“We are living in great irony now” is how Provident Clinical Society President Dr. Dexter McKenzie described the similarity between the health care disparities in the era the Society was founded (in 1905) and the current health system in Brooklyn which he terms “broken” and health policies that are “ill-advised.”
An illustration of the interrelatedness of health issues Dr. McKenzie gave was the 14% increase in malpractice premiums this year forcing obstetricians in Brooklyn to pay upwards of $175,000 for malpractice premiums. “How is that sustainable,” McKenzie asks, “when in the most vulnerable neighborhoods, where a delivery is on the order of $900, when that obstetrician has to deliver about 190 babies just to meet the malpractice premium?” And this is in addition to the regular expenses of running a business and beyond that, trying to earn a living.
McKenzie says the result is that doctors are opting out of delivering babies. “At a Borough Hall hearing called by the Society, Dr. Ing fromthe Medical Society of the State of New York said that there are between five and seven zip codes in Brooklyn where there is no full time practicing obstetrician, and most of those zip codes were in the central part of Brooklyn where the resources are scarcest and the need is greatest.”
It is facts like these that convince Dr. McKenzie that “what we’ve been doing is not working,” and that doctors “cannot just continue to see patients behind closed doors, write prescriptions and assume that all will be well.”
We followed up after the meeting and asked Dr. McKenzie about his analysis and prescription for the health care system.
OTP: It seems that medical decisions for folks in Bedford-Stuyvesant are made in committee rooms in Albany and Washington. You’ve spoken of the formation of a United Doctors Political Action Committee. Do you see this as the best way to influence the political agenda?
Dr. Dexter McKenzie: Firstly, you’re absolutely correct. The decisions about how physicians practice and what tools we can utilize and what resources we have at our disposal are generally made as part of a political process that physicians are oftentimes divorced from. When the physicians are divorced from medical policy, then the public is even more divorced.
We look at our role as being the legitimate advocates for our patients and that physicians must now adopt a new posture and become vocal and involved in the health care process. The United Doctors Political Action Committee will have at its active central core health care professionals. But our intentions is to open the process for the involvement of the citizen in the political action committee so that we can have, in a methodical way, community-level discussions about health policy and keep the public abreast of these issues and begin to affect the political process at the local level.
OTP: You’ve spoken about the conditions for African-Americans in 1905 which prompted the creation of the Society and yet in looking at pictures of that period, everything seems to be quite nice. These images don’t tell the other story.
Dr. M: It was very difficult for black Brooklyn in those early years. The mortality around the time of the creation of the Provident Clinical Society was dismal. It was 86% higher than for whites. The black physicians at the time were hampered from addressing this issue in any effective way because of the larger social issues of segregation and racism. Physicians in Brooklyn were not allowed to admit patients into the public hospitals. That went on until 1927.
Provident Clinical Society commissioned a historical work by scholar Irma Watkins-Owens, An Introduction to the History of Black Physicians, Dentists and Pharmacists in Brooklyn from 1850-1985 which included a compilation of Provident Society members from 1905-1985. She brought into light that era before the Provident Clinical Society in the 1880’s. In the book she speaks of recorded accounts of black physicians performing surgery on kitchen tabletops.
Provident and its founders realized, even at that early juncture, that the medical problems they were contending with were really the end result of larger social issues and nothing has really changed since that time. And outside of those genetic forces that determine disease, most of what physicians are contending with, even now in 2007, are as a result of social policies. Those areas of our cities where infant mortality is the highest, it’s where people are the poorest and it’s where African-Americans live predominantly. Those are the same areas where you’ll find an excess of disease, an excess of unemployment, an excess of early loss of life and an excess of a lack of political power. That all culminates into disease. These statistics are well-known. The maps of poverty, disease, unemployment, lack of insurance, they all coincide. So it feels a bit futile as a physician to deal with the ends of these issues from day-to-day without involvement in the root cause.
OTP: It seems like we’re seeing the same problems now as in 1905. What can be done differently to get some different outcomes?
Dr. M: There are those who would argue that there are striking similarities between 1905 and 2007. And I would agree that we have made advancement in terms of technology in medicine and we have more pharmaceuticals than at anytime in history and yet at the same time, over the last thirty years, the incidence of diabetes has risen consistently over the last three decades. There is more hypertension than ever, more obesity than ever. So there is a paradox that is occurring. We’re making advances but not all of our citizens are benefiting from those advances and in some cases segments of our society have made retrograde steps. We have a dismal situation in the education sector where less than 50% of our high school students are graduating and we know that there is a link between education, poverty and health insurance; we know that 75% of those with health insurance get it through their employer. So if you are unemployed, but not destitute, meaning you don’t qualify for government programs, then you will be without health insurance. Or you may be underinsured. The result of this is the disparate appearance of disease. We know that these kids who are not finishing high school are going into the prison system. 82% of the prison population of New York State are Black and Latino young men and women. Despite the advancements made since 1905 we are not totally better off, and in some ways we are worse off.
OTP: Looking at your associations, Chairman for the Brooklyn NAACP Health Committee, Chairman for the National Black leadership commission on AIDS, part of the Executive Committee for Black Brooklyn Empowerment, Assistant Professor of Medicine at SUNY-Downstate as well a President of the Provident Clinical Society, what are the results of those cross-pollinations, how does that work to help you fulfill your mission and what is your mission?
Dr. M: It may sound a bit contrived, but it is really about service to my fellow man. I have a deep and abiding, total antipathy for human suffering and that has been a part of my makeup since I was a child. I never dreamed when I was attending junior high school in Brownsville that fulfilling my dream to mitigate the suffering of those who are most vulnerable that it would take the form of being a physician. Even after becoming a physician, I realized it’s totally futile to lock yourself in the office and attend to those individuals who come through the door and leave for home and come back to do it again. I cannot see that as being the end of the road for the fulfillment of any dream or any promise.
It is indeed true that to those who much is given, much is required. And I am totally inspired by the character of the founding members of the Provident Clinical Society and the part they played in the social fabric of Brooklyn. For those early members, their social and community commitment far outweighed any economic gain as a motivation and I’m trying in my feeble way to live up to that same mission and dream. So my approach is really nothing new. In fact a founder of the Clinical Society, Dr. Walter Beekman, was very active socially and was a co-convener and co-organizer of the Brooklyn NAACP with W.E.B. Du Bois. They had the inaugural meeting of the organization at the Concord Baptist Church in Bedford-Stuyvesant, so Beekman was very much there in the creation of the Brooklyn chapter of the NAACP and I think it is only appropriate that Provident is once again playing a role in this very important organization. As physicians, we have to move out into the community, hold meetings and educate the public, not only on diabetes and hypertension, but to educate the public in terms of the political process and health care. When we do that, I think we will again have the respect of the public like the founding members had.
OTP: Is part of that process the presentation the Society is doing at the Adelaide Sanford Institute at Medgar Evers College?
Dr. M: Yes it is. The Adelaide Sanford Institute is the brainchild of Dr. Lester Young Jr. and Dean Richard Jones of Medgar Evers College and it represents the health cluster of the Black Brooklyn Empowerment Coalition. Their talking about a new approach to educating our children based on well thought out techniques and a comprehensive approach to education, drawing upon the success of programs currently at work in various parts of the city. The PCS is bringing some ideas into that paradigm and giving insights into the determinants of cognitive development of children and the child’s capacity for learning. There are health determinants of intelligence and aptitude that have to do with what happens to the child while in gestation. There are choices the woman makes such as smoking, alcohol, drug use, poor nutrition, not getting proper pre-natal care, which culminate in pre-term delivery, having lifelong limitations in terms of academic achievement.
Having said that, it is unthinkable that we can have five zip codes with no fulltime practicing OBGYN physicians. It is deplorable, abominable and unspeakable that should not be a reality in this time. It is because of our lack of involvement in the political process and I believe the medical community has the responsibility to protect the welfare of the most vulnerable citizens of Brooklyn, by being more than doctors. We re supposed to be well-educated and we’re standing on the shoulders of people who have gone before, people whose names we don’t know. People who probably never had the opportunity to go to college, but fought for the liberties we have as physicians. That’s a debt and we have to repay that. We have to be more than the proverbial definition of the doctor. We have to demonstrate our commitment by assuring the empowerment and giving the community a voice.
OTP: We were very impressed by your two Christians at the meeting, Christian Bijoux, the premed student on your board and Christian Paylor-Smith, who has just graduated from Midwood High School. What aboutyour mentoring program?
Dr. M: A few years ago, we initiated a mentoring program was to not just to engage the children in motivational speech and disappear, but to be present in their lives throughout. At the end, have them take on mentees so that it is a sustained process. What we are doing in this next phase is developing a science academy, a virtual academy for math and science enrichment for children who are interested in the scientific sphere. We structure it in such a way that it augments their regular scholastic responsibilities. We understand that children learn in a particular way. They are involved in experiments and some are publishable. We have them in our offices. We take them to the university. They get to do hands-on work. The children, they bloom, they flourish, and these are two examples of many that do exist. We are now expanding the program down to the 7th grade. David Ruggles School 258 will be one of the schools we will be bringing onboard. I saw wonderful talent at their last science fair. Sometimes it’s important that the community knows that there are people out there who care deeply and are working every day to make things better.