that these one-off events that could do a little bit of good somewhere are the systemic solution, because they are not,” he said.
The least healthy municipality
Year after year, the Bronx is ranked as the least healthy county in New York, comes in 62nd place out of 62, according to County Health Rankings & Roadmaps, a project of the University of Wisconsin Population Health Institute that compares county health metrics. Manhattan, on the other hand, was at number 7, Queens at number 12, Staten Island at number 21 and Brooklyn at number 22.
Within New York City, the Bronx has the highest diabetes rates and rates asthma in children. One in three deaths in the Bronx is classified as ‘premature’, meaning the person died before the age of 65; across the city that percentage is about one in four.
Access to health care and doctors can play an important role in reducing the toll of chronic diseases such as diabetes and hypertension. For example, diabetes can lead to lower limb amputations and kidney failure. But the disease can be controlled through lifestyle and diet changes, medications and blood sugar management – all things GPs try to address with their patients.
“The GP prevents the disease from bothering patients so much that they even have to be amputated, so that they do not end up in a wheelchair three times a week or have to go on dialysis,” says Dr. Perez, member of the SOMOS Community. Care, a large network of physicians working in underserved neighborhoods in New York City.
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 the development of health problems.
Many chronic diseases are rooted in socio-economic circumstances. The high toll of asthma in the South Bronx is related 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… keep weight under control. But that can be difficult for people who work multiple jobs, have long commutes and have limited meal options.
“The vast majority of these differences have their origins in the living and social circumstances that long precede the onset of the disease,” said Dr. Saini of the Lown Institute.
Still, doctors’ messages 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 rinsing canned vegetables to reduce sodium levels.
From 2015 to 2021, there was a significant improvement in the Bronx’s rankings for “health behavior” — which includes smoking rates, physical activity and diet, according to Charmaine Ruddock, project director at Bronx Health REACH, a community program that aims to reduce health disparities . Ms Ruddock said the improvements were the result of efforts by community groups, doctors and other healthcare providers.
A shortage of doctors
The Bronx has the fewest general practitioners per capita of any municipality. Asked if they have a doctor, Bronx adults are more likely to answer no than those who live 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. That translates into lower salaries for doctors. However, the number of primary care physicians per capita in the Bronx has increased significantly over the past fifteen years. It is now only slightly below that of Queens.
Yuliana Dominguez Paez, 24, a first-year medical student at Einstein, wants to do her part to change these statistics.
“I’ll stay in the Bronx,” she said. As far as she knows, she is the only one of the 183 medical students in her class who grew up in the neighborhood. (About half of the students in the class are from New York.) “I would like to stay here and really serve the community that raised me.”
The question is whether others will join her.
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 the financial pressure off medical education, it will encourage physicians to stay in these areas,” he said.
Others weren’t so sure. Dr. Saini of the Lown Institute said the donation would help people “who have already set their sights on becoming primary care physicians” to persevere.
But he doubted whether making medical school free would convince many students to pursue more lucrative careers or keep them close when they graduate. “It won’t change the incentive structure,” he said.