New hospital doctors bolster Island's health care ranks

By Nelson Sigelman - January 26, 2006

Even as Martha's Vineyard Hospital leaders look to replace their ramshackle facility with a new, modern medical building, another less visible transformation has already taken place at the Island's medical center. In the last six months, five new doctors have joined the hospital staff, bringing their own medical perspectives and skill sets to the delivery of health care on Martha's Vineyard.

In a series of interviews this week, the hospital's newest doctors identified the opportunity to practice medicine in the close-knit Vineyard community and interact with their patients as their primary reasons for moving to the Island.

They join a medical staff that includes veteran primary care practitioners Dr. Henry Nieder, Dr. Peter Laursen, Stuart Kendall, and Dr. Michael Goldfein, a pediatrician and hospital chief of staff, as well as a crop of new doctors hired by the hospital over the last several years to bolster the emergency, surgery, and primary care departments.

The latest hospital hires are the result of an ongoing effort to address the need, identified in numerous assessments of the community's health-care system, for more primary care doctors and the difficult financial environment new doctors face in setting up a private practice on Martha's Vineyard. That reality is responsible for the hospital's decision to hire doctors, as opposed to subsidizing private practices while waiting for new doctors to become established - a practice that is no longer feasible, according to Tim Walsh, hospital chief executive officer.

Mr. Walsh said that, including pediatricians, there are now nine hospital-based primary care doctors. The three physicians who maintain private practices in the hospital - Drs. Nieder, Goldfein, and Laursen - are part of an ongoing discussion among all of the staff aimed at creating a hospital group practice.

Mr. Walsh said that arriving at the right number of doctors is an imperfect science that requires a careful assessment of the community's needs and the physicians' experience. He said that with the recent loss of two experienced and well-respected Island doctors, Drs. Bill Tsikitas and Ilene Klein, it is important to have a blend of newly trained and seasoned professionals.

Yesterday the entire primary care staff, including its newest members, gathered together for the first time. Mr. Walsh is looking ahead to the future.

"It feels like we have been waiting forever to get to this point but I am very optimistic," said Mr. Walsh. "It is change, so there will be ups and downs, but I think ultimately what we are going to end up with is having a primary care physician for every resident. My goal is not to have people get on the ferry because they have to. If they chose to, that is another matter."

The newest doctors bring a mix of professional and academic experience. All had an existing relationship to the Vineyard that prompted them to seek a job with the Martha's Vineyard Hospital.

Dr. Marc Shapiro, a 1989 graduate of Tufts University School of Medicine, joined the hospital emergency room staff in July. Previously he worked in the Rhode Island Hospital Department of Emergency Medicine, taught emergency medicine at Brown Medical School and was the director of the Rhode Island Hospital Medical Simulation Center, a high-tech training facility he helped to design.

Dr. Shapiro and his wife, Dr. Gail O'Brien, were longtime seasonal visitors and owned a home in Oak Bluffs before moving here full-time. The opportunity to spend more time with their two boys and be a part of a community they had only enjoyed as summer visitors was the driving force behind their decision to relocate.

"My wife and I both had 60-hour-a-week jobs and really wanted to spend more time with our children," said Dr. Shapiro. "And the other real reason is that we wanted to be part of a community. You are appreciated more as a physician in a small community like this and that has really been borne out in my experience over the months that we have been here. It makes the job a whole lot more rewarding."

After six months on the job, Dr. Shapiro said he thinks the hospital administration is committed to providing the highest level of medical care possible, and he is encouraged by the prospect of a new facility.

At Rhode Island Hospital, the emergency medicine department alone had 80 beds, three times as many as all the beds in the entire hospital here. However, Dr. Shapiro said that despite its small size, the local emergency room (ER) offers plenty of challenges, particularly during the busy summer months. "There are definitely plenty of things to keep you interested, that's for sure," he said.

Dr. Gail O'Brien, a 1989 graduate of Tufts University School of Medicine, has an authentic Island summer pedigree, a 1977 stint as a dishwasher at the Home Port restaurant in Menemsha.

Prior to arriving on the Vineyard she was on the general internal medicine faculty of Rhode Island Hospital and medical director of clinical services for the hospital. She and her husband, Dr. Shapiro, both had busy, stressful jobs with lots of responsibility and not enough time to spend together as a family.

Looking for a change in pace, the Vineyard was a natural choice because she and her husband already owned a house and had heard good things about the hospital from Dr. Jeffrey Zack, an ER physician and friend. After six months, Dr. O'Brien is not disappointed. She said, "There are a lot of good things happening." She described Tim Walsh as a good leader with a vision for getting the physicians to work together as a team to provide a strong base of primary care and more services for the community.

Despite the publicity given to reports of various health issues associated with Island living, Dr. O'Brien said that people might not appreciate the fact that there are a tremendous number of people living healthy lifestyles. "And they are remarkably healthy. There are 85-year-olds out there hunting deer. As a physician it is really heart-warming and so nice to see people who really take great care of their health and their families care about them," she said. "I cannot tell you how many people I see who are older and their families are really keeping an eye on them and making sure they are taken care of and if they do not have family, the community looks out for them. I think that is special."

Dr. Judith Fisher, a 1978 graduate of the University of Pennsylvania Medical School, has an extensive medical and academic background in community health care and family medicine. She formerly taught at the University of Pennsylvania Department of Family Practice and Community Medicine where she developed a model for community health and taught a bio, psycho, social, cultural, economic approach to health care, a long phrase that describes a way of taking care of people within the context of their lives.

"There is usually not just one answer to a medical issue," said Dr. Fisher. "It depends on the person and literally the context of their life." As examples of outside influences on a person's health, she cited economic factors like insurance or whether a person is a new or long-time resident of a community.

After visiting here for two weeks in August for the past 22 years, moving to the Vineyard was a long-deferred dream for Dr. Fisher - until December, when she moved into a house in West Tisbury with her two Labrador retrievers. "I used to have a solo practice in a rural area of New Jersey right outside of Princeton and I really loved the lifestyle of that community," she said. "Everybody sort of took care of each other the best way they knew how and my way was the medical side of it. So I wanted to reproduce it." Dr. Fisher said that as part of her family practice she would be accepting patients of all ages "from little league kids up to grandparents."

Her initial impression of the hospital is that it is an institution that is in a state of flux staffed by people who "obviously really care a lot about each other and the community. I have met people who talk about individual patients in a very caring, loving way and want to take care of them."

Recalling her previous experience on the University of Pennsylvania campus, Dr. Fisher said she hopes to play a role in the current effort to develop a community-based approach to Island health care. She also hopes get to know her neighbors. "I very much want to be integrated into the Island in lots of different ways," she said.

Dr. John Lamb, a 1979 graduate of State University of New York medical school in Buffalo, arrived on the Island Jan. 1 and was at work one day later. Prior to moving to the Island, he was in solo private practice for 20 years in internal medicine, but he was associated with a large medical group located in Elmira and could consult with one of the many medical specialists located at Arnot Ogden Memorial Hospital.

"This is a whole different world," said Dr. Lamb. His decision to relocate was a culmination of 25 years of enjoyable summer visits to the Vineyard with his long-time partner, David Geiger, a sculptor and painter. The vibrancy of the Island art scene and the openness of people they met and their description of the lifestyle set the wheels in motion.

One night at dinner they struck up a conversation with an off-Island doctor who owned a house on the Island. He mentioned that the hospital was looking for physicians and Dr. Lamb decided to explore the job possibilities. "It was very slow, very gradual," he said.

Dr. Lamb is busy settling in at the hospital. He has already begun to repaint and refurbish his office even as he and his partner are in the midst of building a house in Chilmark with an attached studio. With three weeks under his belt he observed, "I think the hospital is going through a big transition in a very positive way."

Dr. Julia Stunkel, a 2001 graduate of the University of Pittsburgh School of Medicine, recently completed her residency in family primary care at the Albany [New York] Medical Center.

Dr. Stunkel joined the Vineyard Family Medicine practice of Dr. Nieder in September as a family practitioner filling a void left by the departure of Dr. Klein. But she is no newcomer to the Vineyard. Members of her extended family own houses on the Vineyard. Her mother grew up coming to the Vineyard and the Island was often the site of Langmuir family reunions.

Reading a medical journal, she saw a help wanted advertisement. "I thought that was too good to be true," said Dr. Stunkel. "I had always wanted to practice medicine in a small community where I get to know my patients so it seemed like the perfect opportunity for both of those things."

Dr. Stunkel said she is very excited to be living on the Vineyard and working in a caring environment. "I love this hospital, it has been a really great place to work," she said. "The nurses, doctors, and other members of the staff have all been really friendly and helpful to me and I also see how well they interact with the patients. This is why I went into family practice in the first place, to really be in a community situation where I knew people and could have long-term relationships with them."