Hometown: West Chester, Pennsylvania
Agency: Camden Coalition of Healthcare Providers and Cooper University Hospital: Camden, New Jersey
What did you enjoy most about the internship?
I really enjoyed getting acquainted with the city of Camden. It has a rich history and a lot of hidden treasures. My favorites included the view from the PATCO and a great running trail at Cooper River Park.
What was the greatest challenge?
My greatest challenge was seeing the discrepancy between how patient felt like they were treated by doctors and how hard doctors worked to successfully treat their patients. Despite hospitals and doctors striving to provide the best possible care to the greatest number of patients, some patients still felt slighted by the hospital and their physicians. It was frustrating to both parties.
What was the greatest lesson you learned through your experience?
The greatest lesson I learned in Camden was that the healthcare system is complicated. Patient care requires involvement from not only the patients and doctors, but also other healthcare staff, insurance companies, and hospital administration. I had been oblivious to so many steps of the healthcare process, and decisions at any of these steps can have a significant impact on the care received by the patient.
How might the internship affect your career path?
This internship has reaffirmed my plan to apply to medical school. I got lots of shadowing experiences with many types of professionals including physicians, lawyers, researchers, consultants, administrators, nurses and teachers: all of which reaffirmed my desire to be a physician. This internship has also encouraged me to consider a career in urban healthcare. There are many aspects of healthcare in an urban setting that differentiate it from healthcare in a rural or suburban setting and after interning in Camden, I would definitely consider working with an urban population long-term.
When I found out I would spend the summer in Camden, New Jersey, I got two similar yet very different responses: "Are you serious?!"
The first was from my mother. Camden has consistently ranked in the top three of the nation's most dangerous cities. Particularly in the Philadelphia area, its reputation is notorious. I was promptly forwarded excessive emails about "Rutgers- Camden Campus Safety" and "Camden Policing and Public Safety" and "How Pepper Spray Works."
The second was from my supervisor at the Rockbridge Area Free Clinic, Laura Simpson. She was literally jumping with joy. "You get to work with Jeffrey Brenner?! Are you serious?! I'm coming to visit. I'm definitely coming to visit." Jeffrey Brenner and his work with the Camden Coalition of Healthcare Providers, the organization I would get to intern with, had recently been featured in an article in The New Yorker, which, coincidentally, Laura had copied for me a few weeks earlier.
The "Coalition" has an innovative method of approaching poverty-related healthcare. Following research on medical facility use in Camden, Dr. Brenner discovered that just 1% of patients accounted for 30% of medical facility costs. In order to lessen costs, Dr. Brenner decided to target that 1% of healthcare "super-users" in an effort to decrease costs. He did, it worked, and people noticed.
The program, called the Care Management team, uses an outreach team that consists of a social worker, a health outreach worker, and a nurse practitioner. The team helps clients stabilize their social environment and health condition with a goal of finding a long-term medical home. This process involves helping patients apply for government assistance benefits, secure temporary shelter, enroll in medical day programs, and coordinate primary and specialty care. The program has over 115 enrolled patients and has been extremely successful.
I was very excited to begin work with the Coalition, but my internship would not stop there. I would also spend half of my time with Cooper University Hospital's Dr. Anthony Mazzarelli--an ER doctor, lawyer, radio-host and, most importantly, W&L alumnus.
My work in Camden began with a little education. Hailing from Philadelphia, Camden was always overlooked. But in my first couple of weeks, I learned that Camden was once a cultural epicenter. Home to Campbell's soup and RCA Victor, Camden was an industrial hotbed. Camden was a must-stop on political campaigns, and it was inappropriate to walk down the main street unless you sported a suit and tie. However, as industries and jobs disappeared, so did the prosperity of Camden. What remains is a city with a huge potential for revitalization, which numerous groups and organizations have already begun to capitalize on.
Working with the Coalition, I began to understand the full scope of the healthcare problem in Camden. My work ranged from quantifying available primary care providers, to assisting in a local family practice, to sitting in on a neighborhood support group, to helping with diabetes and asthma education classes. The general mistrust between the uninsured and underinsured and the healthcare system was shocking. People discussed how they felt slighted during medical visits and would avoid necessary testing because they "were afraid of what they'd find out." This sentiment reemphasizes the importance of organizations such as the Coalition, which work to coordinate care of patients and improve the relationship between patients and the many types of medical organizations.
This sentiment was also surprising given how hard hospital staff work to provide their patients with the best possible care. Working with Dr. Mazzarelli, I got a candid view of the ins and outs of hospital administration. I worked closely with a consulting group hired to improve Cooper Hospital's relationship with the city's largest primary care provider. I sat in on a "Complex Case Management Meeting"--essentially a meeting designed to coordinate the care of the hospital's most complicated, and often neediest, patients. I met with the hospital's assistant director of financial services and learned about the hoops patients and hospitals have to jump through to treat the uninsured and underinsured. I attended meetings with the dean of the nation's newest medical school at Cooper. Each experience furthered my knowledge of the extent of coordination required to facilitate all aspects of healthcare, from medical school to primary care to emergency departments.
My work at Cooper Hospital also gave me insight into life as a medical student. I sat in on medical school lectures. I spent the afternoon with a fourth-year medical student who graphed out how medical school and residencies work on a whiteboard, then swore that while first- and second-year are "hell," third and fourth-year are "so, so awesome." I shadowed physicians and medical students on shifts in the ER, experienced my first overnight shift (Camden ER is still busy at 3 a.m....), watched someone get stitches in their head, saw a triage in the trauma area, got an up-close (and a bit gory) look at tendons in the arm and even helped to mend a finger.
Overall, my summer in Camden has really widened my perspective of not only Camden and urban healthcare, but healthcare in general. In addition to reaffirming my desire to become a physician, Camden has introduced to me to the nuts and bolts of healthcare and the many, many steps required to successfully treat patients. I was impressed with the constant drive of every organization I worked with to better Camden and its population. While some may consider Camden to be at rock-bottom, its citizens and employees are determined to lift its reputation, and even as a Philadelphian, it's impossible to dismiss the potential across the Ben Franklin in Camden, New Jersey.