Will $1 billion awarded to a Bronx medical school improve the borough’s health?

For Trevor Barker, a first-year student at the Albert Einstein College of Medicine in the Bronx, a former professor’s $1 billion donation that will eliminate medical school tuition could very well be life-changing.

Barker works two jobs on campus and sends money to his mother in California. She expected to graduate hundreds of thousands of dollars in debt. But free tuition has made her think about new options for his career.

“I hadn’t really been able to consider family medicine, but I might want to,” she said.

Family medicine doctors do everything from delivering babies to caring for seniors, often in underserved communities. Barker said he might consider practicing medicine in the Bronx, although doctors there generally earn less.

Dr. Ruth Gottesman’s billion-dollar donation made national news last week for her generosity and her life story. She also resonated because she didn’t go to a school in Manhattan, where major medical and educational institutions regularly receive gifts from billionaires.

Instead, his donation went to the only medical school in the poorest and unhealthiest county in New York State: Einstein, a prestigious medical school with more than 1,000 students affiliated with a major hospital, Montefiore Medical Center. Almost immediately, doctors and health experts began considering what effect it would have on health care in a district with high rates of chronic diseases such as diabetes and asthma, and with relatively few primary care doctors.

Dr. Gottesman’s donation is intended to help Einstein and his medical students and encourage more low-income students to apply to medical school. He could also encourage students like Mr Barker to practice medicine in the district. And some doctors and health care experts were optimistic that Einstein’s blessing would be felt beyond the campus, with a trickle-down effect that would eventually 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,” said Dr. Luisa Pérez, a Bronx internist. “It’s a win-win 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, at best, have “a marginal impact” on health care in the Bronx.

“Let’s not pretend that these one-time events that could do some good somewhere are the systemic solution, because they are not,” he said.

Year after year, the Bronx ranks as the least healthy borough in New York, coming in 62nd out of 62, according to County Health Rankings & Roadmaps, a project of the University of Wisconsin’s Population Health Institute that compares county health metrics. In contrast, Manhattan ranked #7, Queens #12, Staten Island #21, and Brooklyn #22.

Within New York City, the Bronx has the highest rates of diabetes and the highest rates of childhood asthma. One in three – one of three deaths in the bronx It is classified as “premature”, that is, the person died before the age of 65; In the city as a whole, that rate is about one in four.

Access to healthcare and doctors can play an important role in reducing the number of chronic diseases such as diabetes and hypertension. Diabetes, for example, can cause lower limb amputations and kidney failure. But the disease can be managed through lifestyle and diet changes, medications, and blood sugar control, all of which primary care doctors try to address with their patients.

“The primary care doctor prevents the disease from hindering patients to the point of being amputated, or from ending up in a wheelchair or going to dialysis three times a week,” said Dr. Pérez, a member of the SOMOS Community. . Care, a large network of doctors working in underserved neighborhoods in New York City.

But even with many more doctors in the Bronx, it would be difficult to reverse the prevalence of chronic diseases without also addressing the complex factors that contribute to the emergence of health problems in the first place.

Many chronic diseases have their roots in socioeconomic conditions. The high number of asthma victims in the South Bronx is related to air pollution, diesel exhaust from truck traffic, cockroach particles, mold and other factors related to the environment and housing conditions.

Diabetes can often be prevented by eating a healthy diet, staying physically active, and keeping weight under control. But that can be difficult for people who work multiple jobs or have long commutes and limited dining options.

“The vast majority of these disparities have their origin in living and social conditions that long precede the onset of the disease,” said Dr. Saini of the Lown Institute.

Still, messages coming from doctors can make a difference. They can encourage patients to exercise more and make healthier choices whenever possible, such as drinking less juice, eating less rice, or rinsing canned vegetables to reduce sodium.

From 2015 to 2021, there was a significant improvement in the Bronx’s ranking for “health behaviors,” which includes rates of smoking, physical activity and diet, according to Charmaine Ruddock, project director for Bronx Health REACH, a community-based program that seeks to reduce health disparities. . Ms Ruddock said the improvements were the result of the efforts of community groups as well as doctors and other healthcare providers.

The Bronx has the fewest number of primary care doctors per capita of any municipality. When asked if they had a doctor, Bronx adults It is more likely to respond no more than those who live in other parts of the city.

One factor is that the Bronx has a higher percentage of residents receiving 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 15 years. It is now only slightly below that of Queens.

Yuliana Domínguez Páez, 24, a first-year medical student at Einstein, wants to do her part to change these statistics.

“I’ll stay in the Bronx,” he said. As far as she knows, she is the only one of the 183 medical students in her class who grew up in the district. (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, a Bronx internist, believes the donation could lead to more primary care doctors and pediatricians working in the Bronx. “I think if you remove those financial pressures from medical education, it will encourage doctors to stay in these areas,” he said.

Others weren’t so sure. Dr. Saini of the Lown Institute said the donation would help those “who already have their hearts set on becoming primary care physicians” move forward.

But he doubted that making medical school free would persuade many students to reconsider pursuing more lucrative careers or keep them close when they graduate. “It won’t change the incentive structure,” she said.