In addition to aiding the sick, dermatologist Marie-Louise Johnson and family practitioner David Mesches have created training programs for other doctors that have vastly enriched the quality of health care in the Valley
by Alex Silberman â€¢ Photographs by Dion Ogust
More than Skin Deep
The canaries are singing cheerfully in the solarium of her High Falls, Ulster County, home as Marie-Louise Johnson, M.D., Ph.D., mulls over the question that’s just been put to her: Which of the many accomplishments during her long career as a dermatologist, medical educator, and researcher is she most proud?
A petite woman with dark, sparkling eyes, at 78 Dr. Johnson has much to consider. Is it the Ph.D. in microbiology she was awarded by Yale in 1954, a year when only 290 women nationwide achieved a doctorate in the sciences? Is it graduating from Yale Medical School in 1956, one of only four women in a class of 80? Or, perhaps, becoming
the first dermatology resident at Yale-New Haven Hospital?
Certainly being the first dermatologist sent to Japan by the Atomic Bomb Casualty Commission to study the effects of radiation on blast survivors is something to be proud of (as is learning enough Japanese to lecture there). Perhaps she’s proudest of training generations of dermatologists at Yale, Dartmouth, and NYU while writing some of the medical books central to their studies. Getting elected president of the American Dermatological Association in 2000, the first woman to hold the post, must have been a high point, too.
After a moment of reflection, Dr. Johnson allows that being the first dermatologist chosen for membership in the prestigious National Academy of Sciences Institute of Medicine in 1981 was deeply satisfying. But what she is really proud of is “making use of the opportunities that have been presented me.” Chief among these, she says, was the opportunity to marry Kenneth Johnson, an intern at the time, who went on to become a noted cardiologist, public health authority, and passionate supporter of her endeavors.
“I don’t know how she does all these things,” says her husband. “She’s kind of a warrior. She gets an idea, and she’s persistent. She doesn’t look for glory, though she has accomplished everything a dermatologist can. I think she’s a star, a great agent for change for the good.”
The opportunity Marie-Louise is currently taking advantage of is pretty much of her own making, and it will provide better skin care for the residents of the Hudson Valley.
The story starts some 63 years ago. Johnson spent her summers in High Falls, where she began her education in the hamlet’s two-room schoolhouse. In her teens, Marie-Louise volunteered at Benedictine Hospital in Kingston. “The summer I turned 13, I knew I wanted to be in medicine,” she recalls. “They didn’t have candy stripers in those days, so they didn’t know what to do with me. They put me in the operating rooms; the war was on and they were happy to have any kind of help. They had to put me on a stool so I’d be high enough to hold a retractor. I always said, since that summer, I would come back here and do something, and so I did.”
In 1980, Johnson left her tenured professorship at NYU Medical School and became director of medical education at Benedictine Hospital. At the same time, she took on a visiting professor post at Yale (where she continues teaching dermatology to medical students) and soon set up private practice in Kingston as well.
There’s a severe shortage of dermatologists across the country, notes Johnson, especially in semirural areas like ours. Only about 300 new dermatologists are minted annually, barely matching the number of specialists who are retiring. And just as an aging population is experiencing an increasing number of skin problems, many dermatologists are focusing on cosmetic procedures and surgery, creating a significant shortfall among those available to deal with medical dermatological problems.
For the residents of the mid-Hudson Valley, as in most places, the effect of this shortage is clearly felt: once your primary physician and managed care company decide you need specialist care and approve a referral, it generally takes four to five weeks to get a first appointment with a dermatologist.
The way things currently stand, about 70 percent of skin problems are dealt with by family physicians and internists. “Unfortunately,” Johnson says, “in medical school and residency programs these physicians received little if any training in medical dermatology. And they feel insecure dealing with many skin problems.”
So now, at an age when most would be ready to rest on their laurels, Johnson has taken on a new challenge, spending the past few years pouring her energy and personal funds into establishing the Skin Center in Kingston, which opened in September. Not, mind you, the Marie-Louise Johnson Skin Center. “Not a castle on the hill or anything like that,” she says, “but a place where patients can get a good assessment of their problem and get good care.”
If family physicians are delivering most skin care, Johnson reasons, then the skills of those physicians need to improve. “The practiced eye is our instrument,” Johnson says. “You notice when something is a little bit different. Like seeing a person with 150 moles — it’s the eye that notices that one is not typical of the others.” To develop more practiced eyes, Johnson has established a fellowship program in which she provides a salary for physicians to come under her wing for a year for advanced study in dermatology. The first fellow, Dr. Peter Wentzel, has come aboard after serving as chief resident at Mid-Hudson Family Health Institute.
“I’d been interested in dermatology,” Wentzel says, “but typically in medical school you’ll have just a few weeks of training in dermatology. When you’re in the hospital seeing patients, you might get to work with a dermatologist. Then, in family medicine training, you get a month of training.”
The regimen is a lot stiffer under Johnson’ tutelage. “Three days a week we see patients,” Wentzel recounts. “One day a week we go to Yale and participate in Grand Rounds. That’s the time when a resident or fellow sees patients who are educational or challenging. The fifth day is a self-study day.”
Wentzel doesn’t expect to become a dermatologist, “just to be a more competent family physician,” and, furthering Johnson’s goal, “continuing on to help train other primary care doctors to be more proficient in dermatology.”
Working with Johnson, adds Wentzel, “is sort of going back to how I always thought medicine and doctors would be. It’s inspiring, it reminds you that medicine is alive and well and it gives you back all the optimism you started with. She’s remarkably generous and profoundly dedicated to her work. Her patients adore her, and the reason is, she cares for them so much.”
Treatment for All
Last November, Congressman Maurice Hinchey rose in the House of Representatives to read into the record an appreciation of “the distinguished career of Dr. David N. Mesches,” commending him for working “tirelessly to improve the delivery of health care services” throughout the Hudson Valley. The statement was relatively long and touched on Mesches’ major accomplishments, but even so it couldn’t really communicate how central his work has been to the well-being of our community.
David Mesches came to the Hudson Valley early in his medical career. “Actually, I was drafted into the military while I was in my medical training, back in the days of the doctor draft, in the early ’60s,” he says. “I trained at the University of Buffalo School of Medicine and did my residency training in Detroit, so lo and behold they sent me to Stewart Air Force Base in Newburgh. That was my introduction to this area. I spent two years there as a physician in the Air Force and decided to settle into private practice in New Paltz. That was in ’63, and I’ve been here ever since.”
Mesches had been in private practice for 16 years when Kingston Hospital asked him to get involved in establishing a family practice residency in Kingston. “The driving force of the residency training program, and the desire of Kingston Hospital,” Mesches recalls, “was to recruit family physicians for the area, since at that time there were very few of us family and general practitioners. The hospital felt if we established a training program we would attract the graduates of that program to stay and provide service to patients in Ulster County. In fact, we had a department of only seven or eight people in those days, while today there are well over 70 family physicians in the hospitals’ departments of family practice. That early incentive really is being fulfilled: 80 percent of our graduates, now numbering 125, have settled in New York State, which is a good record in retention.”
The physician-training program was initially cosponsored by Kingston and Benedictine Hospitals, which caused some administrative problems. So in 1983, Mesches and his associates founded the nonprofit Mid-Hudson Family Health Institute, where he served as CEO until January of this year and continues as chairman of the board.
The institute was created with a far-reaching mission in mind. “First and foremost,” says Mesches, “is to serve all people, regardless of ability to pay and station in life, with the best quality health care we can provide. The second part of the mission is to educate doctors through graduate and undergraduate training programs. And thirdly, that we provide medical research under the auspices of the institute, which we have done in human genetics.”
Today, the institute is a unique organization: a group of 50 doctors and dentists providing care to patients in Ulster, Dutchess, and Orange counties, as well as training physicians and doing research. According to Mesches, the institute has over 300 employees and fields about 175,000 patient visits a year.
“We have middle- and upper-income patients, but a significant percentage of our patients are on Medicaid, uninsured, or on a sliding-fee scale,” says Mesches. “We have special programs that really reach out to individuals who are most underserved. We don’t just wait in our office for the door to open.”
Working closely with state, regional, and county organizations, the institute has a wide reach. In cooperation with local departments of social services, for example, it runs the Healthy Families program (known in Ulster County as Healthy Start), which involves contacting “poor, pregnant women and following them through their pregnancy,” says Mesches, “caring for their offspring, and educating them in parenting all along the way until the children reach school age. This is a program we’re very proud of.”
There’s an institute program that provides primary care services for HIV/AIDS patients in Dutchess County. There’s an initiative offering obstetric services to inner-city patients in Newburgh and Kingston. “That’s very active,” Mesches notes. “We’re serving almost all of the Medicaid and indigent patients. Between the two, we’ll have at least 750 deliveries in 2005.” Then there’s the Home Care program in Kingston that delivers medical services to elderly patients who can’t get out of their houses. These comprise just a sampling of the life-altering services the Mid-Hudson Family Health Institute makes available.
In September 2000, the institute fulfilled its research mission with the establishment of the Center for Human Genetics and Child Neurology under the direction of Dr. Joseph J. Higgins. Important discoveries about the genetic influence on mental retardation and essential tremor have already been made.
What drives a doctor to develop and maintain such an enterprise? “When I went to medical school, we were told that our main purpose in life as physicians was to serve the poor,” Mesches says. “That was part of the profession, something that was deeply ingrained in me personally. We certainly treat others, but it means we have a commitment morally and medically to those who need care the most.
“There’s a sense of gratification in doing that,” he continues. “And to be able to multiply that and motivate our graduates to do that is something that seems natural to me. It’s something that medicine does every day, but we do it in an organized fashion as a freestanding group of doctors. It takes a certain culture to be able to do what we do, which is true for the nurses, technicians, medical records people, and receptionists. It’s important that they feel the sensitivity of the missions. We’ve developed a strong cadre — this isn’t for everyone. To serve in a nonprofit manner is our way of doing things.”
This way of doing things, as Congressman Hinchey noted in his tribute to Dr. Mesches, “has made Ulster County, and much of the Hudson Valley, a better, healthier place to live.” ■