Former New York Governor David Paterson, JD, has a new job as a distinguished professor at Touro College of Osteopathic Medicine in New York City (TouroCOM), but he’s in many ways returning to familiar territory. The medical school is on 125th Street in Harlem in Manhattan, down the street from the legislative building where Paterson worked as a state senator before ascending to lieutenant governor in 2007. In that building, Paterson lobbied against closing hospitals and other medical facilities in the neighborhood. Later, as governor of New York from 2008 to 2010, Paterson was an early supporter of the Patient Protection and Affordable Care Act and also pushed for increased HIV and AIDS testing in health care facilities.
At TouroCOM, Paterson will use this real-world experience to teach health care policy to medical students. He will also be advising the school on grants and community outreach efforts, such as a drive to vaccinate Harlem’s senior citizens against pneumonia.
Following is an edited interview with Paterson.
What role does health care policy play in a medical student’s education?
Medicine is a seamless web, and there’s a great deal of public policy that infuses itself even to the practice of medicine. It’s great for doctors to know what the environment around them is, so they can better understand their patients. Doctors have traditionally been called upon to go way beyond their training. Fifty years ago, in the days of Ben Casey and Marcus Welby, the family doctor was also the family counselor. He was also the family sex therapist and the family nutritionist, but the medical schools weren’t really teaching that. It was just what doctors went out and learned in order to be effective. We’d like to give the new doctors of the 21st century a little more information to work with.
You could have gone in a number of directions academically. What drew you to TouroCOM and teaching medical students?
Touro College is teaching a record number of minority students, and Touro has had the vision to put some of their facilities in minority neighborhoods. Both the medical school and the pharmacy school are right in the middle of Harlem. They stand as symbols of hope for younger people. I can’t remember the last medical school that located itself in a predominantly Dominican and black neighborhood. I’ve had a relationship with this school for 25 years. When they were going to build the medical school, they asked me to help them pick the site, and I was actually the keynote speaker at the groundbreaking. Then I was the keynote speaker at the graduation of the first medical school class.
This is an immense opportunity for me. It’s a little different. Most people, when they leave office, they sit around and try to find another office to run. But life is short, and I always thought the medical profession was intriguing. When I was in the Queens District Attorney’s Office, I worked on insanity defense pleas, which put me in close touch with the health care industry, as did the closure of hospitals when I was a senator. I’ve always been around health care professionals and admired them. To have an opportunity to work with them now is a big thrill for me.
You’re also advising TouroCOM on community projects. What does that entail?
Here’s an example. Right now in Harlem, where the medical school is located, fewer than 40% of seniors have had a pneumonia vaccine. Just to the south, on the Upper East Side and the Upper West Side of Manhattan, 80% of the seniors have taken it. Part of the reason for the discrepancy is that eight major hospitals in Harlem have closed over the past few decades. So the constituents of the neighborhood don’t trust the profession and think that every visit they make will be the last at that institution because they’ve seen so many of them close. We’ve started to go to the senior centers and people’s buildings with the vaccines, and we’ve had great results so far.
What are the most important health care policy issues that medical students and young physicians will want to be aware of?
Medicine is going to have to become more preventative. Doctors are going to have to be more proactive and perhaps use social media for a better dialogue with the public in order to steer people away from conditions that are treatable.
The Affordable Care Act was passed in 2010, but fewer than half of the states are expanding coverage as intended because they can’t afford it. The act was a great idea, but in practice, it’s a problem. And when regulation and government can’t solve the problem, we have to go back to what we’ve always had, which is dedicated people who try to find the answers individually in different communities around the country. We want to let physicians know that they’re not alone. We’re all fighting this problem together. TouroCOM is trying to develop a new network of information and dialogue.
Do you see physicians and policymakers working more closely together in the future on issues of public health?
Yes. Traditionally they didn’t think they needed to, and perhaps some of them frowned upon the other. What I like about President Barack Obama’s plan is not necessarily that it was perfect because it was far from it, but that he had a plan. I respected his effort, and it spawned a greater communication between the policymakers and the researchers and the practitioners. I’m hoping that this communication will endure to benefit families and communities looking for the type of health care they may have felt was traditionally denied them.
You supported the Affordable Care Act while in office. Many physicians also support it, but many other physicians and medical students do not.
I don’t think the Affordable Care Act works for physicians. They are being monitored and maybe even muzzled from making the best medical judgment with a reasonable degree of certainty, which is what we want clinicians to be able to do. I certainly supported the act, but I did realize that it was going to be expensive and tried to point that out back in 2010 when I was governor. It is going to cost a lot of money, and it’s restrictive. I hope the administration will be flexible as people try to fix it. They’re getting early feedback on what the problems are, particularly in the case of doctors. The health care environment under the act is going to heighten the anxiety of doctors, with all they have to do and all the costs they incur. It’s going to hurt morale and inevitably hurt productivity.
What changes in the Affordable Care Act would you like to see that would help physicians?
The administration is going to have to review the parameters that restrict doctors from making choices in the best interests of their patients.