Programs and Services
Ambulatory Medicine Hospital Medicine Methadone Maintenance Treatment Program (MMTP) Occupational Medicine/Health Services
Henry C. Bodenheimer, MD
Chairman, Department of Medicine, Beth Israel Medical Center
Professor of Medicine, Albert Einstein College of Medicine
Dr. Bodenheimer came to Beth Israel in 2002 from Mount Sinai Hospital; where he was the Deputy Director, Medical Services of the Recanati/Miller Transplantation Institute. Recognized for his work in primary biliary cirrhosis and liver transplantion, he has authored more than 50 peer-reviewed manuscripts, served on NIH study sections, was associate editor of Hepatology and is a medical board member of the New York Organ Donor Network.
Allergy & Immunology
James M. Rubin, MD, chief of the division, has major interests in drug allergies and the diagnosis and treatment of asthma. He has published numerous papers on these and other subjects in the field. Since 1975, Dr. Rubin has organized a postgraduate course for allergists and immunologists that has come to be recognized as one of the best such educational efforts in the country.
The Residency Experience
Residents are offered an opportunity for one-on-one education, with exposure to patients through a weekly clinic, inpatient consultations and a preceptorship in which private patients are seen in attending physicians' offices. Residents are trained in diagnostic techniques and in immunotherapeutic approaches for allergy and asthma. They also have experience with specialized procedures such as bronchoprovocation, a method for identifying asthma in otherwise undiagnosable patients. The division is active in clinical research, primarily evaluations of various medications and treatment regimens, with particular emphasis on asthma.
This optional rotation is of significant value to residents, since there is little exposure to allergy and immunology during the medical school years. Future clinicians can benefit greatly from the opportunity to explore these fields and become familiar with the most advanced diagnostic procedures and therapeutic modalities.
Ambulatory Medicine/General Medical Associates
John Andrilli, M.D. is the Medical Director of the General Medical Associates(GMA), the Department of Internal Medicine’s faculty primary care ambulatory practice of Beth Israel Medical Center.
The mission of GMA’s training program is to prepare our residents to represent excellence in healthcare in their future ambulatory practice. We are located in the Phillips Ambulatory Care Center in Zeckendorf Towers on Union Square. The Center, which occupies 300,000 square feet, provides a broad range of diagnostic and treatment services in an efficient, patient-friendly environment. Nearly all the subspecialty and surgical departments are conveniently located in this building.
The Residency Experience
GMA approaches each housestaff developmentally in the six core competencies defined by the Accreditation Council on Graduate Medical Education. You will have a dedicated faculty attending assigned to personally coach you through the next three years. With personalized evaluation and feedback, you collaborate and build a relationship with the faculty attending who will intentionally and continually help take you to the next level in your medical knowledge and clinical skills. Residents treat every patient under the direct supervision of actively practicing faculty attendings who are solely dedicated to primary care ambulatory medicine. They will equip you to be professional and have a confident understanding of the systems-based practice in medical care.
Emphasis is placed on training residents to take responsibility for organizing all aspects of patient care and on continuity of care. Residents learn to utilize sub-specialty consultations appropriately, while providing the majority of the patient’s care. Beth Israel’s provides access to healthcare to a rich, ethnic mix of all ages and socioeconomic status. This is where communication skills and cross-cultural awareness is actively developed. Sub-acute and chronic diseases most commonly seen include high blood pressure, diabetes, cancer screening, coronary artery disease, asthma, osteoarthritis, and depression. GMA provides healthcare to over 50,000 patients annually. Residents see their patients for a block of two weeks period very six weeks. In addition, residents have continuity sessions approximately every four weeks when on the electives or floors. During the ambulatory block, you will encounter an intense primary care academic curriculum with emphasis on evidence-based medicine, the most current practice guidelines, and psychosocial medicine. Residents have consistently ranked GMA as one of the top experiences in the residency training program. GMA will lay for you the foundations of practicing excellence in ambulatory medicine.
Steven Bergmann, MD, PhD, is the Chief of Cardiology. A leading authority and active researcher on cardiovascular imaging, Dr Bergmann has published over 170 papers, in addition to extensive other academic work. He came to Beth Israel from Columbia Presbyterian.
Cardiology at the Beth Israel Medical Center is a very active clinical service that treats the full spectrum of cardiac diseases. The service admits patients to two fully monitored, geographically localized units and also runs an 8 bed Cardiac Care Unit (CCU) and a post-intervention step down units. The patients we serve represent the full spectrum of New York’s socioeconomic diversity, with approximately 50% “private” admissions, the remainder being “service” cases.
Cardiology services include Catheterization and Interventional Cardiology, Nuclear cardiology, Echocardiography, Electrophysiology, Heart Failure, Consultative Cardiology, Preventive Cardiology and Cardiac Rehabilitation. Approximately 3000 invasive coronary diagnostic and 1500 interventional procedures are performed each year. The Nuclear Cardiology Laboratory performs over 2000 studies annually and includes a large volume of studies performed with Positron Emission Tomography (PET). The Echocardiography laboratory performs over 7000 procedures per year including Transesophageal and Stress Echocardiography. The Electrophysiology section performs all invasive and non-invasive procedures including radiofrequency ablation of tachyarrhythmias, ICD, resynchronization therapy and pacemaker implantation. We have recently acquired a 64 slice CT and perform coronary calcium scoring and “non-invasive” CT coronary angiography.
BIMC sponsors two ACGME accredited fellowship training programs in Cardiovascular Disease, one with all clinical experience at the BI main campus and the other combined BI-LICH program with 50% plus experience at BI main campus and the remaining 50% at LICH which is the Brooklyn campus. LICH also has an active CCU and Consult Service as well as Echo, Nuclear, EP and Catheterization Laboratories. We also offer Advanced, Interventional and Electrophysiology fellowships.
The Division has an active research component with an emphasis on use of clinical pathways, treatment of acute myocardial infarction, diagnosis and treatment of acquired and inherited arrhythmias, imaging, syncope, prevention of contrast induced nephropathy and therapy for heart failure. Residents are encouraged to participate in these research activities during their elective periods. Publication and presentation of results of research is highly encouraged and supported.
The Residency Experience
Residents are responsible for, and play a major role in the care of all patients. Internal medicine house officers devote approximately five months of their time to Cardiology with the goal of learning the signs, symptoms, diagnostic evaluations, and care of patients with primary cardiac disorders. Two months of the residency is spent in the CCU caring for critically ill patients. Clinical electives in Cardiology are available as well. Residents participate in daily rounds with attending physicians as well as have didactic teaching sessions, and obtain progressive experience in clinical decision-making in an environment of technical and clinical excellence, intellectual rigor, and openness.
Stanley Yancovitz, MD, a board-certified specialist in infectious diseases and chief of the Nathaniel Meltzer, MD, Division of Chemical Dependency, also is director of AIDS clinical activities at Beth Israel. Under his leadership, the chemical dependency division has become a paradigm for educational programs in the field of chemical dependency. The division faculty is involved in clinical research in substance abuse and AIDS.
There is ample opportunity for residents to develop and participate in ongoing clinical research projects. Current studies in which residents are involved include an investigation of the effects of cocaine on the liver and a clinical study of tuberculosis in the addicted population. Other recent research projects have been concerned with the effects of cocaine smoking on the lungs and the utility of routine chest X-ray in identifying disease in the population of patients undergoing detoxification.
The Residency Experience
Patients with alcohol or drug abuse problems who also have an acute medical disorder that requires hospital care are admitted to the General Medicine Services. Many of these patients suffer from infectious diseases, including HIV-related infections; pneumonia and tuberculosis; skin, soft tissue and bone infections related to intravenous drug abuse; and liver disease related to chronic viral infections such as hepatitis. Most do not have a private attending physician, and residents therefore have major responsibility for primary care under the supervision of faculty. In addition to dealing with the many and varied medical complications affecting these patients, residents have the opportunity to learn the principles of the identification of substance abuse, the management of detoxification and the long-term management of substance abusers. Weekly grand rounds in chemical dependency are provided for residents. Speakers from Beth Israel and other institutions discuss various aspects of chemical dependency and its medical and psychiatric complications. The quantity and quality of teaching by faculty with special expertise in dealing with the problems presented by substance abusers set this program apart from the training available in most institutions.
Endocrinology & Diabetes
Dr. Leonid Poretsky is the Chief of Endocrinology as of June 2000. He graduated cum laude from the First Medical Institute in Leningrad, Russia, in 1977. He completed his endocrine training at Boston’s Beth Israel Medical Center Hospital at Harvard Medical School and is board-certified in both internal medicine and endocrinology. Dr. Poretsky's prior position was Director of Diabetes Center, Associate Director of General Clinical Research Center and Professor of Medicine at Cornell University Medical College. He is the author of over 70 publications. His research work has been supported throughout the years with NIH and other funding sources.
He has served on review panels of many general medical and endocrine journals. His research studies are presented annually at the Endocrine Society and American Diabetes Association meetings.
The division's clinical program encompasses all aspects of endocrinology in both in-patient and outpatient settings. The division is administering a two-year endocrine fellowship program. The division operates a fully equipped basic science research laboratory. An innovative diabetes management program, Friedman Diabetes Institute, opened in Spring, 2007.
The division's research programs include studies of interaction between insulin and insulin-like growth factors and their receptors on cellular and molecular levels; studies of endocrinological aspects of AIDS; studies of thyroid disease in patients exposed to radiation from the Chernobyl accident; vitamin D deficiency in patients with diabetes, and clinical outcome trials in diabetes.
The Residency Experience
Rotations provide residents with the opportunity to explore and confirm an interest in endocrinology. Much of the training experience is one-on-one, with exposure to private and clinic patients, as well as inpatients. Faculty members are both knowledgeable and accessible and are prepared to devote substantial time and effort to individualized training. Residents see a wide variety of patients, with the heaviest concentration in the areas of diabetes, thyroid disease and reproductive endocrinology. The division collaborates closely with other departments, particularly obstetrics and gynecology, pediatrics and nuclear medicine. Clinics include general endocrinology, diabetes, gynecological endocrinology and pediatric endocrinology. Residents also participate in the activities of the Diabetes Management Team, which provides intensive coordinated management by physicians, nurses and dietitians. A nuclear scan conference is held weekly, in which residents review thyroid, parathyroid and adrenal scans. Other conferences include Endocrine Grand Rounds, Research Conferences, Journal Club, Clinical Case Discussion, Joint Endocrine/ENT Thyroid/Parathyroid Conferences and Joint Endocrine/Rheumatology Bone Metabolism Conferences.
Dr. David Carr-Locke is internationally recognized in the field of therapeutic endoscopy and brings 35 years of experience in gastrointestinal endoscopy to BI. He previously served as Director of the Endoscopy Institute at Brigham and Women's Hospital in Boston.
Dr. Carr-Locke has more than 250 original articles, book chapters, books and videos to his credit. He also has conducted extensive research into new devices for therapeutic endoscopy, and has lectured worldwide. He is a fellow of the Royal College of Physicians of London, the American Society for Gastrointestinal Endoscopy (ASGE), as well as past president of the ASGE and the International HepatoPancreato-Biliary Association. Additionally, Dr. Carr-Locke sits on the editorial board of and is a reviewer for numerous professional journals, including Lancet, Endoscopy, Gastroenterology and the New England Journal of Medicine.
The Division of Digestive Diseases has expanded rapidly in the past few years with the addition of new faculty members and provides state of the art expertise in clinical gastroenterology and liver diseases and liver pathology. Division has recently enhanced and modernized the Endoscopy Unit. The Unit has been treating patients for more than 20 years and is one of the busiest in the region. This unit performs highly specialized procedures such as endoscopic retrograde cholangiopancreatography to outline the ducts of the gall bladder and pancreas, endoscopic ultrasound, laser endoscopy and capsule endoscopy. The gastroenterology laboratory performs a number of sophisticated tests such as 24-hour pH monitoring of the esophagus and esophageal and rectal manometry. The Division also supports specialized expertise in interpretation of liver biopsy pathology. In cooperation with the Department of Pathology, liver biopsy slides from throughout the Continuum system are evaluated by Dr. Neil Theise, an internationally recognized leader in hepatopathology and hepatic stem cells.
Residents are strongly encouraged to participate with faculty, fellows, associates and coordinators in research projects. Albert Min, M.D. is the Director of Hepatitis Research and together with Drs. Henry Bodenheimer, who also serves as the Chairman of the Department of Medicine, is involved in many clinical trials of new therapeutic agents in the treatment of HBV and HCV. Neil Theise, M.D. is a world renowned hepato-pathologist with a research focus in adult stem cell biology and the canals of Hering. Brett Bernstein, M.D. supervises capsule endoscopy and gastro-esophageal disorders, and is currently investigating the utility of magnification endoscopy in detecting Barrett’s mucosa.
The Residency Experience
In addition to conferences, journal club, bedside teaching and laboratory work, the training experience includes a course in basic physiology as it relates to gastroenterology. An ambulatory GI clinic is held twice weekly and a liver clinic weekly. Patients at all these clinics are seen in consultation for gastrointestinal problems. Residents will work with six clinical fellows and two advanced fellows in endoscopy and pathology. This rotation allows residents to acquire a working knowledge of gastroenterology and provides a foundation for the practice of general internal medicine.
Joyce F. Fogel, MD FACP is the new Chief of the Division of Geriatrics.
The Betty and Morton Yarmon Division of Geriatric Medicine has expanded the training component of the service and has developed a consolidated approach to caring for the geriatric patient.
The Residency Experience
The Geriatrics consultation rotation includes house officers, a geriatrics fellow, geropsychiatrists and specialized social workers. They collaborate in a true team effort to provide the best possible quality of care for these patients. This serves as the educational base for residents who spend at least one month during the program focusing on geriatric medicine. The goal of the educational program is to educate the resident about the special needs of the elderly, spanning the spectrum from the healthy individual to the dying patient. Residents also learn to apply the principles of long-term care of the elderly, such as the avoidance of restraints and sedating medications. The resident joins in addressing geriatric syndromes through a team effort and enhanced support and educational services for patients and families. In addition, residents are introduced to principles of outpatient management at the Phillips Ambulatory Care Center and home visits.
Occupational Medicine & Employee Health
David D’Souza, M.D., M.P.H., medical director of the Division of Occupational Medicine and Employee Health, is a board certified physician with over 15 years of experience in Occupational Medicine. Under his direction, the Division provides occupational health care to Beth Israel employees, as well as to the employees of various metropolitan area employers, and also provides consultations regarding occupational health and safety programs to employers. The division brings a very important perspective regarding the prevention, medical surveillance, diagnosis and management of work-related illness to the Beth Israel Medical Center system.
Clinical research studies include the evaluation of various tools for surveillance for tuberculosis infection. The utility of various incentives to achieve high participation rates in medical surveillance is also being tracked.
The Residency Experience
All residents will receive a broad exposure to occupational medicine and toxicology. The occupational health of both health care workers and workers in many other occupations will be reviewed. Residents will become familiar with the structure and support necessary for delivering high-quality occupational health care, as well as the role of various entities such as the federal, state and local governments, unions and employers. The patient mix includes patients with occupational pulmonary disorders, heavy metal poisoning and repetitive motion musculoskeletal injuries.
Residents will work several sessions per week in the occupational medicine/employee health clinic. Residents also will participate in occupational medicine and toxicology consultations within the Medical Center.
Michael Grossbard, MD, Chair of the Hematology/Oncology Division for both Beth Israel Medical Center and St. Luke’s-Roosevelt is a recognized expert in hematologic malignancies, with over 60 publications. He has contributed to academic programs in thoracic oncology, breast cancer, gastrointestinal cancer and melanoma. He has authored many peer-reviewed publications and is a Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons.
Ronald H. Blum, MD, Director of Continuum Cancer Centers, assumed leadership of the Hematology/Oncology fellowship program in July 2003, and is involved with daily teaching and supervision of the subspecialty program. In addition, he directs the Cancer Center research program and mentors fellows and residents in the Oncology Clinic. Dr. Blum is a Professor of Medicine at Albert Einstein College of Medicine and an internationally recognized expert in lung cancer, melanoma and sarcoma. Dr Blum has over 90 publications, and is a frequent and valued mentor to the house staff.
The Hematology/Oncology fellowship at Beth Israel Medical Center provides comprehensive training in Medical Oncology and benign and malignant Hematology. The program is directed by Dr. Ronald Blum, an internationally recognized expert in lung cancer, melanoma and sarcoma. The curriculum is designed to offer exposure to patients with the full spectrum of disorders in hematology and oncology. The fellows’ experiences with patients are supplemented by a full complement of didactic lectures, disease specific academic conferences, weekly grand rounds, a research conference and a monthly journal club. Fellows are expected to actively contribute to a scholarly research project during their second and third years of training. Because Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital are partners with a single division of Hematology-Oncology, fellows also can take advantage of clinical and research opportunities at the St. Luke’s-Roosevelt campus.
The inpatient program of the division is clustered on a 35-bed hematology/oncology unit, utilized for patients hospitalized for chemotherapy, as well as for the initiation of diagnostic and therapeutic efforts. In addition to fellows and residents, several physician assistants work on this floor. A major clinical cancer center facility at the Phillips Ambulatory Care Center is where patients are seen in an interdisciplinary outpatient setting. A 12-station chemotherapy infusion unit suite is located within the facilities.
The division's current research interests include many protocols for the clinical investigation of newer agents in the treatment of malignant diseases. As a satellite member of the Eastern Cooperative Oncology Group (ECOG), as part of our affiliation with the Albert Einstein College of Medicine, several cooperative group trials are available for patients. A monthly research conference serves a forum for the discussion of both new and currently active protocols. All fellows are required to actively participate in the research program.
The Residency Experience
Residents and interns rotate through the hematology/oncology inpatient unit, receiving in-depth instruction by fellows and sub-specialty attendings. During elective rotations on the consult service, each resident is assigned to a hematology/oncology fellow who sees all service consultations in both hematological and neoplastic diseases. Residents become familiar with blood morphology and bone marrow biopsy procedures and may assist in performing them. They also attend the division's two weekly outpatient clinics, one in hematology and one in oncology, and meet regularly with the assigned attending physician for review and discussion of case management of both inpatients and outpatients.
Divisional conferences and tumor board conferences are held each week. This rotation offers the opportunity to become familiar with the fundamentals of neoplastic disorders and a variety of hematological disorders and is valuable in helping house officers determine whether they wish to specialize in these areas.
Dahlia Rizk, D.O., leads the Hospital Medicine group. Dr. Rizk trained at Beth Israel and has built the hospitalist program into one of the major inpatient clinical and teaching services in the hospital.
Since its inception in 1998, the Beth Israel Hospitalist Program has become an integral part of the Department of Medicine's training program. The group's initial focus was to provide inpatient medical care and continuity for the Medical Center's primary teaching practice. Paralleling the nationwide trend towards increasing numbers of hospital-based physicians, Beth Israel's Hospitalist Program has since expanded from one physician to its current size of twenty-six physicians.
With a growing referral base, including many community primary care and specialty physician practices, the Hospitalist Program now sees approximately 65% of Beth Israel’s hospitalized medicine patients (nearly 10,000 admissions in 2010). The Hospitalists play a critical role in direct patient care and supervision of medical students and medical housestaff. This supervision allows the housestaff to remain autonomous yet supported in the management of their patients.
The Hospitalist group's mission is to provide excellent quality of care with a focus on patient satisfaction and safety. Our 7 day, 24-hour availability allows the primary care physicians and specialists in the community to focus on outpatient practices and procedures. Our physicians specialize in the care of sicker, hospitalized patients while utilizing evidence-based medicine and best practices in daily patient management.
Beth Israel's hospitalists have been integrated into key areas of hospital culture, making important contributions to initiatives in efficiency, patient safety, and patient satisfaction. Perioperative and consultative medicine are also a focus for the group. With our diverse backgrounds, clinical skills and interests, we will continue to make our mark and contribute to the many facets of inpatient medicine providing a dynamic and positive experience for all.
Faculty includes 26 board-certified physicians with academic appointment to The Albert Einstein College of Medicine.
The Hospitalist group focuses on systems research and quality improvement, conducting various research projects with the house staff. The hospitalists are active on many committees at Beth Israel and are involved in designing and staff new and innovative clinical service programs.
The Residency Experience
House staff have more contact with the hospitalist group than perhaps any other Division, since the hospitalists serve as both teaching attendings and also as full time inpatient general medicine attendings, managing upwards of 50% of the inpatient medical service.
Hospitalists often conduct highly efficient, "lean" attending/resident work rounds where bedside teaching, patient care and decision making occur all at once. Members of the hospitalist group have twice recently been named as "Full Time Faculty Attending of the Year" by the house staff.
Donna Mildvan, MD, is Chief of the Division of Infectious Diseases, Director of AIDS Research at Beth Israel Medical Center in New York, NY and Professor of Medicine at the Albert Einstein College of Medicine, Bronx, NY. Dr. Mildvan is an elected fellow of the Infectious Diseases Society of America and of the American College of Physicians. She has served on numerous national committees and panels, including the AIDS Charter Research Review Committee for the National Institute of Allergy and Infectious Diseases (NIAID), and has been a consultant to the Centers for Disease Control and Food and Drug Administration. Dr. Mildvan has authored more than 100 peer reviewed articles, and over 200 total papers and chapters on HIV/AIDS and other topics. She is principal investigator of the NIAID-sponsored AIDS Clinical Trials Unit at Beth Israel Medical Center.
The AIDS Clinical Trials Unit (ACTU) at Beth Israel Medical Center has been conducting studies under the auspices of the National Institute of Allergy and Infectious Diseases (NIAID), a division of the National Institutes of Health, and the pharmaceutical industry since 1987. During the past 16 years Beth Israel has participated, and continues to participate, in numerous trials that led to the approval of many of the treatment that are now licensed for use in HIV infection and the associated opportunistic infections. The BI ACTU has enrolled over 1000 patients in ACTG studies and industry-sponsored trials. The Division also engages in research on epidemiologic, health service and clinical aspects of tuberculosis in general, in drug users and other subgroups, on epidemiologic, clinical and health service aspects of viral hepatitis, on sexually transmitted infections in drug users, on vaccine development for HIV, on many aspects of infection control, and on a wide range of infectious diseases issues.
The Residency Experience
Residents in Internal Medicine rotate through the HIV/Infectious Diseases clustered unit as ward rotation learning about the care of HIV-infected patients and the management of the diverse complications of HIV infection. The core curriculum for this rotation address, among other things, the pathophysiology of HIV infection, the epidemiology of HIV, the clinical manifestation of infectious, hematological-oncologic, neurological, ophthalmologic, gastroenterological, renal, mental health as well as antiretroviral therapeutic approaches and strategies to promote adherence. Attending physicians on the AIDS rotation include members of the Infectious Diseases Division, and other attendings from the Department of Medicine with significant clinical experience and interest in the care of patients with complications of HIV infection. Residents participate in multidisciplinary conferences and a multidisciplinary team approach to care of the HIV-infected patient.
Medicine residents have the opportunity to be part of one of two active infectious diseases consult teams, composed of one of the infectious disease fellows, the teaching infectious disease attending, and possibly medical students on elective. The medical resident sees consults under the supervision of the fellow and attending. A wide variety of viral, bacterial, fungal, and parasitic diseases are seen. There is a particularly extensive exposure to HIV-related complications. Residents may attend sessions in the infection diseases outpatient clinics. They will also attend weekly case presentation conferences, interdisciplinary conferences, infectious diseases grand rounds, evidence-based journal clubs, and basic science and clinical review sessions.
Peter Krueger Clinic
The Peter Krueger Clinic is an HIV primary care clinic with co-located mental health, dental, social, and specialty services, including dermatology, pain management, neurology, and ophthalmology services. The medical staff includes 6 HIV specialists and four Infectious Diseases fellows who together provide longitudinal care to over 1100 HIV-infected patients. The Peter Krueger Clinic represents a unique opportunity for outpatient elective and for clinical research.
Infectious Diseases Fellowship Program
The fellowship is a two-year program of clinical training, with 7 months devoted to the performance of a clinical research project. In addition to general infectious diseases inpatient consultations, there are rotations in transplant infectious diseases, infection control, sexually transmitted infections, pediatric infectious diseases, and the microbiology laboratory. Fellows follow a panel of patients in their weekly sessions in the Peter Krueger HIV Clinic and see other patients in monthly general infectious diseases clinic sessions.
Nephrology & Hypertension
James F. Winchester, M.D., FRCP (Glasgow), FACP, received his internal medicine and nephrology training in Glasgow, Scotland, developing clinical and research interests in poisoning and removal of toxins with dialysis and hemoperfusion. Dr. Winchester joined the staff at Georgetown University Medical Center, Washington, DC, in 1976, achieving tenure as Professor of Medicine (1987), as well as Chief of the Division of Nephrology from 1988-1994. From 2000-2004, he was Chief Medical Officer, RenalTech International, directing research into the use of sorbents in end-stage renal disease, inflammation and sepsis. His New York appointments include faculty positions at Albert Einstein College of Medicine, Downstate Medical Center and Columbia University. He was appointed Chief, Division of Nephrology and Hypertension at Beth Israel Medical Center in July, 2004. He has over 120 scientific papers, and over 250 total papers, reviews and chapters. He was editor of “Clinical Management of Poisoning and Drug Overdose”, and is currently Editor-in-chief of “Replacement of Renal Function by Dialysis.” He is past President of the American Society for Artificial Internal Organs, and was in leadership positions in the International Society for Peritoneal Dialysis, and the National Kidney Foundation.
The Division of Nephrology and Hypertension is recognized nationally as a leader in the refinement of state-of-the-art technology for both hemodialysis and peritoneal dialysis. Current active areas of research include dialysis kinetics, body composition, cytokine responses to dialysis as well as inflammation, and hemodynamics, examination of the dialysis process in the production of B2 microglobulin induced amyloidosis. Other research interests include the development of a new generation of hemodialysis machines that automatically adjust blood flow, temperature, on-line solute clearance and modify the concentration of dialysis chemicals. A major interest of the division is the treatment of renal osteodystrophy with new calcium receptor sensitizing agents. In addition the division has a clinical research laboratory on site at BIMC. This laboratory supports the cytokine and chemokine studies being performed by the division in collaboration with both the Renal Research Institute and other divisions in the Department of Medicine. The residents are encouraged and mentored during their research experience, and are given the opportunity to attend and present their findings at national meetings.
The Residency Experience
The nephrology and hypertension division offers comprehensive training in all aspects of nephrology, including hypertension, transplantation, renal biopsy performance and interpretation, acid-base and electrolyte disorders, statistics and clinical trial design, clinical and bench research, acute renal failure as well as hemodialysis and peritoneal dialysis for end stage renal disease (now called chronic kidney disease (CKD) – stage V). Training specifically addresses the 6 competencies of medical training, as required by the Accreditation Council for Graduate Medical Education (ACGME). Inpatient experience for the resident is at Beth Israel Medical Center (BIMC) Petrie Division, where there are significant numbers of admissions of new-onset end stage renal failure as well as acute renal failure related to patients in the medical, cardiac and surgical intensive care units. The rich clinical environment at BIMC is conducive to the rapid acquisition of knowledge in clinical nephrology.
Clinical experience with dialysis is gained from the management of patients receiving hemodialysis at two large outpatient facilities, one located on the lower east side of Manhattan (Irving Place Dialysis Center) in proximity to the Petrie Division, the second on the upper east side of Manhattan (Yorkville Dialysis Center). Peritoneal dialysis experience is gained by rotation to Long Island College Hospital, Brooklyn, where Dr. Paul Fein has the largest ambulatory peritoneal dialysis unit in the New York Metropolitan area. Transplantation experience is gained at Montefiore Medical Center, Bronx, where Dr. Daniel Glicklich has a large group of kidney transplant patients. Continuity clinical experience is gained at the Phillips Ambulatory Care Center in proximity to BIMC, and the Irving Place Dialysis Center, where the residents see their own group of patients through the training years, supervised by the nephrology faculty.
The hemodialysis program is a unique experience for the residents as a result of the expertise of our faculty and our relationship with the Renal Research Institute. The Renal Research Institute is an organization designed to promote the highest caliber of care based on advanced clinical technology and is committed to research and innovation that will lead to improved patient outcomes and quality of life. Dr. Nathan Levin, the medical and research director, is an international figure in the field of dialysis, and has published hundreds of articles and peer reviewed papers. Major publications by the Renal Research Institute since its inception in 1996 along with divisional faculty members have resulted in changes in the practice of dialysis. Nephrology fellows and Beth Israel medical residents may participate in RRI projects.
The fellows and faculty are involved in research in various aspects of nephrology including, treatment of poisoning, all stages of CKD, acute renal failure, hypertension, bone disease, anemia and dialysis.
Teaching is bedside-oriented and based on the application of physiological principles to the analysis of clinical phenomena. Teamwork is stressed, with physicians working closely with nutritionists, nursing staff, technicians and social workers to deal with all the medical, social and psychological problems of the patient with end-stage renal disease. Scheduled conferences include a “Teaching Day” with rotating journal club, renal grand rounds, renal biopsy conference, research conference and a separate clinical case conference presided over by Dr. Winchester and Dr. Feinfeld and members of the attending staff. Visiting professors from other institutes frequently give lectures and describe their research experiences. Members of the division collaborate closely with other subspecialists, allowing for a coordinated and multidisciplinary approach to the wide variety of diseases and disorders to which end-stage patients are susceptible.
Pulmonary Disease, Critical Care and Sleep Medicine
Dr. Patricia Walker is currently the Interim Chief, Division of Pulmonary, Critical Care and Sleep Medicine. A specialist in Cystic Fibrosis among other areas, Dr. Walker leads a Division with clinical, teaching and research arms.
Research within the division covers clinical pulmonary physiology, pulmonary and critical care complications of HIV infection, emergency endotracheal intubation, thoracic and critical care ultrasonography, arterial and central venous catheter insertion, quality improvement in critical care units, respiratory monitoring, computer simulation in training, sleep medicine and related disorders, and pulmonary arterial hypertension.
The Residency Experience
Residents rotate through the medical ICU during all three years and are responsible for management of critically ill patients under the supervision of full-time certified intensivists along with a pulmonary and critical care fellow, both of whom are present in the MICU for the entire day. Multidisciplinary rounds by members of the division are held daily in the 16-bed unit MICU.
Residents also rotate through a 6 – 12 bed respiratory special care unit that focuses on care and weaning of patients on prolonged mechanical ventilation, typically after care in one of the ICUs. In addition, residents have an opportunity to participate in the Pulmonary Consultation elective rotations on this popular service. A Sleep Disorders Laboratory is available on site and run by the division staff.
An outstanding and enthusiastic faculty offers a program of training in the diagnosis and treatment of a wide variety of pulmonary diseases, critical illnesses and sleep disorders. A series of conferences cover topics that include pulmonary radiology, pathology and physiology. Residents on elective participate in consultations and are trained in indications for procedures such as bronchoscopy, pulmonary function testing and cardiopulmonary exercise testing.
Members of the Pulmonary Division provide state of the art simulation training for the house staff. All interns are trained in CPR and bag-valve mask ventilation. PGY-2's are trained to lead both Code and Rapid Response Teams via real time videotaped simulation scenarios. Personalized video review and feedback is conducted for each house officer with a pulmonary attending and a fellow.
Harry D. Fischer, MD, heads the Division of Rheumatology. Dr. Fischer was one of the first rheumatologists to describe the rheumatic manifestations of HIV infections. Additional clinical interests include systemic lupus erythematosis, rheumatoid arthritis, vasculitis and Lyme Disease.
Paula Rackoff, MD, has a particular interest in women's health. She is a principal investigator for the Women's Health Initiative. Beth Israel Medical Center is the Manhattan site for this NIH-funded study. Her other area of interest is osteoporosis, and she serves on the board of a major osteoporosis journal. Residents on rotation have the opportunity to evaluate, diagnose and help manage patients with rheumatic diseases. The underlying disease mechanisms as well as the multi-system nature of rheumatic conditions are emphasized. Physicians see patients in both an inpatient and ambulatory setting.