Making The Rounds: What It Means to be a Doctor in Pittsburgh
In a city known for world-class care, a life dedicated to health is rewarding, challenging, and innovative at every level — from med school to the board room.
photos by david kelly
It’s not for nothing that two of Pittsburgh’s largest skyscrapers are adorned with signs for major healthcare companies. Medicine is big here.
More than a third of Allegheny County’s top 50 employers are in the health care industry, with hordes of doctors, nurses and medical assistants employed by the UPMC system or the Allegheny Health Network, as well as a handful of independents in suburban communities. All combined, Allegheny County alone contains 31 hospitals, which hold more than 7,000 hospital beds.
Quantity doesn’t always indicate quality, but Pittsburgh has that, too. Last year, U.S. News and World Report ranked UPMC Presbyterian as the 13th-best hospital in the country, above the medical centers at Duke and Stanford and just behind those at Northwestern and New York University. In that same issue, U.S. News also ranked Children’s Hospital of Pittsburgh of UPMC as the eighth-best children’s hospital in the nation; the well-regarded rankings also gave regional accolades to both Allegheny General Hospital and Western Pennsylvania Hospital. When it comes to health-related research, few world institutions can match the University of Pittsburgh. In fiscal year 2015, Pitt ranked sixth in the country for National Institutes of Health funding, pulling in more than $430 million for research in areas such as genetics, brain health and pancreatitis.
Despite its sheer amount of high-quality care, though, western Pennsylvania still has serious health care problems that require attention. According to the Allegheny County Health Department Community Health Assessment for 2015, the region outpaces the country in smoking, alcohol abuse and other metrics related to poor health. Six communities lack primary-care doctors: the Hill District, Hazelwood, Manchester, Homewood-Brushton, North Braddock and McKeesport. Most troubling are stark racial disparities in life expectancy: The median age at death for white Allegheny County residents is 77.9 years, while it is 66.9 years for black residents.
Given those disparities, as well as the region’s rapidly aging baby-boomer population, the region’s need for health providers will remain strong. Future caregivers, including second-year medical student Chris Murawski and pulmonary and critical care fellow Dr. Rihab Saeed Sharara, will have myriad opportunities to pursue long and vibrant careers, as has Dr. Gerald Rossman, a primary care physician for more than three decades.
This month — in addition to presenting our annual list of Best Doctors — we introduce seven medical professionals whose careers, while at different stages, are thriving. They are representative of the medical opportunities and objectives found in Pittsburgh, from education to administration. In addition to the aforementioned medical student, fellow and primary care physician, we also look at the work being done by an obstetrician-gynecologist who conducts research on premature babies, a breast surgeon who operates on women with cancer, a department chair who works with students at the University of Pittsburgh School of Medicine and a top-level administrator tasked with raising care standards across a health network. All practice different types of medicine, but they share one goal: improving the health of our city and region.
When Chris Murawski was playing baseball at Stroudsburg High School in Stroudsburg, Pa., he didn’t like to listen when coaches recommended that he rest his oft-injured ankle. After one particularly harsh twist, he was off to see a specialist in New York City.
Murawski became so interested in the physical therapy relating to his injury and the field of orthopaedics that he and his doctor hit it off — enough that, after he graduated from high school, his doctor offered him a chance to spend the summer learning how to conduct scientific research and shadow in the operating room and clinical environment.
Eight years later, that experience clearly has made a difference. Murawski, now 26 and entering his third year of medical school, is an author on 55 peer-reviewed studies. His research on feet, ankles and knees got him noticed by Forbes’ 2016 “30 Under 30: Healthcare” round-up.
“It’s a surprise, and it’s an honor, especially during this exciting time in medicine. You look back and say, ‘Look what was accomplished in the last 100 years without these things.’ You look forward, and it’s incredible to think that in the next 10 years we’ll probably do more than the last 100 combined,” he says, referencing medicine’s current confluence of breakthroughs in imaging, personalized medicine, big data and health care economics.
Murawski sensed that same excitement when he visited Pittsburgh to look at potential colleges for his undergraduate degree. As soon as he learned the University of Pittsburgh had accepted him, he didn’t apply anywhere else. It felt right here.
“It’s on a perpetual cusp. Something happens and then you’re waiting for the next thing. That feels like [it] characterizes Pittsburgh pretty well. There’s always something coming next,” Murawski says.
On a separate trip to New York City, Murawski met with Dr. Freddie Fu, chairman of the Department of Orthopaedic Surgery at the University of Pittsburgh School of Medicine. Fu invited Murawski to sit in on his research meetings after his arrival at Pitt.
Fu said undergraduates tend to come to meetings and stay quiet. Murawski was different.
“Somebody like Chris makes life very easy. He came to all of the meetings, took part in the discussion and put in new ideas,” Fu says.
Murawski had planned on going straight into medical school after completing his undergraduate studies. Fu proposed something different — why didn’t Murawski join his research team for two years? Murawski acknowledges he was nervous about getting off track from his plan, but he was swayed by Fu’s legendary stature in the field of orthopaedics and sports medicine.
“Working with him was way more than research,” Murawski says. “You’re seeing a guy who has to lead a [world-renowned] department — someone who can oftentimes sway an entire city with the flick of his fingers. You don’t learn to be a thought leader, but it was interesting to learn what someone like that does and how they run their ship.”
Now Murawski is a medical student at the University of Pittsburgh. It was a no-brainer for him to stay.
“This school has a culture for investigation and discovery. It’s a freedom to allow the students to [embark] on scholarly pursuit. It’s intimidating at first, but that’s the power of it,” he says.
Murawski spent his hours this spring studying for the boards; he plans to graduate in 2018. His eyes are still on orthopaedics.
Fu already is thinking ahead about working more with Murawski. Fu himself was a medical student at the University of Pittsburgh.
“He will be much sought-after as a trainee in any program in the country. We would definitely like to see him stay in Pittsburgh if he can,” the doctor says.
Dr. Rihab Saeed Sharara
Rihab Saeed Sharara was attending high school when her uncle, who had been suffering from lung cancer, was rushed to a hospital in Sudan. In his mid-50s, he was having trouble breathing and was desperately in need of a ventilator. The hospital where he sought care was the best and most expensive in the city, but it was equipped with only two ventilators. Both already were being used by other patients.
Although Sharara’s northern Sudanese family was educated and well-off — her father was an academic with a Ph.D. from UCLA, her mother was the first female judge in Sudan and another uncle was a physician — they could do nothing to help her uncle. He died a short time later.
Young Rihab was heartbroken. “He was the person closest to me,” she says today. “He was like a second father.” Her physician uncle, too, was devastated — and counseled her to never go into medicine, so she could avoid such situations. “But I’m stubborn,” she says with an easy smile. “It really pushed me toward medicine.”
In 1995, a few years after her uncle’s death, she enrolled at the school of medicine at the Ahfad University for Women in Omdurman, the largest city in Sudan, which sits on the western bank of the Nile River. She survived the inevitable winnowing-down process that came with a difficult program, watching her class dwindle from more than 100 down to 30, and graduated in 2006. After meeting her husband in the United Kingdom and completing an internal medical residency in Qatar, Dr. Sharara, 29, and her family moved to the United States in 2010.
While she had to repeat her three-year residency to comply with U.S. medical regulations — she did so at St. Agnes Hospital in Baltimore — she remains upbeat about it. “It was a little frustrating,” she says, “but it gave me a lot of perspective for the culture. You meet people with such multicultural backgrounds [working in the United States].”
Today, Sharara works as a pulmonary and critical care fellow at Allegheny General Hospital, where she treats patients struggling with breathing problems. Her days are long: After waking up at 4:30 a.m. to get her two children ready by the time the school bus arrives, she’s at AGH well before rush hour to see patients. It’s usually 6 or 7 p.m. before she returns home. “I have a really caring husband,” she says, with another quick smile. “If not for him, I don’t know what I would do. I can just come here and forget myself in the work.”
Pulmonary and critical care is a critical specialty in and around Pittsburgh due to twin hazards: a high rate of smoking and a long, dirty legacy of air pollution. While the national rate of smoking in recent decades has dropped from more than 40 percent in the 1960s to 18 percent, around 23 percent of adults in Allegheny County still smoke — nearly 230,000 people. Allegheny County’s smoking-related health care costs add up to a stunning $635 million annually. Meanwhile, reports from the American Lung Association show Pittsburgh is the ninth-worst city in the country when it comes to deadly particulate matter in its air, and Allegheny County falls short of national air standards.
All of that adds up to a lot of diseases of the lungs and respiratory system, ranging from asthma to emphysema and lung cancer. “You have to look at the patient as a whole,” says Sharara, to understand fully all of the health issues that might have an impact on breathing and life. “Critical care is like general medicine but at a higher level.”
Dr. Hyagriv Simhan
Dr. Hyagriv Simhan has been dedicated to researching premature babies for 17 years. But his relationship to his research was made more personal in 2005 when his own children were born prematurely. His wife gave birth to twins at 33 weeks.
“People expect their babies to be healthy and go home with them. Many babies do not do that. Having had the experience of having my own children be pre-term and spend time in the NICU has made me a better doctor in many ways,” says Simhan, 44; today, his children are healthy.
Simhan’s road to his current role — chief of the Division of Maternal-Fetal Medicine and Medical Director of Obstetrical Services at Magee-Womens Hospital of UPMC — was winding. Early on, he wanted to be a heart surgeon; one of his earliest memories included drawing a picture of someone having heart surgery.
Medical school in Boston was an awakening. Obstetrics/gynecology was his first rotation, smack in the middle of the city at the former Boston City Hospital, now part of Boston Medical Center. There was a walk-in clinic, run by one director and four medical students. The med students had to step up. Simhan loved the work.
Later he was introduced to maternal-fetal medicine, which involves managing high-risk pregnancies. It was the right fit: He saw it as the opportunity to do a lot of good for a lot of people. When he was looking for a place to complete his fellowship, he visited Magee on a whim because it was within driving distance of his residency in Philadelphia. He loved Magee immediately.
“This hospital is pretty unique. It’s a full-service obstetrics hospital but has so many other services we can bring to our patients. The volume, acuity and training opportunities clinically and research-wise were unparalleled.”
Simhan initially believed he would complete a three-year fellowship at Magee before returning to a “real” city, but both Pittsburgh (he’s a die-hard Steelers fan) and the hospital won him over.
“I chose to stay here after my fellowship because this place has a great tradition of physician-scientists. It does an incredibly good job at that development,” Simhan says.
Simhan’s research focuses on prematurity — the single biggest cause of illness, injury, handicap and death for babies. Specifically, Simhan has been studying premature births in the African-American community. In the United States, the frequency of a premature birth is twice as common among African-American women as it is among Caucasian women.
“The reasons for that are fundamentally still fairly unclear. It’s not completely explained by differences in socioeconomic status, access to care or education,” Simhan says.
Based on prior research, he and his team suspect preterm birth does not have a purely genetic cause; rather, they believe it stems from a combination of environmental factors interacting with genetics. They’re looking carefully at nutrition, studying how a low level of vitamin D in particular relates to a variety of abnormal outcomes in pregnancies.
“My feeling is that there are real clinical interventions and benefits to be had in respect to nutrition improving pregnancy outcomes. I think that will be forthcoming from our group and other groups in the next five years or so,” Simhan says.
Simhan also is the medical director of the Women’s Health and Outpatient Telehealth Services, which launched in summer 2015. For women who live outside of the region, a high-risk pregnancy could lead to a local hospital visit, which could lead to a transfer to Magee. Because that drive could mean, on average, a three-hour round trip; many of those women were foregoing the services.
Now Simhan and other doctors can watch a patient’s fetal ultrasound remotely and offer consultations. The service mimics a Skype session but occurs on a secure line that meets federal privacy regulations and also allows doctors to share images.
“The actual rendering of care is as good, if not better, than face-to-face,” Simhan says.
The Primary Care Physician
Dr. Gerald Rossman
While working on a pharmacy degree at Duquesne University in the late 1970s, Gerald Rossman had a revelation: “I thought, ‘This is really interesting — I like learning about all of the medicines,’” he says today. “But I also felt like it was frustrating because I knew all of the medications but not the diagnoses [the doctors had made].”
He came home and told his wife he might want to ditch the pharmacy program and move into medicine. Well-acquainted with his fear of needles — Rossman hated going to the doctor as a kid — she laughed. “You’re crazy,” he remembers her saying. “You pass out when you get shots!”
Five years later, in 1984, he graduated from Hahnemann Medical College (now part of Drexel University) in Philadelphia.
Since then, Dr. Rossman, 59, has worked at Allegheny General Hospital, first as an intern, later as a resident, and for the past 29 years as a primary care physician. That means the soft-spoken doctor is putting in 14-to-16 hour days that start with 6 a.m. hospital rounds, followed by patient visits from 8 a.m. to 4 p.m., capped by a few hours of paperwork, dictation and administrative work. Despite the long hours, Dr. Rossman says he loves it. “Some patients have been with me almost the whole time,” he says, “and you build up really neat relationships. That’s very rewarding.”
While some patients have stayed with him for care over the course of his career, medicine itself has changed dramatically. When he started, he says, patients tended to come in only when they were sick. Today, he’s pleased that many more of them are visiting for preventative maintenance — getting cholesterol checked or talking about family histories.
Technology, too, has made extraordinary leaps in that time. “When I was first in practice, if you had your gallbladder out, you were in the hospital for 10 days,” he says. “Now, you have your gallbladder out and you go home the same day.”
What hasn’t changed, Rossman says, is the atmosphere at Allegheny General Hospital, which he says is what first attracted him during his internship interview. “From the nurses to the doctors to the support staff,” he says, “everyone is really interested in the patient. At the other places I went to, they were good people, but it wasn’t quite the same.”
Those long-lasting relationships with both patients and fellow health care providers mean he’s regularly tapped to work on new programs. In the mid-1980s, one of his fellow residents at AGH was Dr. Tony G. Farah, who today serves as chief medical officer for the Allegheny Health Network. Dr. Farah has appointed Rossman to work on various programs, including serving on a committee to develop new ways to reward primary care doctors for quality care — all of which drives his ongoing love for his work.
“This is sort of like a big, impressive community hospital,” Rossman says. “In general, we treat people more like a hospital in your local neighborhood, except we can do all of the [advanced] care that big-city hospitals can do. For me, it blends the best of both worlds.”
Dr. Raye Budway
When Raye Budway was 3 years old, her mother was sure of her daughter’s future career. She pressed the girl to tell everyone she met.
“She would say, ‘What are you going to be?’” Budway says. “And I would always say, ‘I’m going to be a doctor.’”
Now specializing in breast-cancer surgery at St. Clair Hospital in Mt. Lebanon, Dr. Budway, 53, is usually the first person patients encounter after they receive a diagnosis of breast cancer. She meets with them to talk about creating a plan of care. Those plans tend to involve three options, all of which affect each other — surgery, chemotherapy and radiation.
Budway works through different options: If a patient starts with surgery, how might that influence the type of chemotherapy and radiation used later? Can drugs be used to shrink the tumor? How might that choice affect surgery and the potential need for radiation?
“Helping a woman negotiate these muddy waters is what we do best,” Budway says.
Budway honed her approach while working as a surgeon and teaching in the residency program at Western Pennsylvania Hospital. At the time, general surgeons handled breast surgeries; those procedures could make up 30-40 percent of their caseload. (Now the work is done by specialists.) Budway found her load of these surgeries was increasing; the speciality came to her, as female patients sought out Budway and the handful of other women surgeons in the hospital.
“They liked us because we didn’t have the paternalistic, ‘This is what you’re going to do [approach].’ We had the maternalistic ‘This is what you can do [approach],’” Budway says.
A Brookline native, Budway wanted to return to the city after attending medical school at Drexel University in Philadelphia. She did her residency at West Penn. Pittsburgh was the right place for Budway to learn from the best; in pioneering work across town at the University of Pittsburgh, renowned Dr. Bernard Fisher had been discovering the efficacy of the lumpectomy (removing only cancerous or abnormal material from the breast) versus a full mastectomy (removing one or both breasts). When Budway went to national medical meetings, those in attendance were talking about studies being done in Pittsburgh.
Despite being one of the few female surgeon residents, Budway was relieved to find she didn’t encounter a drop of chauvinism from her peers.
“I was treated as just another doctor, not as a woman surgeon,” she says.
After her residency, Budway didn’t want to leave Pittsburgh, and she didn’t have to. She was offered a year-long critical care fellowship at UPMC, where much of her work involved
learning about liver transplants; she saw the sickest of the sick.
“It was an unbelievable amount of education in a very condensed period of time. When you see that many sick people in a year, it’s amazing how much you can learn,” Budway says.
The following year, West Penn offered her a job. Budway practiced there for 16 years until officials at St. Clair Hospital recruited her. They wanted her, they said, because they sought to bring the quality of city medical care to the suburban South Hills. They started wooing her in 2009; in 2011, she joined the hospital.
In the future, Budway says she wants to use lessons learned in pursuit of her undergraduate degree in engineering to think about the process of patients’ experiences in hospitals. She’s previously involved committees and created projects in her own intensive-care unit to monitor quality of patient care, but now she’s thinking about how to improve quality of care in major surgery, endoscopy and even outpatient procedures.
“I want this process to help the individual patient,” she says.
Dr. Jeannette South-Paul
Growing up as one of six children, Jeannette South-Paul found medical care in her home was simple. First: If one kid came down with the chicken pox, her mother threw them in a bed together so they all got it at once. She didn’t have time for the ailment to make the rounds. Second, all answers came from a Licensed Practical Nurse encyclopedia. When a family member became sick, her mother looked up the treatment.
Dr. South-Paul, 62, now the chair of the Department of Family Medicine at the University of Pittsburgh School of Medicine, uses those experiences in her practice. She knows her own health didn’t exist in a bubble — her family and environment influenced it as well. That’s why, when one of her patients moved into a nursing home, she also met with that patient’s four siblings to talk about their ongoing participation in their sister’s care.
Her experience growing up without a family physician inspired her journey to become one. And she wanted to reach communities like the one in which she grew up — communities that are home to people who might not be able to afford care.
“If you’re going into a community that doesn’t have any access to health care, they might be able to only afford one or two docs,” South-Paul says. “I always say: ‘We’re your people.’”
She also wanted to reach those communities because her parents, who had immigrated to the United States from Jamaica and ran a rescue mission in inner-city Philadelphia, emphasized one purpose to their children.
“They told us that you give back to the country that gave you a chance to succeed,” South-Paul says.
She graduated from the University of Pittsburgh in 1979, bound for medical school on an Army Health Professionals Scholarship. But her time at Pitt left a sour taste in her mouth; she says she was dismayed to discover the remarkably limited degree to which her own academic health center interfaced with the community — especially the African-American community.
“I vowed I would never come back to Pittsburgh [after med school]. It was a pretty racist, discriminatory environment,” she says of her experience then.
South-Paul went on to serve as a family doctor in the U.S. Army. Through 22 years of work, she began to understand her job was to motivate people to work together on teams.
“We learned we were more efficient and more productive if we took care of each other,” she says.
South-Paul reconsidered Pittsburgh for two reasons: she wanted to work with a large corporation that was financially stable, and she also wanted to make a positive impact on the community.
One of her flagship ideas came after treating teenage maternity patients. Many of the teens South-Paul saw during their first pregnancies returned to her within a year and a half for care with their second pregnancies. While offering contraception and counseling to the young mothers-to-be, she noticed who accompanied them to their appointments — fellow pregnant teen friends. She realized these young mothers were without mentors.
She founded the Maikuru program, a group that matches teen mothers with older women in the community; Maikuru is a Shona word from Zimbabwe meaning “wise woman of the village.” South-Paul says she found that teen mothers often didn’t have a relationship with someone who was at least 15 years older than them who they could look up to, so she sought out community members who wanted to be maikurus. They now meet monthly at Pitt’s department of family medicine with the teenagers to talk and share advice.
It’s from this small-team experience that South-Paul leads her much larger department of family medicine.
“I believe we need leaders in health care who see the broad picture, not just how we finance it. We need people making decisions in health systems who understand the realities of how health is created, not just how disease is managed in the community,” South-Paul says.
Dr. Sam Reynolds
The courage to assume leadership,” the wall-mounted whiteboard stated, “is the best way to serve society.”
“Intriguing,” thought Dr. Sam Reynolds, after spotting the motto in the office of his resident director at Lancaster General Hospital in Lancaster, Pa. Leadership was far from his mind — he was in the midst of his family-practice residency — but it stuck with him and pushed him into later opportunities. “It’s what shaped me,” he says today as the chief quality officer for Allegheny Health Network. “I’ve always looked for opportunities to serve and not for positions to fill.”
Reynolds, 44, was the kind of kid who liked to take apart broken stereos and fix them. By the time he reached 10th grade, he was in his guidance counselor’s office at the former Beaver County Christian Academy, asking about a path to medical school. At Geneva College in Beaver Falls, he majored in biology and worked his way through the torturous medical school admissions process, earning an acceptance at Pennsylvania State University College of Medicine in Hershey.
After completing his residency at Lancaster General in 2000, Reynolds and his growing family — today, he and his wife have six children ages 2 to 15 — moved to Erie, where he practiced family medicine and obstetrics in the St. Vincent Health System.
While at St. Vincent, Reynolds increasingly was tapped for early leadership roles, such as overseeing medical-student rotations and helping to implement electronic medical records across the system. Reynolds didn’t have a computer until he was in his 20s, but he knew what it was like to practice medicine on the ground. “There was always part of me that was relating to physicians,” he says, “because I was facing the same challenges.”
Most of the St. Vincent doctors were on board with the new system, but around a third of them required winning over. The resistance provided a lesson in leadership and communication.
“You couldn’t just put computers on doctors’ desks and flip them on,” he says. “You have to determine how they work. You have to ask, ‘What are you doing now and how can we make it better?’” For the first time, St. Vincent physicians were able to compare treatments between different subsets of patients and even see which diabetic patients weren’t receiving the regular blood tests they needed — something that had been nearly impossible with paper records.
The executive team at St. Vincent later promoted Reynolds to chief medical information officer and medical director of population health. In those roles, he pioneered a team approach to medical care that brought health coaches into physician offices to work with patients on treating chronic conditions as well as providing motivational training and goal-setting.
Last August, after a dozen years in Erie, Reynolds moved his family back home to the Pittsburgh area, when he joined the Allegheny Health Network in the role he holds now. Today, he’s overseeing a number of initiatives to improve the system, including bringing the team-based model to AHN and working to continue the standardization of treatment across AHN hospitals.
The biggest project, though, is helping to lead AHN’s transformation from a fee-for-service to a value-based system. It’s part of a national movement to reward doctors for providing good health outcomes for patients, rather than charging for each individual test or operation. While he admits it’s “unnerving” for doctors to see their compensation model changed suddenly, he’s trying to work with his physicians. “I try to involve people in the process. I want to take input from the people around me,” Reynolds says. “Leadership is about bringing people together.”
Jennie Dorris is a journalist and research associate at Carnegie Mellon University who regularly writes on health, technology and education. Patrick Doyle, who has worked at magazines in Denver and Boston, teaches journalism at the University of Pittsburgh.