All parents hope their kids are healthy enough never to need more than an annual checkup, but when they’re not, it’s great to know that our city is home to some of the world’s finest doctors. New York Family worked with consumer health research firm Castle Connolly Medical Ltd. to present our fourth annual list of Manhattan’s top-ranked pediatricians and pediatric specialists. We also spoke with eight of these doctors, who represent a range of pediatric specialties and medical centers. They shared with us the joys and challenges of their profession, as well as their thoughts on where their fields are headed. We found their insight especially meaningful now, given the many debates surrounding the future of our nation’s healthcare system. What follows is a celebration of all the work they do to keep our city kids healthy and strong.
DR. BONITA FRANKLIN, GENERAL PEDIATRICIAN AND PEDIATRIC ENDOCRINOLOGIST
How did you decide to go into medicine?
The story for me really started with my love for science. I was one of those kids who was fascinated by the natural world—I loved collecting rocks, looking at stars and figuring out what’s behind all the natural beauty of the universe. I was always attracted to the idea of using science to help people.
What drew you to pediatrics? Pediatrics is fascinating because it’s
medicine for the time in life when people are changing the most rapidly.
I find it fascinating to see how the mind develops, how the physical
capabilities develop, and all of the changes that happen. It’s a time
when people can change for the better and a time when there’s a lot of
joy.
You have a private practice in pediatrics, but you also
specialize in pediatric endocrinology, correct?
I have a private practice
office in Tribeca where I see pediatric patients from birth to age 21.
Then I have a position at NYU in the division of pediatric
endocrinology.
What is a typical day like for you?
If the weather is good, a
typical day will start out with a bike ride up the East River bike path,
from where I live to the hospital. I take care of business over there,
which involves teaching, attending in the clinic, lecturing, then
usually around lunch time I go down to the office and have an afternoon
of patient care.
What is the most gratifying part of your
job?
Bittersweet
though it is, I enjoy doing that pre-college appointment—when a child
that I’ve known for years is going off to a new exciting time in their
life. I feel very gratified when I know that over the years I have built
a relationship with a child who is now a young adult, and they’re going
off and they’re going to do well.
What is next for you in terms of
the work that you’re doing?
Every day I have discussions with parents in my office
about vaccination. The prevention of diseases has been one of the most
successful public health achievements in the last 50 years, so I am
going to continue to advocate strongly for vaccinations, and help allay
the unfounded fears that people bring to this topic. —Krista Keyes
DR. HOWARD
GINSBURG, PEDIATRIC SURGEON
Tell
us a little bit about your path to becoming a surgeon.
I was an undergraduate at
Brown and went to medical school at the University of Cincinnati. That
was followed by my surgical residency at NYU, two years of a pediatric
surgery fellowship at Columbia-Presbyterian, and another fellowship at
Massachusetts General Hospital. Then I returned to NYU. At that time,
there was no established pediatric surgical unit, so we built one— and
that’s what I’ve been doing ever since.
What are the
pros and cons of working as a pediatric surgeon?
The clinical processes that
you see are unbelievably interesting—children born without their
esophagus attached, or with their intestines outside their body. But the
gratifying part is that you can fix these things, you can take these
babies that are three, four, five pounds to the operating room and then
watch them grow up and be invited to their confirmations and bar
mitzvahs and their weddings and be part of their families. The cons are
the failures. Probably one of the worst experiences in my whole career
was when I was working on a child who had leukemia, who was about the
same age as my older son—about 3 at the time. He eventually died and I
sat by
his bedside all night.
At that time, I said to myself, “Can I do this?”
What is a typical day like for you?
I get up at 4:35
every morning and I’m usually in the office by 5:45. I take care of all
the administrative work I need to do and then I usually make rounds with
the residents at around 7. Then we’re off to the OR at 7:30 and we work
in the operating room until we’re finished, which is sometimes not
until 7 at night. There’s one day a week I see patients and don’t go
into the operating room. There’s one day a week where I spend my day at
Bellevue and do all the pediatric surgery at Bellevue as well. And then
of course there are emergencies. Another challenge is that there aren’t a
lot of pediatric surgeons. There have been many years where I’ve been
the only pediatric surgeon here, and I’m on call every night, 365 days a
year.
What challenges ahead do you see for medicine?
The training of future
doctors is so different than it used to be. The hours that the residents
are allowed to do in the hospitals now are limited by laws; they are
allowed to be in the hospital a maximum of 80 hours a week. That’s a
challenge to be able to adequately train those residents in surgery,
because surgical residents learn by being in the operating room and
actually scrubbing in on cases, and if their hours in the hospital are
limited, they don’t get that experience they used to get. So the
challenge is to be able to provide enough training so that we can create
talented surgeons for the future. I also think the cost of medicine is
an immense challenge. The amount of paperwork and red tape that we have
to go through to take care of patients is staggering. It takes an
enormous amount of time and manpower that could be better used taking
care of patients. —Robina Josephine Khalid
DR. DARRYL DE VIVO, PEDIATRIC NEUROLOGIST
What inspired you to become a doctor?
Probably it was my
experience as a child with our family practitioner, who was a very
remarkable person. He would look after our needs and then he might sit
and have a cup of coffee with my parents. He was part of the family.
That’s something we’ve lost these days.
How did you choose pediatric
neurology as your specialty?
I was a pre-medical student but I didn’t understand
much about being a doctor, until my youngest brother was struck down by a
complication of infectious mononucleosis and developed paralysis below
his chest. He was 15. I would come down every weekend from Amherst
College to be with him in the hospital. My brother had the benefit of
being cared for by Dr. Phillip Dodge, who was building a pediatric
neurology service at Massachusetts General Hospital. I guess Dr. Dodge
took a liking to me, probably because my brother said I was a nice guy
[laughs]. So in my summers, after my brother recovered, I worked for Dr.
Dodge.
Are there any career highlights that stand
out in your mind?
At Washington University we had an epidemic of Reye’s
Syndrome, a life-threatening disease that would occur [alongside] a
viral infection. Here’s a healthy child who gets the flu, and a week
later that child might be dead. Can you imagine how devastating that is
to a parent? Roughly 90 percent of children who developed Reye’s
Syndrome would die. We worked very hard and turned that figure entirely
around. Instead of 90 percent dying, we saved 90 percent.
Only later did people realize that what was causing this condition was
aspirin.
So
when you’re not curing diseases, what’s a typical day like?
[Laughs] Well, I see
patients. We see children with cerebral palsy, epilepsy, behavioral
disturbances from ADHD to autism. Occasionally, we see a child with a
brain tumor or meningitis or [traumatic] brain injury. We’re very
involved in trying to find a cure for spinal muscular atrophy. I think
that can happen, hopefully, within the next several years.
Do you have children? If
so, what effect have they had on your career?
I have three [grown]
daughters. I probably learned most of my pediatrics at home. It’s an
abstraction when you’re a pediatrician without children. When you have
your own, you start seeing it from the parents’ point of view.
What challenges do you see ahead for your field?
We should be focusing on
[prevention]. Our society has largely failed to pay attention to social
factors that contribute to disease. I think this whole debate about
healthcare is very threatening. I’m aware that more needs to be done.
The United States offers the best healthcare in the world, but it isn’t
available to every [person]. We don’t want to throw out the baby with
the bathwater; we want to maintain the best care in the world while
increasing its availability. That’s going to take serious thinking by
informed people.
—Lisa
Rogal
DR.
DONNA MOREAU, PEDIATRIC
AND ADOLESCENT PSYCHIATRIST
How do you
approach the practice of psychiatry?
My approach is always to
look at the whole person and look at a person’s environment and social
circumstances.
I
understand the importance of medication, but I’m not quick to jump to
medications. I like to get a complete understanding of the person. It’s
more of an inside-oriented, exploratory therapy using some cognitive
behavioral and interpersonal psychotherapy techniques.
What’s your area of expertise?
Anxiety and depression,
including bipolar disorder. But I’ve worked with lots of patients with
eating disorders and other types of anxiety disorders.
What do
you like about practicing in this city?
I like kids from this area. Kids from the city tend
to be exciting. They’re fairly sophisticated and streetwise, and I enjoy
that.
Are there
specific issues that adolescents are more likely to face living in the
city? Yes. Unfortunately, drug use is widespread, but I think that it’s
more prevalent in New York and other large cities. Kids are starting
sexual relationships at much younger ages than they used to. The city
offers so much in terms of culture and exposure to things, but what
comes with that is exposure to things at an age where it’s hard to
handle that.
What has been a career highlight for you?
There was one young boy
that I worked with for several years, who was a super-bright kid, but
was eccentric and isolated. I knew that he was smarter than most of the
kids around him and he saw the world in a way that kids his age
wouldn’t. That isolated him from friendships, and he was retreating into
a fantasy world because of that. I got into that world with him and helped him see what he was getting out of it and gave him a
sense that as he got older, he would be able to find that in work and in
relationships. To see him really understand that and move to a place
where he started having friendships was really exciting for me.
Would
you say that children are being overmedicated today?
Yes. I see some adolescents
on three, four, or five medications. Number one, I think they’ve been
misdiagnosed—I don’t think they really are bipolar. And number two,
they’re taking medications that are serious, that have significant side
effects, and that are just masking things, not treating anything. This
is not to say that there’s no place for medication, but I think that the
diagnosis of bipolar disorder is grossly overused, and one of the
primary treatments of bipolar disorder is medication, so I think that
there are kids who are being overmedicated, and it’s tragic.
Do you
see any challenges for your field ahead?
I think that psychiatry has always been
considered a stepchild of medicine, and that somehow psychiatry wasn’t
real medicine.
In
an effort to change that opinion, I think psychiatry has gone too far
into a medical model and has lost a lot of what I think is special about
psychiatry, which is looking at a whole person and understanding a
person’s psychology and their emotion. Many psychiatrists are moving
towards treatment options that are basically pharmacological, which I
think is a mistake. —Megan Maxson
DR. MORTON BORG, PEDIATRIC CARDIOLOGIST
What
drew you to medicine, and what do you like about working with children?
In high school, science
always interested me, and I worked at camps with children. Upon entering
college, I decided to follow medicine, and by senior year wanted to
specialize in pediatrics. With kids you can make them laugh and change a
cry into a smile. Also, adult cardiology is almost routine—adults
undergo heart attacks and irregularities of the heartbeat, but when
you’re dealing with kids there is a wide range of abnormalities that can
occur, and you have to sit and figure it out.
What is a typical day like for you?
My mornings begin with
going around the pediatric areas to see if there are any questions or
problems. Next, I visit our newborn intensive unit, because even the
mildest types of problems can cause significant difficulties with
premature babies, especially if they’re on respirators. Then, I head
over to our outpatient facility where I spend about seven hours seeing
patients. The types of issues and diagnoses vary in the course of the
day.
What is the most challenging part of your
job?
Trying
to convey the information to the parents in a non-threatening way while
remaining informative, and comforting the family. Not every parent is
going to take the information the same way; some break down right away
because they can’t believe that their child is sick. The challenging
part is saying the right words to the parents to get them through the
initial shock and placing the child on the proper therapy.
What
career highlight are you most proud of?
At Beth Israel we used to have a residency training
program and one of my career highlights has been receiving the
outstanding teacher award from the residents several times.
Right now there’s a lot of talk about health
care reform—if there was one thing you could change about the country’s
health care system, what would it be?
The child health care and
the insurance coverage of child health care is actually pretty good,
because if the families cannot afford the treatments, they can get the
Medicaid or other insurances for their kids. I’ve not had any children
who were unable to get coverage. At Beth Israel we place kids into our
teaching care program where they receive free care.—Theodora Guliadis
DR. NANCY A.
KERNAN, PEDIATRIC ONCOLOGIST
Tell us about your path to becoming a doctor.
For
college, I went to Wheaton in Norton, MA, and I intended to be a math
teacher for 10- to 12-year-olds. I always loved working with kids. At
Wheaton, I took a mandatory biology course and fell in love. I saw
medicine as a chance to combine my loves of children and teaching and my
newfound love of bio and physiology. I went to med school at Cornell in
New York, and during my clinical rotation, I developed an interest in
hematology and oncology. I was in Washington, D.C., from 1978-1981
working at Children’s Hospital, but I came back to New York to do my
residency in general pediatrics, and I was offered a fellowship program
at Sloan-Kettering in 1981.
You’ve worked in
hematology/oncology since the 1980s. What has it been like to see cancer
treatment develop over the years?
In 1981, stem cell and
bonemarrow transplantation was in its infancy. There was a small team at
Sloan- Kettering that was exploring the role of bone-marrow
transplantation in the treatment of childhood leukemia and immune
disorders. I became involved with starting a national marrow donor
program, which has become international, to find bone-marrow donors for
patients who don’t have donors in their family. I have been extremely
lucky to have been in this specialty in the 1980s and ‘90s and into
2000, because our success with treating children with pediatric cancers
and specifically pediatric leukemias has been enormous.
When I started, about 20
percent of kids with leukemia survived, and now about 80 percent survive
and do well. It’s been extraordinarily rewarding. The downside is we’re
not successful with everyone. The upside is that when we win, it’s a
home-run.
How do you see the field of medicine
changing?
The
next generation of medical students are demanding a more balanced life.
Medicine is a wonderful career but one has to pay attention to doing it
in a more balanced way. I think it’s possible.
Do you have kids? If so, how have they impacted your career as a
pediatrician?
My daughter Kate is 12. She just started sixth grade at the
Convent of the Sacred Heart, the same school my sisters and I went to.
When you see people who have such challenges on a regular basis, it
makes you treasure your child’s health and well-being a touch more. I
can also appreciate how difficult it is for the parents I work with to
get children to do what they want them to do, like change their
dressings and take their medicine. —Elizabeth Zelma
DR. SARLA INAMDAR, GENERAL PEDIATRICIAN
What drew you to medicine? Did you always want to be a doctor?
I’ve always wanted to be a
professional, and growing up in India there were two professions that
were friendly to women: medicine and law. Even though there were
limited opportunities for higher education for women, I was drawn to
medicine as early as elementary school. In fact, in my family, I stuck
my neck out saying I wanted to study further, and I got my way.
Tell us
about your path to becoming a doctor.
I studied in India, in what is now Mumbai. After
graduation I came to the U.S. and did two years at New York Medical
College’s residency program and the affiliated hospital’s training
program. In ‘72, I joined the faculty at New York Medical College and
have been with them since.
Tell me about your
specialty. How did you choose it?
I developed an interest in
pediatric rheumatological disorders, which means I deal with the
management of children with chronic illnesses. When I first came here,
pediatric rheumatology was a very young field. I saw the need for it
because these children were being lost in the shuffle—they needed
someone to anchor their care and carry them year-to-year. Many of my
kids have now gone to college. They have married or settled down, and I
am still in touch with them.
What is your favorite
part of your job?
Besides taking care of patients, I really enjoy
teaching. In this current era of technology, I am really trying to focus
the students on the patient’s story. Listen to the parents. Listen to
the patient and do a thorough assessment. Don’t get sidetracked by the
tests and the laboratories.
What career highlights are you most
proud of?
I’ve been
chief of pediatric education for several years at New York Medical
College. I have been program director for the residency training and
have received several federal grants for training residents in primary
care pediatrics. I have also been working with the Department of Health
over the past two decades on trying to get the immunization levels up,
and we are also promoting healthy eating habits for children right from
the newborn stage. We try to focus the energies of the department in
areas that affect our community.
What do you like to do when you’re
not working?
Interacting with my two grandkids is my current hobby. I am trying to
encourage my granddaughter to be a scientist, but she wants to be a rock
star.
What do
you love about working with children? The trust and hope that they bring
with them. They inspire a sense of confidence. I feel like I have to do
my best for them. They are so vulnerable—it would be a shame not to
give them my best. —Jean Halloran-Monaco
DR. STEPHEN ARPADI, GENERAL PEDIATRICIAN
When did you begin working with children with HIV and AIDS?
I came to New York in
1982. One of the things that was unfolding in northern Manhattan was the
AIDS epidemic, which sort of erupted. I saw kids in my practice with
HIV/AIDS, and realized that these children needed specialized care.
What
was different about the care you offered children with HIV/AIDS?
The prior model was: the
mom had HIV, so she’d see one doctor, and the child would see me, an
infectious disease doctor, or immunologist.
But when they had crises the doctors weren’t
going to be available on the day-to-day basis. What they needed was a
medical home, and someone to help them navigate through the different
doctors. So we created a center for comprehensive care at St. Luke’s
Hospital for children and families with HIV or AIDS.
What were some of the challenges you faced?
There really wasn’t much we
could do to treat HIV in the initial years. It was a hopeless disease
in that you knew it would end in death. My patients needed support
managing through the end of their days.
What’s most rewarding about
your work now?
People don’t die from HIV. Now we are able to treat people with HIV
successfully, and either restore their good health or sustain their good
health and get them well into adulthood and beyond. Now it’s not about
supporting people as they’re dying, but supporting people as they’re
living with HIV and making life decisions.
When was the turning point
in finding effective treatment for HIV and AIDS?
1996. We started using a
combination of drugs—people were calling these combinations
“cocktails”—that could suppress the virus and restore people to good
health, especially children. The other part of the story is, starting in
1994, we developed the ability to reduce the transmission of HIV from
mother to baby by conducting pre-natal testing, and offering these women
treatment with HIV medication for six weeks.
Now we’ve come really close
to eliminating the transmission of HIV from mother to baby in the
United States. It’s a rare event in the U.S., less than 2 percent.
That must have drastically affected your own patient population.
Most of my patients now
are adolescents or young adults; my youngest patients are 9 or 10. Some
patients have gone on to be parents. Some are going off to college—we’re
having conversations about where to keep medication in the dorm room,
and how to handle disclosure. So, as this has diminished in the U.S.,
there’s been increasing awareness of the inequity of having effective
treatments here, and the fact that in the parts of the world where 90
percent of HIV/AIDS cases are occurring, those treatments are not
available.
How have you been involved in addressing that
inequity?
I have
been providing technical support to health care providers in sub-Saharan
Africa, in Kenya, Nigeria, and South Africa. I work with people weekly
through phone calls and email, and I am physically in the countries
every three months or so for two to three weeks at a time. I am not
directly providing the care, but rather moving information to my
counterparts so that they can do the treatment.
—Marisa Suescun
