Capital Region’s Best Doctors
Dr. Jill Braverman-Panza, MD
Braverman-Panza Medical Group, Washington Avenue, Albany
Undergraduate School: Skidmore College, biology major, music minor
Medical School: Albany Medical Center
Residency: Albany Medical Center, 3 years of internal medicine
Fellowship: Albany Medical Center, 1 year as chief resident
Growing up in New Jersey, Doctor Jill Braverman-Panza always knew she wanted to work in medicine or become a pharmacist, like her father.
After graduating from Skidmore College with a degree in biology, she waited tables for a few years to save money for the Brooklyn Pharmacy School. That’s when she met her husband Tony. They married and moved back to the Capital Region, where Braverman-Panza started her doctorate in clinical pharmacology at Albany Medical Center.
One year into her research, they closed her program down. Undaunted, she applied to the medical school.
“In medical school, they used to tell me to stop thinking like a pharmacist and start thinking like a doctor,” laughed Braverman-Panza, who feels that being a primary care physician makes her a gatekeeper. “When you have patients on multiple medications from multiple doctors it’s nice to be able to tell them that what they’re experiencing is just a side-effect from one of their medications or a drug interaction, and not something serious.”
She spent a year as chief resident at Albany Med following her residency and worked part-time in the emergency room at Ellis Hospital. It was there that she became interested in preventive medicine and the holistic approach to practicing her craft.
“I got tired of cleaning up congestive heart failure patients who had pizza for Christmas when they knew they shouldn’t,” she said. “I love doing preventive care and giving people back charge of their lives.”
In 1991, Braverman-Panza opened her own practice with a partner on Western Avenue in Guilderland. A year later, it became hers. Together with two part-time doctors, two full-time physician assistants and two part-time nurse practitioners, she treats patients from adolescent age (13) through adult. Had there been a specialty in adolescent medicine when Braverman-Panza was in medical school, she knows that would have been her calling.
“You really can make a change with young people before they get all of these debilitating diseases,” she said.
One of the last vestiges of an all-female practice, Braverman-Panza thinks that women’s natural tendency to nurture has helped her practice fill up quickly from the outset.
Doctor Walsh has five children and Doctor Dalzell has three children under the age of five. Braverman-Panza, 55, has a 20-year-old son who was three when she started the practice.
“We’re very female-friendly because we’re all mothers,” she said. “We’re probably the only practice that closes on Halloween so the staff can attend their children’s Halloween parades.”
The cost of staying small
Nearly two decades later, little has changed in the way Braverman-Panza runs her practice. Prevention and taking a holistic-approach, evaluating the “whole person” including the psychological and physical circumstances, is still central to her philosophy of medicine.
The biggest change has been with her patients. More computer savvy, knowledgeable and interested in their own health, patients have become “partners” in their care forcing practitioners to stay on top of newer herbal remedies and complementary medications.
But, the dwindling economy and annual threat of Medicare cuts also leaves patients scared and left to make difficult choices regarding health care and competing priorities. This winter was the first time since opening her practice that Braverman-Panza saw a slow down in the first quarter.
CDPHP is providing electronic medical records to some smaller practices through a subsidized project. But, the growing reimbursement issue and discounted fees of service is putting a stranglehold on practices large and small forcing internists to look at other subsidies.
“The reality of practicing internal medicine today is that I make more money freezing a wart then I do diagnosing cancer,” Braverman-Panza explained. “So, procedures are regarded ‘higher’ on the reimbursement scale than cognitive diagnosis.”
The practice offers laser cosmetic procedures in the office once a month and one of her nurse practitioners also runs a complementary medicine practice called Integrative Care.
Braverman-Panza pursues her passion for prevention working with bariatric, obesity patients through the Bariatric Center at Albany Med and on an out-patient basis through her practice.
Having an in-house laboratory allows them to perform tests and follow-up with patients while they’re waiting, which further enhances the practice economically and augments the range of services they can provide.
The other challenge small practices face is lack of personnel to fill in when someone is sick. When her son was small, she had help from her in-laws and parents. Encouraging her staff to have a back-up plan was essential.
For Braverman-Panza, maintaining the balance is the hardest part about being a woman in medicine.
Her crowning moment remains the fact that she’s still in business. Voted a “Woman of Excellence” by the Albany-Colonie Chamber of Commerce a few years back, she’s proud of the recognition because it recognizes her as a successful business owner in addition to practicing medicine.
Still, having grown up in a family business, she manages to find time to help her husband Tony with the family restaurant, Panza’s, on Saratoga Lake.
“I met my husband when I was waitressing. You do what you have to do. Besides, we have a nice working relationship: he fattens them up and I reduce them.”
Dr. Gerald Hausler, MD
Center for Family Practice, Latham
Undergraduate degree: RPI, biology
Medical School: Michigan State University College of Osteopathic Medicine
Residency: Wayne State University in Detroit
Dr. Gerald Hausler is the kind of person who whistles on his way to work. “As long as you’re whistling it will never feel like you’re going to work,” the cheerful physician said.
Besides, with your beloved pooch next to you on the ride to work, how can you not help but whistle?
That’s right; Hausler brings his Scottie/Basset Hound mix, Shortsop (“Shorty”), to work each day. It’s a rare sight to behold in a doctor’s office, but one that puts a smile on everyone’s face.
“He’s always around the office somewhere. He’ll scratch on patients’ doors and they let him in so he can say hello,” he said.
Hausler, an Albany native, who has been practicing medicine for 27 years (at the Center for Family Practice in Latham for the past nine), is happy to be in a field that has interested him since adolescence. He attributes his two family doctors for inspiring him. “I just thought ‘boy this is what I want to do.’ I was very goal-directed. I knew I was going to be a physician.”
His experiences as a medical student at Michigan State University College of Osteopathic Medicine only further strengthened his passion for his chosen field. “When I went to medical school, I started rotating through family doctor offices and I learned physicians are an integral part of the family. Many were involved with two, three, four generations.”
After completing his residency at Wayne State University in Detroit, Hausler returned to the area in 1981 and began teaching at Albany Medical School. The following year he began practicing with Latham Medical Group. He left there after 18 years for his current practice, craving a smaller venue where he could give his patients more personal attention.
It’s those patients that are his favorite part of the profession. He works hard to cultivate a trusting relationship, which in turn results in a lasting one. “My favorite thing to hear is ‘I haven’t been able to tell anyone this but…’” said Hausler.
But it’s not just the doctor-patient relationship; it’s a bond with the entire family that is essential, he said. “I want to be a part of their family; share everything that’s important to them and try and achieve their trust.” Hausler enjoys catching up with patients and families and frequently receives letters and even baskets of apples or tomatoes from people he’s treated.
A married father of three sons, Hausler’s youngest is following in his footsteps. He currently helps out at the office and is set to attend the University of West Virginia Medical School this fall.
Dubbing his field a “potpourri of medicine”, he appreciates the eclectic nature of his daily work. “You never know what’s behind that door. It’s like a game show… what’s behind door number one, door number two? It’s always different.”
But every day isn’t always rosy. The obvious downside for a physician is telling someone they have a terminal illness or that a family member has passed away. “You never know how to approach it, even after all these years. The more you know someone, the worse it is.”
One of the more difficult cases was when he had to diagnose a young, pregnant woman with breast cancer. “She elected to keep the baby knowing she was going to die and not see it grow up. She delivered it, but eventually succumbed to the cancer. It was very emotionally draining,” he said.
However, he perseveres, knowing this is a reality in his profession. His proudest moments as a physician are when, “I do everything right and a patient beats out cancer.”
Hausler credits catscans, MRIs and ultrasounds with progressing the field of medicine. “We can do more and more immediately so patients don’t have to wait and we can make more accurate diagnoses on a faster basis.”
However, said the doctor, the future of primary care doesn’t look as promising. He believes that his field is in a very precarious position now, and that the high cost of medical school is partially to blame. “Medical students are coming out with more and more debt so they are taking jobs in a high-paying specialty. And they don’t want to work that hard or be on-call all the time and put in the hours. I personally feel there’s going be a real problem finding them [primary care physicians].”
Hausler encourages people pursuing any career, not just one in medicine, to pursue something that they are passionate about and will never tire of. “You really should choose something that you love; you want it to be enjoyable. I love what I do.”
Dr. Paul P. Hospodar, MD
Bone and Joint Center, Albany, and professor at Albany Medical College
Undergraduate School: University of Scranton, PA
Medical School: Penn State College of Medicine
Residency: Penn State College of Medicine
Fellowship: Methodist Hospital in Indianapolis, Ind., in traumatology
Doctor Paul P. Hospodar became an orthopedic surgeon because he likes to fix things.
“Orthopedics is about improving the quality of people’s lives,” he said. “We can’t always extend people’s lives, but we improve the quality through working on arthritic joints and debilitating fractures and trying to repair those injuries.”
A specialist in traumatology, Hospodar has been working in the field for 14 years. He works at the Bone and Joint Center on Washington Avenue, which is affiliated with Capital Region Orthopedic Group. He’s a part-time professor at Albany Medical College where he lectures and teaches the residents and he’s also one of the team doctors for the River Rats hockey team.
Unheard of in the 90s, there’s been an explosion of ACL injuries in young teenage girls due to soccer. During his years in residency, Hospodar remembered treating only one female with an ACL injury for nearly every 30 men.
“Tearing your ACL has become an equal-opportunity injury,” said Hospodar. “It’s tough when these gals who are 15-16 blow out their knee and have to take a year off, have surgery and perhaps never play at the same level that they were.”
Clearly more women are playing sports since Title IX was enacted and soccer is popular worldwide. Some studies implicate that the structure of the knee or the cycling of estrogen make women more susceptible. There’s also scientific research citing a difference in the hamstring reaction time between men and women. Hospodar thinks it’s a lot simpler than that.
“They’re playing harder and more aggressively. I think it has a lot to do with the design of the cleats as well. They don’t allow for any slip of the foot so that all of the energy is departed to the knee.”
Hospodar himself can’t play basketball anymore. Instead, he plays hockey in a non-checking men’s league. “Unlike soccer, football and basketball, you can get away with having an ACL injury in hockey. But you’re still coming down on the knee and putting a lot of torque on that joint.”
Many of the increased ACL problems are also societal according to Hospodar, who declares flip flops the root of all evil. Western civilization has an abundance of spurs and bunions, particularly from women wearing high heels. But, there’s a whole school of thought that shoes are a problem, not a solution, because other cultures wear similar shoes or none at all and lack foot problems.
The obesity epidemic and sedentary lifestyles are also causing injuries and taking a toll on people’s joints. Hospodar advises people to stay active through walking and stretching to avoid injuries and the onset of arthritis. Still, he can’t help but feel frustrated when a 300-pound patient doesn’t understand why they’re experiencing knee pain.
Need for speed
Society is moving at a faster pace with a lot of motorized devices. Hospodar has seen an explosive increase in the number of motorcycle accidents—particularly on new, high-performance bikes with young kids driving 80-90 mph and taking a turn too quickly.
“People are continually coming up with new and more exciting ways to hurt themselves. It’s the whole generation we belong to, none of us wants to admit we’re getting older and our bodies are taking the beating.”
Baby boomers in their 50s and 60s are retiring and buying their first motorcycles, even though their reaction times and ability to learn new skills are reduced. The practice has treated patients with multiple pelvic fractures and has seen unbelievable cases of road rash.
Enter one of his favorite patients, a flight nurse who recently returned from a tour of Afghanistan with her husband, who was a medic. One Saturday morning, they took a ride in the country on their motorcycle and through no fault of their own, a car pulled out and crushed her left leg beyond repair from above the knee to her foot.
“She was only in her 40s, and we had to remove her leg from below the knee,” said Hospodar noting that she couldn’t return to being a flight nurse and had to settle for being a training nurse on the ground. “The irony is that she was in highly dangerous operations under fire running soldiers back and forth from the front line and she’s home one week and loses her leg.”
Perhaps his biggest nemesis involves four wheelers and young children. He recently treated a nine-year-old girl and her 11-year-old brother for multiple fractures of the wrist and forearm, contusions all over their body and small head injuries making him question the logic of putting bigger, stronger machines in the hands of youngsters who feel they’re invincible.
“I hate to be a killjoy, but you wouldn’t let them drive a car at that age and tooling down a path at high speeds isn’t much safer,” he said. “When you start seeing trends and debilitating injuries, it makes you wonder.”
Debunking the myths
Hospodar thinks the prevalence and popularity of today’s medical shows skews people’s perception of what the medical practice can really accomplish once a leg is severed.
“They show a major trauma with a leg transplant or re-implantation and at the end of the show the patient walks out,” said Hospodar incredulously. “We can hook a leg back up. The reality, however, is that they might regain some function after months or years. But, their leg will probably never return to normal.”
On the flip side, technology has vastly improved the orthopedic practice, too. Visualization and imaging is better with advanced MRIs and Spiral CT scans making evaluations and diagnoses quicker and more accurate. In addition, the baring surfaces, including plastics and ceramics, have better wear characteristics today making total hip or knee replacements more durable.
The field hasn’t achieved the point of minimally invasive surgery just yet, but robots aren’t out of the question in the future.
“Trauma equipment has become refined where we’re putting more and more hardware through smaller incisions,” said Hospodar. “Whereas before we would have to fillet the entire leg, we can now do it with smaller incisions.”
William Bruce Clark, MD
Obstetrics & Gynecology
Clark, Clements, Klein and Syeda Obstetrics and Gynecology, Latham
Medical School: University of Oregon
Residency: Albany Medical Center
The 20th century was full of milestones in women’s history, from extending the right to vote in 1920 to the controversial Roe v. Wade (1973) Supreme Court decision declaring laws against abortion unconstitutional and a violation of the Fourteenth Amendment.
Still, no one could have predicted that the expanded freedom and scope of reproductive rights would result in the July 2008 birth of a daughter to Thomas Beattie, a transgendered man who retained his female reproductive organs.
“The scope of the practice of obstetrics and gynecology has vastly expanded over the past two decades,” acknowledged Dr. William Bruce Clark, founding partner of Clark, Clements, Klein and Syeda Obstetrics and Gynecology in Latham. “With the advent of infertility procedures and even standard, routine care, it has become more specialized and sub-specialized in the areas of oncology and reproductive endocrinology.”
For Clark, who entered the field simply because he “liked it”, the changes have meant that he performs more routine gynecological procedures than in the past.
“I used to handle more high-risk pregnancies such as patients with diabetes or pregnancies involving multiple births,” Clark explained. “I still do, but there’s a lot more prenatal and well-baby care going on these days. That’s important because if you do a good job of taking care of the fetus, you’re preventing a lifetime of possible problems or harm.”
Originally from Portland, Ore., Clark attended medical school at the University of Oregon. Relocating to the Albany area in 1971, he did his residency at Albany Medical Center. Instead of doing a fellowship, he entered the Army for two years following residency.
“Then, I returned to the Albany area and have never left.”
Upon returning, he served on the faculty at Albany Medical Center for three years. Following that he joined the Latham practice of colleague Dr. Timothy Vinciguerra. They worked together for several years and in the late 70s, Clark started his own practice in Latham, which today includes Doctors Philip Clements, Kristine Klein and Humera Syeda.
The industry has experienced an incremental increase in both knowledge and the technological ability to treat various conditions. Once a taboo subject, the media has put women’s health in the forefront with commercials for breast self-exams, birth control, menopause relief and vaccines to protect against cervical cancer and the Human Papilloma Virus (HPV).
“HPV was discovered a long time ago, and we always knew it was associated with cervical cancer, but the technology to test for it, and the vaccine to prevent it, came along much later as advancements in research and medical knowledge occurred,” said Clark.
Obstetrics and gynecology have also benefited from refined technologies that allow for laparoscopic surgeries with smaller incisions and quicker recovery times. In addition to minimally invasive surgeries for tubal ligation, a procedure for permanent female sterilization known as getting your “tubes tied”, there are also endometrial ablation procedures to decrease uterine menstrual bleeding and cramping.
Clark also credits the advanced imaging processes of the ultrasound for vastly improving the field’s diagnostic and treatment capabilities.
But the biggest challenge for Clark doesn’t have to do with health care; it has to do with running a practice when reimbursement rates from insurance companies and HMOs haven’t kept up with the rising cost of medicine and inflation.
“The cost of running a practice–in particular the liability expenses involved–has increased at a faster rate than inflation,” Clark stated. “The reimbursement rates for routine visits and pap smears are lagging far behind and putting pressure on the practitioners who are trying to deliver optimum care for their patients.”
In addition to low reimbursement rates, Clark mentioned the “alarming” nationwide issue of the growing numbers of individuals without health insurance.
He also noted that the continuing problem of educating teens–be it to stop smoking, use contraception, practice safe sex or to abstain from it altogether–has always been a challenge.
Preferring the office to the lab, Clark hasn’t found time in recent years to pursue much in the way of cutting-edge research or publishing. The father of three grown daughters, and a grandfather of three, he finds satisfaction is all in a day’s work.
“Just knowing that I have benefited my patients and my family is good enough for me.”
Dr. Jennifer Pearce, MD
Pediatric Oncologist Hematologist
Albany Medical Center
Undergraduate degree: John Hopkins University, biology
Medical School: University of Michigan
Residency: Children’s Hospital of Philadelphia
“We laugh a lot,” aren’t words you expect to hear in a hospital, especially when the diagnoses delivered here are anything but humorous. But Pediatric Oncologist Hematologist Dr. Jennifer Pearce, and the entire staff in the Center for Childhood Cancer and Blood Disorders unit of Albany Medical Center (AMC), have managed to make hospital visits fun, if not calming at the same time.
It’s a surreal experience to step off a hospital elevator and face vibrant colors, fish tanks, computers on child-size desks and Winnie the Pooh paintings a la Van Gogh. For almost a second, you forget you’re visiting a place where kids come for treatment. In the next second, there’s a bald, giggling kid stepping onto the floor and you’re snapped back to reality. For Pearce, working with these patients is one of the most fulfilling parts of the job. “I love working with kids and their families. I love having more and more to learn every day about biology and science.”
Pearce loves the diversity that comes with being a pediatric oncologist hematologist. “I love working with a toddler then going next door to a teenager and then on to an eight-year-old. I find the differences fascinating.”
As a child, Pearce not only knew she wanted to be a doctor, but knew she wanted to work with children. “In second grade when writing a basic essay about what I wanted to be when I grew up I asked the teacher how to spell pediatrician.”
Originally from Michigan, where she attended medical school at the University of Michigan, Pearce then headed to Philadelphia for her residency at the Children’s Hospital of Philadelphia and came to Albany in 1985 for her current job.
“I thought I would stay a few years and then move on which is the norm in academic medicine,” said Pearce.
Boy, did Albany prove her wrong. She fell in love with a native of the area, married and had two kids. “I love the region and think it is very underrated. It has been a great place to have a family. I love the fact that it is a highly intelligent community with plenty to do.”
When a child sees Pearce, it’s because his or her primary physician finds something abnormal, at which point they are sent to her for diagnosis and treatment. At times, families arrive with knowledge that some form of cancer is the diagnosis, other times they don’t know it’s a consideration. “Most parents are on the Internet doing their own research at least some of the time; they want to be more involved in understanding the disease and the treatment than they did in the past.”
While her unit treats patients with non-malignant blood disorders, such as anemia and sickle cell disease, the most common type of cancer she treats in kids under the age of 15 is leukemia, about 75 percent of which is Acute Lymphocytic Leukemia (ALL), a blood cancer in which the cancerous change takes place in the type of marrow cell that forms lymphocytes. The good news is that between 75-80 percent of all children diagnosed with cancer will be long-term survivors. “Add that fact and the long hours and sad times are all worth it.”
When working with patients suffering from a malignant disease, Pearce says its energy, and not only her own, that keeps her going. It’s the laughter and endless hope that her patients and their families have that is like a daily shot of adrenaline for her. But the job can also be draining. “Telling families bad news and going through relapses and deaths with families that you care deeply about is emotionally exhausting,” said Pearce. “But then a giggling, bald three-year-old brings you a rock they painted just for you and energy is renewed.”
As a mother of a 20-year old daughter and 18-year old son, Pearce says she never understood how hard parenting a healthy child was until she had her own. “I never really understood how deep the love a mother has for their child. I can’t imagine where the parents get their strength from to deal with their children’s illnesses and yet they do, day after day.”
Dr. Richard Dal Col, MD
Location: Albany Cardiothoracic Surgeons, Albany
Undergraduate School: LeMoyne College, Syracuse
Medical School: Albany Medical Center
Residency: Albany Medical Center, general surgery
Fellowship: University of Pittsburgh
“I think what’s unique to most cardiac surgeons is that we really love the challenge,” said Dr. Richard Dal Col, one of nine doctors at Albany Cardiothoracic Surgeons, the largest and oldest cardiothoracic surgical group in upstate New York.
Originally from Long Island, Dal Col caught the bug for cardiothoracic surgery during a rotation in medical school at Albany Medical Center in the late 70s.
“People really notice the difference after heart surgery. For some people, you save their lives, for others it’s about quality of life and extending their life expectancy.”
Cardiothoracic surgeons perform procedures on and treat diseases of the heart and lungs. Established in 1955 as an affiliated program with Albany Medical Center, Albany Cardiothoracic Surgeons (www.acts.org) went private in 1987 and now operate out of St. Peter’s Hospital, Ellis Hospital and Champlain Valley Physician’s Hospital in Plattsburgh. Dal Col joined the group in 1990.
In the last 10 years, there’s been an explosion of minimally invasive surgery through the use of Heartport technology robots like the single-arm, voice-activated AESOP (Automated Endoscopic System for Optimal Positioning) and the da Vinci.
“The magnification and lighting with the da Vinci is fantastic and you’re sitting down at a console, so you’re relaxed,” said Dal Col. “The operations I perform today are incredibly different than the way I originally learned back in the 80s and 90s.”
St. Peter’s Hospital is a minimally invasive valve center. About 80 percent of their cases are coronaries; approximately 40 percent are coronary surgeries with the balance being valve surgeries. Surgeons at the hospital perform about 800 heart surgeries annually and nearly 1,400 hearts throughout the entire group.
A typical surgery lasts from 2.5 to 3.5 hours, with more complicated procedures lasting as long as eight hours or more.
The average in-hospital stay for a minimally invasive heart surgery is only about two days less than a typical procedure. Patients return to full function from a minimally invasive sternotomy procedure after two-to-four weeks versus three months for a standard sternotomy procedure.
“It depends upon the age of the patient and how early the procedure is performed,” Dal Col explained. “We still see people with late presentation for surgery because they don’t realize there’s a less invasive approach. The earlier we see them, the higher likelihood of doing a minimally invasive approach, in particular with mitral-valve repairs.”
According to Dal Col, the only problem with the new da Vinci robot at St. Peter’s is getting access to it, because everybody wants to use it. The technology is rapidly improving and he feels the future for robotics will be with coronary surgeries.
“True, state-of-the-art is more of a robotic-assist than it really is truly completely robotic,” Dal Col noted. “The second and third-generations of the robots are going to make the coronaries a very doable procedure.”
Coronary surgeries are still fairly invasive even off-pump. But, with some of the anastomotic devices and newer devices for stabilizing the heart off-pump, he’s confident we’ll begin to see a more closed and less-invasive coronary procedure in the not-too-distant future.
Time vs. talent
Even though medical students undergo a rotation in the specialty, the decreased reimbursements for cardiac surgery leave no incentive for people to spend 10 years of post-graduate training becoming a surgeon. Attracting people to the field has become a three-fold problem: the training time is long, the loans are high and the reimbursement is low.
Dal Col said the problem dates back to when the whole reimbursement issue was initially changed for Medicare. Cardiac surgeons weren’t really well represented on the committee and lacked a political action committee (PAC) and strong lobbying effort. Since that time, they’ve developed both and people are starting to take notice.
“There’s really no one answer to heart disease: it’s multi-factorial,” said Dal Col. “People in Washington are finally starting to understand what’s involved and what’s at stake.”
Even with the challenges of the field, daily successes bring multiple rewards. Dal Col’s biggest personal success came in 1997 with a re-operative patient who had been turned down by several other institutions.
“They didn’t think he was a transplant candidate,” Dal Col explained. “So, his only option was this difficult, high-risk operation. My senior partner, who was approaching retirement at the time, felt the surgery really should be done and that I should perform it.”
The patient had a bad heart, and had outlived his initial operation at age 57. This was a re-operative mitral-coronary with mitral repair and a low injection fraction. A difficult case in general, the patient had limited conduit for the bypass. Dal Col’s team ended up using an open-valve process to preserve what was working.
“I hear from him every year on the anniversary of his operation,” said Dal Col. “It’s 11 years out and he’s still doing well.”
Joel Kremer, MD
Center for Rheumatology, Albany
Undergraduate degree: Dickinson College, PA, Biology
Medical School: Temple University
Residency: Albany Medical Center
Fellowship: Albany Medical Center
Dr. Joel Kremer’s fascination with rheumatology has spanned more than 30 years. Yet he’s baffled by the number of misconceptions people have about the field.
“People think that arthritis is when your joints hurt. They don’t understand the interplay of molecules in the immune system that results in these diseases. And, they don’t realize that physicians can intervene at any one of a number of steps, once we understand what’s going on behind the scenes, to make people feel better.”
Another fallacy about the industry is that rheumatologists work primarily with the elderly.
“The ‘old people’s’ disease is degenerative osteoarthritis and yes, we do see that,” said Kremer. “Lupus and rheumatoid arthritis typically start in your 30s and 40s and I have lots of patients in their late teens and 20s.”
Rheumatology is a subspecialty of internal medicine that concerns problems involving joints, soft tissues and allied conditions of corrective tissues. About 95 percent outpatient-based, rheumatology involves multi-system and auto-immune diseases like lupus and vasculitis, which is an inflammation of the blood vessels, where the body’s immune system turns on itself.
The complex diseases require multiple tests and often numerous specialists are involved in the patient’s care.
“Some of these patients are extremely ill and become hospitalized,” Kremer explained. “But, very often it’s not the primary rheumatologic disease that lands a patient in the hospital. We’re typically treating people who are coming in during a flare-up or suffering from comorbidities.”
Comorbidities are diseases that travel along or exist simultaneously with the primary disease. Recognizing these comorbidities, and avoiding or treating them early, is a large part of what rheumatologists do today. The proliferation of biologic drugs introduced during the last decade has also significantly improved the treatment of rheumatoid arthritis.
“These drugs are very expensive because they’re directed at specific steps in the immune process. But, the vast majority of these people who we saw suffering for so long are doing so much better today because of them.”
It’s always been about the patient for Kremer. He became fascinated with patients suffering from rheumatologic diseases during his residency at Albany Medical Center. While most surgeons do their most intensive work while the patient is unconscious, Kremer wanted a profession where he could develop long-term relationships with his patients.
“Plus, the scientific underpinnings of rheumatology are fascinating and really appealed to me.”
Research and education also appeal to Kremer who is the Pfaff Family Professor of Medicine at Albany Medical Center where he also completed his fellowship. He spent 20 years at the Center and was head of the division when he left in 2000 to form a private practice in rheumatology.
Kremer still teaches medical students and fellows every week and has found satisfaction through his research including testing the new biologic drugs on the market and a study using fish oil as a dietary treatment for arthritis. His claim to fame, however, was founding a national registry for rheumatology nearly nine years ago that has grown to be the largest in the country.
The Consortium of Rheumatology Researchers of North America (CORRONA) registry was brought together as an idea and is maintained through the help of physicians around the country.
Through the CORRONA registry, Kremer has been involved with the epidemiology of diseases and genetics and how they intertwine – part of the continual work he performs on behalf of his patients.
“Physicians are human beings and being a good doctor is hard, demanding work,” said Kremer. “Being the most diligent patient advocate without cutting corners takes an unwavering focus and time commitment.”
Kremer is pleased by the large number of medical students who are pursuing careers in rheumatology versus a decade ago when growth in the field was at a stand-still. According to a study a few years ago by the American College of Rheumatology, the average age of a rheumatologist was in the mid-50s. They’re predicting a future wave of retirees in the field, so numerous opportunities will exist for new grads.
He’s also proud of the progress he’s seen in the field since he completed his fellowship in 1979 and foresees really good things happening over the next 15-20 years.
“We’re not at the point where we can prevent arthritis from occurring, but there are a lot of people who are virtually in remission.
“It’s been a tremendously satisfying and challenging journey,” Kremer mused. “And, it’s not over.”
Scott Osur, MD
Allergy and Immunology
Certified Allergy Consultants, Albany
Undergraduate degree: Amherst College, MA, European History
Medical School: University of Virginia
Residency: Strong Memorial Hospital in Rochester
Fellowship: University of Buffalo
A recent survey showed that nasal allergies are the fifth or sixth most costly disease to society in terms of medicine, medical care, lost productivity and everything combined.
“People don’t realize that nasal allergy sufferers score lower in terms of quality-of-life than asthmatics, which would intuitively be regarded as a more life-debilitating condition,” stated Dr. Scott Osur, allergist with Certified Allergy Consultants (CAC).
Nasal allergies have a documented significant impact on work and productivity including “presenteeism”, where an employee is present at work, but not fully functional. Nasal allergy sufferers don’t sleep well, are fatigued, perform lower on tests and suffer from chronic nasal congestion, but according to Osur, many primary care physicians aren’t aware of these quality-of-life issues because allergies aren’t a dangerous or life-threatening condition.
Originally from Stores, Conn., Osur relocated to the Capital Region in 1987 following a two-year allergy fellowship at the University of Buffalo. Employed with CAC since the outset, Osur chose his profession because he thought it was an area where he could make a difference.
“I knew the prevalence of allergies and asthma was not only frequent, but that with the proper diagnosis and treatment, you could make a substantial difference in someone’s quality of life for years and decades to come.”
As a specialized subset of internal medicine or pediatrics, allergists must undergo two-three years of extensive training following their internal medicine training. Patients with chronic sinus disease and/or structural issues would be referred to an ear, nose and throat (ENT) specialist.
“We trade patients back and forth depending on whether it’s more of a medical or a surgical problem,” said Osur. “ENTs require two-three weeks of additional training, whereas allergists train as much as cardiothoracic surgeons.”
Common outdoor allergens include ragweed, pollen and grass. Notably, the number of children with peanut allergies and asthma has doubled over the last 20 years leading researchers to consider “hygiene” as the culprit.
“Allergies are common in the West, but virtually non-existent in third-world countries with reprehensible public health conditions,” Osur explained. “Researchers believe our infant care environments are so clean that children aren’t exposed to bacteria and are unable to develop antibodies to protect them from these allergens.”
Osur employs a three-tier process to diagnosing and treating nasal allergies: determine the cause, avoid the cause and when all else fails, give allergy injections.
The cause, or triggering allergens, hasn’t changed much over the years. Avoiding the cause through changing or removing the patient from the environment or controlling his reaction with medications is the next basic step.
Though antihistamines haven’t changed all that much, new ones are continually entering the market along with prescription nasal steroid sprays. Medicines to treat asthma symptoms have changed in the last 20 years. Theophylline, a common treatment back then, is fifth in line as a choice today.
The final treatment option for patients with nasal allergies and/or asthma involves getting allergy desensitization injections.
“This treatment option has become vastly better over the last few years because the re-agents used to test someone are more sophisticated and scientifically based,” noted Osur. “Also, because many of the insurance companies now cover injections without charging a co-pay, the cost has actually gone down for people getting injections while medicine costs continue to rise.”
Early on in his career at CAC, Osur participated in a number of pharmaceutical trials. These days, he spends his time researching and publishing in areas that interest him, namely asthma and pregnancy, and the role of viral infections in asthma. Osur found that one of the most common issues asthmatics run into is when they catch a common cold, because it settles in their chest and causes serious complications.
Regardless of the treatment method used, making sure patients will comply with what they develop as a plan is critical. Osur and his colleagues at CAC feel physicians don’t emphasize this engagement enough so they spend a lot of time asking critical questions like: Does this make sense to you? Are you okay with this? Can you get allergy shots regularly?
“The plan can be great, but, if the patients don’t comply, it’s worthless.”
Dr. Joseph Sacco, MD
Samuel Stratton Veteran’s Administration (VA) Medical Center, Albany
Undergraduate degree: Massachusetts Institute of Technology, Bachelor of Science & Chemistry, Bachelor of Science, Life Science
Medical School: University of Connecticut School of Medecine
Residency/Fellowship: St. Mary’s Hospital, Waterbury, Conn. affiliated with the Yale University School of Medicine as a teaching hospital for nearly 40 years.
Nearly half the people in the United States die of cardiovascular disease or stroke each year while 10-15 percent is currently suffering from some form of heart disease.
“I’m in this environment because I like to teach,” said Dr. Joseph Sacco, chief of cardiology at Samuel Stratton Veteran’s Administration (VA) Medical Center in Albany. “It’s a good way to keep a broad spectrum of patients.”
During his undergraduate years, Sacco took many science courses and a “little bit of engineering.” The latter eventually led him to pursue a career in cardiovascular disease, or diseases of the circulatory system including the heart, blood vessels, arteries and veins.
“Cardiology is a little bit of ‘hand waving,’ but it’s mostly mechanics, technology and engineering,” said Sacco. “I didn’t like lab work and wanted something more interactive.”
How he deals with patients is everything to Sacco. He stressed that [preventive] education, through routine check-ups, must be part of every interaction and feels it’s the doctor’s job to engage people and to learn to work together to keep his patients out of the hospital.
Balancing what patients believe becomes paramount, requiring physicians and surgeons to stay informed of all types of medicine, including holistic treatments. But, he noted that prescribing the best medicine in the world becomes useless if the patient doesn’t take it.
“When I sit with a patient, I have to learn what’s going on with them from them, and then teach them how to care for themselves.”
Originally from Connecticut, Sacco has spent the last 25 years in the Capital Region. He started at Albany’s VA Medical Center in 1985 and spends over 85 percent of his time there and the remainder teaching cardiology to students and fellows at Albany Medical Center.
He enjoys the clinical research portion of his work and has been involved with testing both new drugs and new treatments involving Acute Coronary Syndrome (ACS) and a trial fibrillation.
“You feel like you’re on the cutting edge when you discover something new that works,” he said. “My work is all about managing patients’ health better and keeping them from having strokes.”
Formerly considered a junior partner in the health system, VA Medical Centers nationwide have been touted as the model and benchmark for how care can be improved by the Institute of Medicine.
“In the last 15 years, the VA Hospitals have pulled themselves up by their boot straps and worked to revise the science of improving care delivery,” said Sacco. “We’ve learned a lot from the business industry with regard to the design and number of clinics needed in a given area, to how often patients should return for visits.”
Like most fields, the growth of technology has had a huge impact on the profession. Sacco is extremely proud of the Computerized Patient Record System (CPRS) that the national VA initiated.
The system tracks a patient’s medicines, procedures and care and prompts you to perform certain tests at the appropriate times to aid in preventive medicine efforts and keep costs down for the patients and hospitals. The CPRS also helps alleviate safety issues concerning drug interaction because all medicines and procedures are recorded with bar codes and scanned into the storage system.
“If a patient has a reaction to a medication or misses a procedure, it could result in an extended hospital stay,” Sacco explained. “We started the [CPRS] system ahead of the curve and are leading the charge!”
That accomplishment is highly significant to Sacco because he feels medicine has become extremely difficult to practice. Increased scrutiny from New York State, seemingly infinite layers of monitoring and all the people physicians have to satisfy along the way have proved challenging, even as technology makes the profession more precise.
“I couldn’t work without all the mid-level providers and nurses assistants in my treatment teams,” Sacco conceded. “I have a great team and it makes it so much easier to get in touch with patients and follow up on procedures and treatment plans.”
Sacco’s electronics background has come in handy when installing pacemakers and cardiac catheterizations and utilizing new sophisticated techniques like the echocardiogram machines that create 3D reconstructions of the heart. But, he cited the Internet as both a blessing and a curse.
“No test takes the place of listening to the patient, but more patients attempt to self-diagnose or research alternative treatments on the web.
“Tim Russert died because he was trying to take care of himself,” said Sacco remorsefully. “If you drop dead, you don’t get to take advantage of the fancy [angioplasty] balloons and treatments that can save your life.”