Brown Family Medicine Alumni Association

News about your residency...

Spring 2016
Volume 5
Issue 1

Dear Colleagues,

Brown Family Medicine is moving from a single academic community hospital focus to a system-wide and state-wide department...with a combination of sadness for what is being lost and
hope for the future.
I dont 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 experiencing the significant down-sizing of its academic community hospital
(Memorial Hospital of RI) that has been the beloved home to two generations 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. Memorials 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 Neurodevelopment, 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 offsite 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 community 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, Memorial has seen an erosion in its reimbursement as RI Medicaid markedly reduced payments; as the Affordable 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 Memorials downfall -- successful patient centered medical home (PCMH) and accountable care organizational (ACO) efforts have reduced hospitalizations, 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 hospital 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 basket 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 settings for our trainees and patients. Although it has not always been a smooth (contd 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 reasonable health goals.
Outside Interests: staying active through swimming and running; eating healthfully and trying new unique recipes; music; 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 cooking.

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: Womens 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 masters 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 began 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 Fellowship and her skin-to-skin style of caesarean delivery.
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!

Jeff Syme and Jason Salter.

Phil Salko with his mom.

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 Vermont 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 geographic 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 dont 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 didnt 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.

Resident Bowling
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 Pawtucket. Please continue to give, so we can sponsor events like this! The link to donate is below!

Give generously to the

Brown Family Medicine
Alumni Association
100 % of the proceeds support our
Family Medicine residents.

Visit the Brown Alumni Association at http://gifts.brown.edu and

go to Give Now
Once there: Scroll down to the heading "Other Current-Use Priorities"
Check the box "Other" and type in "Family Medicine Alumni Association"

(contd 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 successes in several of the Family Medicine efforts across from Sports Medicine (and the new fellowship), to partnerships 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, devoted 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