Thomas J. Madejski, M.D.

Buffalo-area doctor, elected president of Medical Society of the State of New York, wants to focus on preventive care to curb obesity, diabetes

By Chris Motola

MadejskiQ: What’s the transition like, becoming president of the Medical Society of the State of New York?

A: We have a pretty well-established succession plan, so people work their way through the organization and get elected to various offices. And then if you get into the presidential track, you sort of get designated to be president within a couple years. You spend a year as vice-president, then as president-elect, then as president. So the three of us sort of work together in the office of the president. The president is the main guy, but the other two help him out. Part of the idea is that we have knowledge about what’s going on when we come in.

Q: What do you see as the primary mission of the society?

A: There’s an actual mission statement, which I’ll paraphrase as “to represent the interests of patients and physicians in New York state and promote the betterment of public health.” So it’s about the way healthcare is delivered, new technologies, how specialties evolves. So we have members with different expertise and we come up with policies that we think helps make the care and health of people in New York better. We do that through a committee structure. When we get an issue that comes before us, if it’s not something that can be resolved very easily, we’ll assign it to a committee. The committee will do some research on it. They’ll make some recommendations and then it’ll eventually come before our house of delegates, which is like a small congress that meets annually. We go through the different issues, debate on them, and come up with policy. The rest of the year, the officers try to implement those policies.

Q: Obviously, doctors can’t unionize in the traditional sense, but in what ways would you say the organization is similar to a union?

A: We don’t do collective bargaining for individual practices, but we do work on issues that affect the practice environment and care of patients. The first year or two I was on a reference committee and there was a lot of activity around HIV at the time; this was the early ‘90s. There was conflict between privacy protections for patients and then being able to identify people you could intervene with to hopefully prevent infection. One of the issues was whether you could test mothers for their HIV status so you could treat their babies as they were delivering so that they would not contract the virus. That was difficult to do, but we made some recommendations to move forward on that. More recently one thing that’s been difficult is getting drugs paid for and to patients, particularly with the interference or interaction of pharmacy benefit managers and insurance companies. They may change what they consider to be an allowable medicine for someone. You’ll have someone who may be very stable on a medication, but the insurer will decide they don’t want to pay for it anymore. Over the last couple years, we have done what is called a step therapy bill and that has allowed us to provide protections for patients so they’re not having their medications changed willy-nilly.

Q: Given the lopsided population density of New York state and its distinct regional characteristics, how do does the medical society deal with those differences? Or is it not that big a deal?

A: The society is around 212 years old now and that’s been a problem since fairly early on. Back before we had the ease of communication that we have now, the leaders identified the issue and created a rotational model. This goes back to the model of the office of the president that I described earlier where there are three officers involved. We break the state into three clusters: New York City, the areas surrounding New York City, and Upstate. So each of those three people are from a different region. I’m the Upstate guy. The last president, Dr. Rothberg, was from the suburban region, and the incoming president-elect is from the Queens County Medical Society. Those three areas are roughly balanced in terms of members, maybe slightly more Downstate, but not that much. But we believe in keeping the whole state engaged. There is a geographic component, but it’s very much a meritocracy. We like to think we’re getting the best people from each region.

Q: What do you think the state does well with medicine, and where is it weakest?

A: They’re kind of related. One of the things the state does really well is medical education. We have the most medical schools in the country and train the most medical students and residents. It gives us the potential for a great physician workforce. Yet we, in most surveys, rank either 50th or 51st in desirable places to practice. We train the most residents, but keep less than half of them, which leads to access issues.

Q: What’s the main reason cited?

A: The economic environment, the cost of practice. Some of that isn’t unique to physicians; New York is an expensive state to do business in. Also reimbursement rate, particularly Upstate, is some of the lowest in the country. And we have one of the most expensive liability systems in the country.

Q: To what degree does the state government seem sympathetic? And if not, how do you work around it?

A: We try to put together different coalitions to work on different problems. Sometimes we’re successful, sometimes we’re not. For the most part, we have a good relationship with the health department, the legislature and the governor’s office in terms of hearing us out, but sometimes there are differences of opinion. One recent example is medical marijuana. It’s an interesting issue with legitimate concerns about how it’s been implemented since it’s circumvented a lot of the processes we usually use. But we continue to work with the state on that issue.

Q: What do you want your legacy to be as president?

A: I hope to have some impact on the general health of the state in terms of improving people’s health. We’re trying to emphasize more preventive health, particularly with the obesity crisis and the number of diabetics. We also want to have an effect on improving the practice environment so we can get more physicians in the state to help take care of patients.


Lifelines

Name: Thomas J. Madejski, M.D.
Position: In addition to his internal medicine practice with General Physician, P.C., he is the past president of the medical staff at Medina Memorial Hospital. He is also medical director of the Orleans County Nursing Home, Absolut Care of Gasport, and Hospice of Orleans County.
Hometown: Buffalo
Education: SUNY Health Science Center (SUNY Upstate)
Affiliations: Medina Memorial Hospital
Organizations: Medical Society of the State of New York (President); American Medical Association

Family: Wife, five children
Hobbies: Golf, hunting, fishing, camping, hiking

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