Dr. Andrew Dubin
Physiatrist; Capital Region Orthopaedic Group, Albany
Professor: Albany Medical College
Medical School: Albany Medical College
Residency: Thomas Jefferson University Hospital, Philadelphia
One day in early July, a patient walked into Dr. Andrew Dubin’s office, at the Bone & Joint Center in Albany, for the first time in 21 years.The patient told Dr. Dubin that he had come to see him because, two decades earlier, the doctor had seen a problem when other health care providers had told him nothing was wrong. Dr. Dubin had ordered an MRI, which showed a spinal cord tumor. The patient had surgery that may have saved his life. He now had a new issue, and was confident Dr. Dubin would help.
“He summed it up [that day]when we were chatting,” Dr. Dubin said. “I had my orthopaedic intern with me, and [the patient]turned around and said ‘this is the guy I met 21 years ago, and he was the first person who sat down and let me talk, listened to me and didn’t interrupt and didn’t dismiss anything I said. When he told me what was wrong, I knew I had someone who was going to work with me and walk the problem down. “That meant a lot to me, to have this guy come back after 21 years,” Dr. Dubin added. “That was a real kick. It was a lot of fun.”
As a general physiatrist—rehabilitation physician—with Capital Region Orthopaedic Group, as well as a full-time professor in the department of Physical Medicine and Rehabilitation at Albany Medical College, Dr. Dubin has fun most days. He said being a doctor, and helping patients, is what gets him out of bed in the morning.
“I don’t like what I do, I love what I do,” he said. “I look forward to coming to work every single day and I really look forward to working with patients to try to figure out what the problem is, and what we can best do to help them.”
In a typical day at the Bone & Joint Center, Dr. Dubin will see about 30 patients, ranging in age from six months to their 90s, with a broad array of issues. These include neurological disorders such as stroke, multiple sclerosis, spinal cord injury and cerebral policy; muscular disorders such as muscular dystrophy, myopathy and ALS; burn injuries; rheumatologic issues; cardiac rehabilitation and amputation.
He will prescribe exercise, medication, surgery or whatever else is necessary to improve the patient’s mobility, strength, and functioning.
“In the end, the primary goal of physical medicine and rehabilitation is really to improve the quality of life,” he said.
In his 24 years in practice, Dr. Dubin has built a client base stretching as far north as Plattsburgh, as far west as Syracuse and Binghamton, as far east as western Massachusetts, and south to Newburgh.
Considering how much he loves medicine, you might think Dr. Dubin always wanted to be a physician. But when he was growing up in Queens, he had no such vision. His father was an engineer, and when asked what he wanted to do, Dr. Dubin would respond “I don’t know what I want to be, but I know I don’t want to be an engineer.”
His undergraduate degree, from Adelphi University, was in physical education, with a specialty in exercise physiology and biomechanics. He earned a master’s degree, from The University of Toledo, in exercise physiology with a sub-concentration in biomechanics.
One day, a mentor sat him down and encouraged him to go to medical school.
“I guess it all sort of clicked at that point and I decided he was right,” he said. “It was probably the best decision of my life. When I got into medical school I realized, ‘this is for me!’ I just loved being in medical school, and I loved the opportunity to learn, learn from patients. It was really wide-eyed wonderment.”
While at Albany Medical College, Dr. Dubin met Dr. George Forrest, chairman of the Physical Medicine and Rehabilitation department, who took Dr. Dubin under his wing and “really explained to me the beauty of the field.”
He did his internship in internal medicine at Albany Med. But on Dr. Forrest’s recommendation, he left the area for his residency, choosing Thomas Jefferson University Hospital in Philadelphia.
Dr. Forrest had told Dr. Dubin that after training at another facility, he should consider coming back to Albany and helping to build the Physical Medicine and Rehabilitation unit.
“The opportunity to make a difference is, I think, really what drew me back here,” Dr. Dubin said. “I like to teach, and the idea of coming back to an academic institution and teaching medical students and having the opportunity to do research was too big a draw to ignore.”
That was in 1990, and he has been a full-time faculty member at Albany Medical College ever since. He spends about 35 percent of his time at Albany Med, and about 65 percent at the Bone & Joint Center. Dr. Forrest also is his partner in Capital Region Orthopaedics.
Research is a big part of Dr. Dubin’s role as a professor. For the past six years, he has worked with the Biomedical Engineering department at Rensselaer Polytechnic Institute, studying what happens as the muscles that support the spinal column fatigue.
He also does research with the Albany Med urology department, and helped develop an animal model to study ways to treat the pelvic slope problems that develop in some patients after traumatic injury or surgery.
“Actually, that group holds the distinction of having the only functional, reproducible animal model in the country,” he said. “It is a rabbit model.”
But the biggest part of his professorship is working with future doctors. He has medical students rotating with him constantly. One who graduated and is now going into practice recently sent a thank you note that read “I appreciate everything you have done for me. I appreciate all the models you have given me. But most of all, I appreciate that you taught me the joy and beauty of the art of medicine.”
“That is what I try to instill in all the medical students—that it is not about the MRI, not about the X-ray or the CT scan,” Dr. Dubin said. “There is an art and a science to medicine, and the art is very important. It is listening to the patient. It is working with the patient and their family members.”
He told the story of a patient who came to him in July with tingling in his arm, which developed after he was electrocuted. Everyone thought he had a nerve problem, but Dr. Dubin did a physical exam and found a spinal cord injury resulting from the accident.
“I was able to sit down and discuss with him all the other complaints he was having, and all of it tied into the spinal cord injury,” he said.
That same day, he met a young lady who has had tingling and burning in the bottom of her foot off and on for the past four years. She had had an MRI done, and was told there were some “incidental findings” that did not mean anything.
“It turned out it did mean something,” Dr. Dubin said. “When we did electro-diagnostic testing on her [the symptoms]corresponded nicely to the incidental abnormality that was seen on the MRI. So what the radiologist called incidental wasn’t incidental.”
Between those two patients, and all the others he saw that Wednesday, “that was kind of a fun day.”
“I think what I really enjoy the most is the opportunity to talk to the patient, explain to them what is going on, and see that look on their face, that ‘Ah! Now I understand!’” Dr. Dubin said. “Now I have a patient who is working with me and we can work together as a team. And that is what I really enjoy.”
He said one of his favorite things about the field of physical medicine and rehabilitation is that it is very much a team sport. He works not only with the patients and their families, but with other physicians, physical therapists, social workers and others.
“Everyone has to work together,” he said. “If you don’t have everyone working together the orchestra, doesn’t make pretty music.”
When he is not caring for patients, doing research or teaching, Dr. Dubin enjoys reading and spending time with his two daughters, aged 22 and 25. He also loves meteorology. “In particular the meteorology of nor’easters,” he said. “Ever since I was a boy, I have been just fascinated by the physics of storms and why they do what they do. If I hadn’t become a physician, I probably would have become a meteorologist.”
Dr. David Conti
Chief, Section of Transplant Surgery at Albany Medical Center
Medical school: The Feinberg School of Medicine at Northwestern University
Residency: McGraw Medical Center at Northwestern University
Fellowships: McGraw Medical Center at Northwestern University; Harvard University Massachusetts General Hospital
Dr. David Conti sees his position as chief of Albany Medical Center’s transplant surgery program as threefold.
His first duty is to take care of patients, which he does very well. Albany Med has one of the highest success rates in the country for kidney transplants. Dr. Conti himself has an overall patient satisfaction rating of 4.4 out of 5 on Healthgrades, a site that provides information on doctors. This is well above the national average.
His second duty is to share his knowledge and expertise with younger doctors. He was head of Albany Med’s surgical residency program for 13 years, guiding the careers of more than 50 young physicians in the process.
His third obligation is to advance the future of care, which he does through research and publication. He is considered one of the nation’s leading researchers in the field of transplant immunology, and has published about 95 scholarly articles.
Funny to think he started out wanting to be a football player.
“My first love growing up was sports,” said Dr. Conti, now 58. “But I’m a small guy. I was probably 17 or 18 when I realized I was not going to be an athlete.”
So he turned to his other interest, medicine. He did, however, select Washington University, in St. Louis, for his undergraduate degree because he could play football there.
It was then back to his native Chicago, to attend medical school at Northwestern. He remained at Northwestern’s McGraw Medical Center for his residency and the first of two fellowships. Then it was off to Boston, and Massachusetts General Hospital.
He had just completed the second fellowship, in 1989, when one of his mentors in Boston told him of a position at Albany Med. He had three young children, and a visit to the area told him this would be a great place to raise them.
He also saw a lot of growth potential in the hospital’s transplant program, which had started two decades earlier.
“It was just a really nice opportunity for my family and me, academically and clinically,” he said. “And it has worked out very well. Albany Med has been supportive of the transplant program, and the community has been very nice to my now four children.”
Three years after joining Albany Med, Dr. Conti was made director of transplant surgery. At that point, the unit was limited to kidney transplants. He added a pancreatic transplant program in 1994. That year, the program did its one-thousandth transplant. It recently passed the 2,400 mark.
As a transplant surgeon, Dr. Conti has what he describes as a “very hectic, largely unscheduled” life.
“It’s an unusual business,” he said. “There is a lot of work at night and on weekends. When a family is kind enough to donate an organ from a deceased loved one, we have to get that organ into the patient within 24 hours of it being removed.”
He said he was drawn to transplant surgery, in large part, because it allows him to be a variety of different doctors.
“First, I get to implant organs in people,” he said. “A lot of surgeons only get to take out diseased organs. I get to put a healthy organ into someone. Plus, not only do I get to be a surgeon, but a medical doctor as well. I am working with patients who have kidney failure and diabetes.”
He not only performs transplants, but other, related procedures such as biopsies and tissue transfers, as well as general surgeries.
The best part of the job, he said, is “I get a real chance to impact the quality of people’s lives.”
“People have renal failure. With a successful kidney transplant they no longer have renal failure and they can stop going to dialysis a few times a week. Or they have diabetes. With a pancreatic transplant they no longer have to take insulin every day. When it works out well it is a wonderful feeling. When it doesn’t, it is just devastating for everyone.”
He said he finds himself haunted by the patients for whom things did not work out.
Fortunately, there are not many of them. The Albany Med transplant program has been recognized as one of the best in the country. In 2011, the kidney transplant program received a silver medal from the U.S. Department of Health and Human Services. Of the 260 kidney transplant programs in the United States, only six were so honored.
The HHS cited the Albany Med program’s one-year survival rate of 99 percent, which compares to a national average of 97 percent. According to Dr. Conti, even more significant was the fact that 94.6 percent of patients were alive three years after receiving a new kidney, compared to the national average of 84.3 percent.
The silver medal also recognized Albany Med in the area of “wait list mortality,” that is, the number of patients who die waiting for a kidney transplant. Albany Med’s waitlist mortality was 3.2 percent as of 2011, compared to 5.5 percent for New York, and 4.6 percent nationwide.
At the moment, there are about 350 people on the wait list for either a kidney or a pancreas. The Albany Med program is the only transplant program in a 23-country area of upstate New York. It draws patients from as far as Plattsburgh to the north, Binghamton to the west and western Massachusetts and Vermont to the east.
But it seems likely that even if there were other options in the region, patients would chose Dr. Conti. As one of the country’s leading researcher in the field of transplant immunology—that is, how the body reacts to a new organ—Dr. Conti has kept the program on the leading edge of innovative drug studies.
He has worked with other Albany Med researchers, with the support of funding from the National Institutes of Health, to look into better ways of fighting the viral infections that are common in transplant patients.
Dr. Conti has seen a number of advances in the three decades he has been practicing medicine. But he is not sure it is all for the better.
“There have been a lot of advances in health care over the years, but with every new treatment comes side effects and complications,” he noted. “So we can treat things we couldn’t treat 20 ago, but in a way that makes things more complex.”
He said one thing the medical community needs to be particularly mindful of in this increasingly complex environment is keeping care from becoming too fragmented at the expense of patients.
“As physicians we all have expertise in particular areas,” he said. “Mine is kidneys and pancreas. I have expertise in diabetes and renal failure. Another physician will see my patients for other issues. But if we aren’t careful it can fragment overall care. We need to be careful about that. So it is incumbent upon me to have good communication with the patient’s primary care doctors.”
When he finds a break in his hectic life, Dr. Conti still enjoys sports. He runs when he can, and he plays the guitar.
“But mostly I am devoted to my family,” he said. “I spend as much time with them as I can. I have two sons and two daughters.”
Three of Dr. Conti’s children have followed him into the medical profession. His oldest daughter is a pediatrician in Chicago, one son is attending medical school and another son was just accepted into medical school.
While it is fair to say that Dr. Conti’s patients are fortunate to be in the care of a physician of his caliber, he sees it very differently.
“I am very lucky to work with these patients,” he said. “I am always struck by the people with long, debilitating diseases who hang in there for years, dealing with unimaginable hardship. When we can help them, they teach us more than we could ever give them.”
What is the biggest lesson he has learned from his patients? Just to be grateful for everything he has.
“All of us get stuck in a rut sometimes, when we complain about little things,” he said. “But when you meet a patient like that it puts things into perspective—how lucky we are to be healthy. And how lucky we are to serve them.”
Dr. Gregory Krohel(right)
Ophthalmologist, Troy – Saratoga Ophthalmology
Medical school: Albany Medical College
Internship: Swedish Medical Center, Seattle
Residency: Albany Medical Center
Fellowships: Jules Stein Eye Institute at UCLA; Moorfields Eye Hospital, London, England
Dr. Gregory Krohel read the Merck Manual—a popular medical textbook—when he was eight years old.
He became a hospital orderly at 18. He worked as a morgue attendant. He scrubbed operating room floors.
“I always wanted to be a doctor,” said Dr. Krohel, an ophthalmologist in private practice in Troy.
Dr. Krohel has been a physician for four decades, and has published more than 100 papers, and a book, as one of the nation’s leading experts on orbital cancer and vision disorders. He also has trained more than 1,100 medical students and residents.
But his skills are not just academic. His patient satisfaction score on Healthgrades, a web site that provides comparative information on physicians, is 5 out of 5.
Although he is now working part time for a practice headed by Dr. Charles Rheeman, the 64-year-old Dr. Krohel said he has no plans to retire just yet. In fact, he expects to work additional hours in the coming months as the practice expands, as Saratoga Ophthalmology, through a merger with an ophthalmologist in Malta.
Dr. Krohel’s desire to be a physician was triggered, in large part, when, as a boy growing up in New Jersey, he saw several of his relatives wrongly diagnosed. There was the uncle who had renal failure, but instead was treated for arthritis–with steroids, which some studies have linked to kidney failure. There was the aunt who died of thyroid disease because her doctor did not realize that she had hyperthyroid. By the time she passed, she had been driven nearly insane by the illness.
“There are a half a dozen other things, but those two stuck in my mind,” Dr. Krohel said. “I thought, I can do a lot better than this!”
He earned a bachelor’s degree from Rutgers University in just three years because “I couldn’t wait to graduate and be a doctor.”
His dedication, his intelligence, and the various hospital jobs he had held were enough to convince Albany Medical College officials to admit the young Krohel. It was 1970, and he stood out from the many young men who were trying to get into medical school simply to avoid going to Vietnam.
“They could tell I was the real deal,” he said.
His original goal was to be a general surgeon. But when he was working as a floor technician in the operating room, several surgeons pulled him aside and said “don’t do this.”
“And also a cardiologist said that,” he recalled. They suggested ophthalmolology. “I said ‘what is that?’ I didn’t know anything about it.” And so, the summer after his first year at Albany Med, he went to work for the chairman of the hospital’s ophthalmology department. This meant spending the summer in a cadaver lab, with no air conditioning.
But he discovered he liked ophthalmology, and he was such a quick study that he soon found himself lecturing the residents. He was just a second-year medical student.
By 1979, Dr. Krohel’s medical education had taken him from Albany to Seattle, back to Albany, to Los Angeles and finally to London, England.
He is trained in three different sub-specialties. The first is neuro-ophthalmology, which concerns vision problems related to the nervous system.
“We have over 100 patients with multiple sclerosis in our practice because that is one of our specialties–patients with MS and brain tumors who have visual problems,” he said of the Troy practice.
Dr. Krohel’s second specialty is the treatment of orbital cancer, including eye plastics, eyelid surgery and orbital surgery.
“I wrote a book on orbital tumors,” he said.
The third specialty is muscle surgery for the treatment of double vision.
In 1979, he returned to the Capital Region to open his practice. At the time, there were few physicians in upstate New York with his specialties, so he had patients coming from as far away as Buffalo. The competition has increased a bit since then, but he still has patients travel from about 90 miles in any direction.
Some patients have been with him a very long time.
“I actually have some patients I have been seeing since ’79, because they have rare diseases that I know about and they trust me. If someone comes to you for an eye exam and you tell them they have MS or a brain tumor and you are correct, then they tend to stay with you.”
He also believes his patients stay with him because, unlike some specialists, “I don’t kick them out of my practice once their problem is solved. I am willing to see them for routine things like glaucoma and pinkeye.”
Also in 1979, Dr. Krohel become a professor at Albany Medical College, a position he would hold for nine years.
In that time, he would train 1,000 medical students and 100 residents, and conduct 16 one-on-one fellowships.
There were a handful of physicians he saw through all three stages. One of them was Dr. Rheeman, his current partner.
Dr. Krohel and Dr. Rheeman have worked together, and done surgery together, for more than a decade. “He will eventually be taking over my practice,” Dr. Krohel said.
Earlier this year, the Troy practice merged with that of another of Dr. Krohel’s former residents, a Malta retinal surgeon named Dr. Amjad Hammad.
“We are in the midst of expanding,” Dr. Krohel said. “Our office in Troy will double in size in the next three months. So people who are worried about me fading away—the rumors of my demise are greatly exaggerated!”
He said he slowed his practice down in recent years so that Dr. Rheeman could build his practice up. His current schedule has him seeing patients every Wednesday, doing surgery one Monday a month and seeing patients one or two Mondays a month.
“But I am probably going to increase my hours since we are doing this expansion,” he said “I will probably add another day [a week]in the next six months.”
He will be working in both Troy and Malta. The Malta office will include a spa and offer cosmetic surgery.
“I was actually one of the original investigators of Botox in the 1970s,” Dr. Krohel said. “Before it was for cosmetic uses, it was for medical purposes. Now I will use it again.”
While Dr. Krohel was making a name for himself as an ophthalmologist, he also was making a name for himself in another, very different, industry. It was not, however, the same name.
“I was in the music business for a long time,” as a guitarist since age 12, singer and composer, he explained. “They used to call me Doc Roc.”
He recorded three CDs under the name Greg Kroll, using the alternative spelling so people would distinguish the musician from the ophthalmologist.
“Plus I knew they wouldn’t pronounce Krohel correctly, so it made it made it easier,” he said.
Dr. Krohel and Marybeth, his wife of 38 years, also started a pre-school for disabled children in West Sand Lake, which Marybeth ran for 25 years.
“We were both socially oriented from a young age,” Dr. Krohel said. “We don’t care about the big bucks. I drive a 2003 Grand Prix. It still runs well and I don’t care about all the fancy stuff.”
He believes that is part of what makes him a good doctor.
“You can take an extra 20 minutes with the patients and not care about the bottom line,” he said.
Dr. Krohel has seen a lot of changes in the health care industry over the past four decades—the biggest of which is technology. This has made care more efficient and he looks forward to the day when the computers in every physician’s office talk to each other.
But, he said, technology has also made care less personal. He sees some doctors spending a lot of time looking at the computer and not at the patient. “There is not a lot of eye contact. It’s kind of sad.”
With the world of health care ever changing, what is Dr. Krohel’s best advice to the next generation of physicians?
“To stay current,” he said. “To try to know more in your specialty than anybody else in the country. And then, to treat your patients well. And don’t worry about the bureaucracy, the changes. Because really, despite all this technology, it is still you and the patient in that room, and that is what it really comes down to—the relationship. The rest is just fluff.”
Dr. James Figge
Endocrinologist; St. Peter’s Health Partners
Medical school: Harvard Medical School
Fellowship : Brigham & Women’s Hospital, Brookline, Mass.
Fellowship: Dana Farber Cancer Institute, Boston
Dr. James Figge has a varied, and rather impressive, resume. Among other things, he has served patients as an endocrinologist, helped establish healthcare policy as Medical Director for the New York State Department of Health, studied the relationship between radiation and thyroid cancer in Russia, and researched molecular diagnostics in Belarus.
He is now back to seeing patients, at offices in Rensselaer, Troy, Waterford and Cohoes, as part of the endocrinology group within St. Peter’s Health Partners. And he is taking the policy he helped set, and the results of his research, and leveraging them to better care for people with diabetes, thyroid disease and other hormonal disorders.
“It is interesting how things circle around,” he said.
At the moment, Dr. Figge is part of a move by St. Peter’s Health Partners—the area’s largest health system—and Schenectady-based Ellis Medicine to form a joint endocrinology practice. The group will provide care at a number of sites throughout the region, and will administer a diabetes education program with Dr. Figge and Dr. Jill Abelseth serving as co-medical directors.
“What we are doing is putting together a group of endocrinologists, mid-level practitioners, certified diabetes educators, dieticians and so on,” Dr. Figge said. “We will be collaborating with many other clinicians in the area who take care of eye problems, kidney problems [and other issues that can result from diabetes]. It is a big undertaking.”
Dr. Figge grew up in Minnesota, and developed an interest in medicine while studying biology and chemistry as an undergraduate. He went to Harvard Medical School, graduating in 1983, and remained in the Boston area for two fellowships, one at Brigham & Women’s Hospital and the other at the Dana Farber Cancer Institute.
He came to the Albany area—where he had relatives—in 1990, to accept a position at Albany Medical Center.
It was at about that time that Dr. Figge started seeing articles coming out of the former Soviet Union, about an increase in cases of thyroid cancer following the 1986 disaster at a nuclear power plant in Chernobyl, Ukraine.
“I got very interested in that,” he said.
He contacted Erastus Corning III—son of the late mayor of Albany—who organized tours to Russia.
“He helped put me in touch with an endocrinologist in Moscow, and I arranged to travel there,” Dr. Figge said. “We started working on the problem together. We developed a network of scientists in Russia and Belarus.”
Over the next few years, Dr. Figge would travel to Russia and Belarus “12, 13, 14, 15 times—I would actually have to look at my passport!”
Some of those trips were to the state of Tula, Russia, where Albany’s sister city, also called Tula, is located. Dr. Figge served on the board of the Albany-Tula Alliance for several years.
“The state of Tula was devastated by Chernobyl,” he said. “We brought in ultrasound machines and had patients lined up, literally, for blocks outside the clinic. When we found nodules [bumps that may signal cancer]we did biopsies and brought them to Moscow to be analyzed.”
His trips to the former Soviet Union also got Dr. Figge involved in researching molecular endocrinology, which uses a person’s biological markers to diagnose and monitor disease, detect risk, and determine the best course of treatment for the individual patient.
“We actually set up a lab in Minsk [the capital of Belarus]with graduate students working on that,” he said. “Some ended up coming to the U.S. for training. Now some of these molecular diagnostics are being used in the U.S.”
While he was doing his research in Russia and Belarus, Dr. Figge was working full-time at Albany Med. In 1997, he set up an endocrinology practice on the campus of St. Peter’s Hospital.
At about the same time, he returned to school at Union Graduate College in Schenectady, where, in 2000, he obtained his MBA. That degree led him to the position of Medical Director of Albany-based health insurer CDPHP, which he held while continuing to run his Albany practice.
In 2006, Dr. Figge left private practice and CDPHP, to become Medical Director and Public Health Physician for the state Department of Health. He would remain in that role until 2011, serving under four governors—George Pataki, Eliot Spitzer, David Paterson and Andrew Cuomo—in the process.
“I liked working for the state,” he said. “I could have an impact on public health.”
His position involved him in several projects, one of which was promoting the adoption of electronic medical records and electronic prescribing. He worked with the state Medicaid program to develop New York’s part of the federal health information technology incentive program commonly known as “Meaningful Use.” Providers receive bonuses from Medicaid and Medicare if they become meaningful users of health information technology, and are penalized if they do not.
“We did all the groundwork in New York to get that program launched,” he said.
While switching from paper to electronic records has been difficult for some physicians, Dr. Figge had no problem adopting health information technology for this own practice. “I liked it,” he said.
He is still involved with helping physicians become “meaningful users,” as a member of the Health Information Technology committee of the board of directors of the Healthcare Association of New York State.
Another project Dr. Figge worked on while with the state was particularly near and dear to his heart—diabetes education. According to the federal Centers for Disease Control, about 7.5 percent of New Yorkers have diabetes, a chronic disease that leads to a number of other complications, including increased risk for heart attack, stroke, leg amputation, kidney failure and blindness, and is responsible for millions of dollars in annual healthcare costs.
“We pulled together data to show how many people around the state were being hospitalized for things that may have been prevented,” Dr. Figge said. “That led to legislation that opened up diabetes education. It became the standard for all health insurance in the state. So now every patient with diabetes can learn what to do on a day-to-day basis with exercise, diet, medication—the classes empower people to better manage their own health. That was one of my big accomplishments at the Health Department.”
When he left the Health Department in 2011, Dr. Figge returned to clinical practice at Troy-based Northeast Health. That October, Northeast Health and Seton Health, also in Troy, merged with Albany-based St. Peter’s to form St. Peter’s Health Partners.
“I look at it as a continuous thing,” Dr. Figge said of his move from the state back into private practice. “To put the policy in place and then be able to implement it. So now I am in a position where I can help implement this stuff.”
The new group that St. Peter’s and Ellis are establishing will provide full endocrine care, but educating the public about diabetes will be one of its major efforts.
“We are doing that now at Albany Memorial [Hospital], Seton Health, our site in East Greenbush, Clifton Park [and]Ellis’ McClellan Campus,” he said. “We have great diabetes educators already out in the community and they will continue to do what they do, but they will all be under this common program.”
Dr. Figge, who noted that about 45 percent of the patients he sees every day are diabetic, said the main problem is that Americans as a group are far too sedentary.
“In clinical practice I see a lot of people in their 20s and 30s who are right on the verge of developing diabetes,” he said. “And my colleagues in pediatric endocrinology say they are seeing teenagers developing diabetes. This is becoming a very, very serious health epidemic.”
But by eating right and getting enough exercise, people can prevent diabetes or delay the progression of the disease by several years. Dr. Figge tries to be a good role model. He watches his diet, takes long walks every day and plays tennis, for example.
Diabetes education is not the only thing Dr. Figge helped establish that will be part of the new endocrinology group. It also will offer molecular diagnostics and genetic testing—the things he and his colleagues were researching in that lab in Minsk.
“So we are moving into this whole area of molecular medicine, based on all the experience I had in the past and a lot of the research that was done [by him and many others]in the 1990s,” he said. “Now, 15 or 20 years later, it is starting to become commercially available so we are going to roll that into our clinical practice. This is a very high-tech area we are moving into.”
Dr. Debra Tristram
Chief, Division of Pediatric Infectious Disease, Department of Pediatrics at Albany Medical Center
Medical school: Albany Medical College
Residency: SUNY Upstate Medical Center, Syracuse
Fellowship: SUNY Upstate Medical Center, Syracuse
As Chief of the Division of Pediatric Infectious Disease within Albany Medical Center’s Department of Pediatrics, Dr. Debra Tristram is part doctor, part detective.
Her primary role is to care for children with serious infections, including bone and joint infections, infections resulting from chemotherapy or transplants, and HIV, the virus that causes AIDS. This means she and her team are often consulted when other physicians are scratching their heads.
“We are the go-to people,” she said. “We have to figure out what is wrong with a lot of unusual types of circumstances. Sometimes they are common infections that are presenting in an unusual fashion. But sometimes they are not. They are rheumatologic conditions or immunologic conditions, or a tiny portion are a type of malignancy that is presenting in an odd way.”
Dr. Tristram wears a few different hats at Albany Med, including consulting physician, clinician, researcher and college professor.
Each month, she spends a full seven days on call as an inpatient attending consulting physician. She may be summoned to the intensive care unit, the special care nursery, the emergency room or wherever else a child is in need of her expertise. On these days, she is often joined by medical students and residents learning the concept of patient care.
The other three weeks of the month, she is in the outpatient clinic, following up with children she cared for in the hospital as well as those who are referred by outside providers. The three members of the Albany Med Pediatric Infectious Disease unit see patients from a 25-county area stretching from the Canadian border to Poughkeepsie and from portions of lower Vermont and western Massachusetts out to Binghamton and Utica.
“I actually have a personal interest in skin and skin rashes so I get asked to see a lot of those, and that is kind of fun,” she said. “I see kids who have recurrent staph infections, kids who have had a lot of infections so the pediatrician is concerned they might have immune deficiency. We co-manage patients with [the]immunology [unit].”
She and her team also are under contract with the state to care for children and adolescents, to age 24, with HIV.
“That only takes maybe 10 percent of my time because there are less of them, which is nice,” she said. “But we do a lot of outreach and teaching with that particular contract, to get referrals and to find those kids who are infected but don’t know they are infected. Some of them are quite labor intensive because they have a lot of social issues—which is what got them infected in the first place—so they are a challenge.”
Dr. Tristram’s career has put her in a position to watch the fight against HIV from the front row. The virus was discovered in 1981, just a year before she graduated from Albany Medical College.
“There were a couple of pediatric cases right before I became a fellow, but it didn’t look at the time that it would be a huge portion of pediatric infectious disease,” she said.
Then, of course, the virus became an epidemic, affecting millions of children. But thanks to researchers like Dr. Tristram, new cases are down dramatically.
“That’s really been kind of the major success of the century, I think, and it has been nice to be a tiny part of that,” she said.
Dr. Tristram and her team still do clinical research, although, she says, she would like to do more.
“I am hoping to do more vaccine work,” she said. “I used to do that. But I have been back here [in Albany]for only two years and when you move from place to place you lose your base of people, and it takes time to re-establish that.”
The final part of her job is giving lectures, both on road trips to outside hospitals and as part of Albany Med’s educational programs.
In short, “we are constantly teaching, taking care of patients and learning.”
Dr. Tristram did not start out with pediatric infectious disease for her career path. In fact, while she was growing up in Garrison, Putnam County, she had a whole different type of patient in mind.
“I actually wanted to be a veterinarian,” she said. “I actually spent about a year working in an animal hospital trying to make that work.”
The main problem was, she is allergic to animals.
“I probably would have had to say practice limited to lizards or something,” she joked. “I am allergic to feathers and dander and horse hair—what kind of animals are left really?”
When she started at Albany Medical College, her idea was to become an internist. This remained her goal through her third year, when she did her rotations.
“I did surgery, obstetrics, pediatrics…I went through all those things thinking ‘OK, this is cool, I’m learning how to make stiches, tie knots and catch babies but my real love is yet to come. I’m still waiting for my medicine rotation,’” she said. “And then when I got to medicine I thought ‘oh, I really don’t like this!’ I mean, I liked the medical aspects—there is a mystery to what is wrong with you and it’s our job to figure that out. But I actually prefer to do it on small people.”
There are a few reasons for that. One, she has found that many people are more likely to do what is right for their child than they are for themselves.
“It is distressing to be sitting with someone who is overweight, drinks, smokes, etc. and they want a pill to make their knee feel better, where if they lost weight their knee would feel better,” she said. “Plus in pediatrics you can have fun with your patients. I can tickle them and they laugh. They make my day. It is just really fun working with kids.”
After she graduated from medical school, she did a three-year residency in pediatrics and a two-year fellowship in infectious diseases, both at the SUNY Upstate Medical Center in Syracuse. She then spent about a decade at Buffalo Children’s Hospital before moving to Greenville, South Carolina, where she served as Head of Pediatric Infectious Diseases and Director of the pediatric HIV program at Eastern Carolina University.
Much of her work centered on respiratory syncytial virus, or RSV, a common infection for which there is no effective vaccine.
“I did clinical trials on the prevention of RSV in babies and that was sort of my main job, in addition to being a wife, a mother and a full time physician,” she said.
She has one daughter, who is now studying architecture at Pratt Institute in Brooklyn, and two adult stepchildren.
In 2012, three decades after leaving Albany Med, Dr. Tristram returned to the medical center, in her current role.
She and her husband live in rural Slingerlands, where Dr. Tristram can indulge her love of gardening.
“My mother’s father grew up in farm country in Pennsylvania,” she said. “I think I have those farmer genes in me still, because I just love it. I love to grow my own vegetables and go out and pick it and eat them. I love to cook, too. Growing your own and cooking your own is just great.”
She also joined a community farming organization that allows members to pick their own vegetables. This has become a personal escape for her.
“There is nothing but sun and wind blowing through your hair, and just rows and rows of gorgeous vegetables,” she said.
As a professor working with Albany Med residents, Dr. Tristram is also tending to the future of the medical profession. What would she most like them to learn from her?
“I think one of the things I found useful when I was a student and resident was actually going in a room and sitting with the attending [physician]when the attending was talking to the patient,” she said. “How to approach someone, how to talk to someone, how to act with someone. Because you don’t really know. Or how to deal with a difficult family, with giving bad news. You have to learn those things and you can’t learn it from a book. I think that I try to model the things that I learned from the people I admire the most. So I hope [the residents]are watching me when I’m doing my work.”