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By Jenna Johnson Washington Post Staff Writer Friday, December 7, 2007
St. Mary's County was once a place where no doctor wanted to settle. In the 1970s, the county hospital used decades-old equipment, struggled to make payroll and had no full-time specialists -- not even an obstetrician, although more than 600 babies were born there each year.
Then came Vinod K. and Ila Shah, Bombay-educated and D.C.-trained husband-and-wife doctors who were eager to open a practice in the rural area. They had heard about St. Mary's from Vinod's younger brother and were enticed by the potential impact that even a small practice could have there.
"It was just like miracle workers walked in," said Richard Martin, 92, who was then head of the hospital. "I told them, 'You are the answer to my prayers.' "
The couple was soon joined by Vinod's younger brother, Umed K. Shah, a gastroenterologist. Next came two family friends. A few years later, another brother arrived, cardiologist Anil K. Shah, with his wife, Beena Shah, a neurologist.
In time, Vinod and Ila Shah recruited more friends and family, including the rest of Vinod's eight siblings, each of whom is a doctor or is married to one. They built the largest private specialty practice in Southern Maryland, Shah Associates, which has treated about 90,000 of St. Mary's 110,000 residents.
For many years, foreign-born doctors have been the unlikely medical backbone of rural America. In the 1970s, the United States actively recruited them, promoting the opportunities available in remote areas avoided by many U.S.-born physicians. Then, starting in the 1990s, a visa waiver program promised to fast-track doctors to a green card if they worked in a rural area for at least three years.
Today, at least 23 percent of practicing doctors in the United States attended a foreign medical school, and almost all of those practitioners were born overseas. But recent changes in visa policy have had the unintended consequence of slowing the flow of foreign-born doctors to rural areas, a trend that Shah is, in small ways, resisting.
Two generations of Shah doctors see patients who span several generations of Southern Maryland families. "We come here for everything," Navy retiree Paul Hailor said at their main office in Hollywood, Md. "My fiancee is down the hall waiting for a pulmonary appointment. Kids come here for MRIs, CAT scans."
Nurses and patients have a system for keeping all of the Shahs straight. They use initials for the four Shah brothers: Dr. V.K. the cardiologist; Dr. U.K. the gastroenterologist; Dr. D.K. the child psychiatrist; and Dr. A.K., another cardiologist. The other Shahs, especially the four with names beginning with 'A,' often go by their first name: Dr. Amish the cardiologist, also V.K.'s son; his wife, Dr. Arpana the dermatologist; Dr. Beena the neurologist; Dr. Jyoti the sleep specialist.
"Every once in a while, we get someone calling in wanting to talk to 'Dr. Shah,' " said Betsy Warren, a registered nurse who has worked for Shah Associates for 16 years. "You ask them, 'Which Dr. Shah?' And they say, 'The one with dark hair.' "
To Southern Maryland, the Shah family has imported distinctive aspects of Indian culture: colorful saris, lavish parties for hundreds stocked with huge trays of vegetarian Indian food and recitals featuring classical Indian dances.
Family members say it took years to earn the trust of the community, but once they did, the practice quickly grew. Some local doctors who once viewed the Shahs as competition eventually joined the practice.
Each time the nearby Patuxent River Naval Base added employees, the practice received a wave of patients. The practice's offices, where employees had once been asked to park in front so business would appear brisk, were soon overflowing.
In 1995, V.K. Shah found an empty lot on Route 235 in Hollywood. Two years later, he opened the Philip J. Bean Medical Center, dedicating it to a late local physician who he said "delivered half the county."
"We said, 'Let's name it after someone who means something to this community,' " Shah said. "I think people should feel good about this place -- it should mean something to them."
But the facility that felt like a palace then is already too small, and the practice, with 65 physicians in 10 locations, is scrambling to recruit more doctors. "Demand is so high across the board," said Shah, 66. "I can't retire."
Plans were announced last week for a 32,000-square-foot addition to the medical center. The extra space will allow specialists from Georgetown University Hospital and Washington Hospital Center to practice there as part of a new partnership.
Because Shah Associates provides so much of the medical care in the region, the partnership will allow the universities to study health patterns over generations, said Leslie Miller, head of the cardiac program at both hospitals.
Shah Associates has compiled its patients' medical records into a database that allows it to track the medical histories of families and look for early warning signs in younger generations. Such locally comprehensive databases might one day help researchers better understand such hereditary conditions as heart problems, he said.
"They are a model of the health care of the future," Miller said. "These guys, on their own, using their own money, have put together this extraordinary system. . . . We want to extend what they have done."
But in many areas that are more rural than Southern Maryland, as in many inner cities, the gap between medical needs and resources remains great, despite government efforts.
In 1994, Congress made foreign doctors who train in the United States while holding a so-called J-1 visa eligible to apply for a green card if they practiced for at least three years in underserved areas. The program, which exempts J-1 holders from a required return home for two years after their training is complete, has placed thousands of doctors in inner-city and rural communities, as well as in prisons.
They continue to flood the United States with residency applications, but each year the program receives fewer applications and fills fewer spots. Last year, only 900 of the 1,620 available waivers were issued.
Rural health experts attribute much of that drop to the popularity of another visa, the H-1B, which allows U.S. companies to temporarily sponsor highly skilled foreign workers in such fields as medicine, architecture and science.
In 2000, to make more H-1B visas available for technology companies, Congress exempted research institutions and universities, including their hospitals, from a cap on the hard-to-get visas. The popularity of the J-1 waiver program plummeted, and the pipeline that once channeled doctors to underserved areas narrowed.
Today, no medical facilities in Southern Maryland are eligible to sponsor physicians under the J-1 waiver program. A majority of the nearly 30 Maryland primary medical care centers designated as having a specialist shortage are in Baltimore. The District has 13 sites, including the D.C. jail. Virginia has nearly 120, two of which are in the Washington area.
With baby boomers beginning to retire, the American Medical Association says, the country could be short as many as 200,000 doctors before 2020 -- a shortage that is expected to hurt already-underserved areas the most.
V.K. Shah, who is also vice president of the American Association of Physicians of Indian Origin, said a shortage could be prevented by drastically increasing the number of medical schools in the United States, relying more on nurses and nurse practitioners or by allowing more qualified international medical graduates to practice in the United States.
But to practice, foreign doctors must first complete training in a U.S. residency program, for which spots are scarce. Last year, 46 percent of foreign applicants received residencies, compared with 93 percent of American graduates, according to the National Resident Match Program, which facilitates the application process for more than 1,000 U.S. institutions.
Each year, Shah Associates hosts a handful of graduates from foreign medical schools, encouraging them to seek opportunities beyond big cities. This summer, four recent graduates of Mumbai medical schools traveled to Southern Maryland on tourist visas for an unpaid crash course in American medicine.
The graduates watched as the Shahs cracked jokes with their patients, reassured them about upcoming operations and gently recommended diet changes. Mitesh Lotia, 24, one of the graduates, said that the one-on-one interaction held great appeal.
"In India, we would see 100, 150 patients a day," he said. "There was no time to get to know patients. I want to practice here. I'll go anywhere."
President Obama and Dr VK Shah
Though his tenure as President of the American Association of Physicians of Indian origin (AAPI) comes to an end, Dr Vinod K Shah has plenty lined up to contribute to the organization, the community as well as the nations of his birth and adoption, India and the US, respectively.
Dr. VK Shah addressing the convention
A man of clear vision and motivated with the noble intent of touching and healing people’s lives – Dr. Shah’s life and mission are an example for thousands of doctors who take the Hippocratic Oath each year.
Bottom Row: Avni Shah, MD; Geeta Nayar, MD; Manish Shah; Parag Shah; Adarsh Gupta; Vipul Shah; Prakruti Shah; Parul Jani, MD; Bhargesh Mehta, MD; Chirag Parghi, MD
2nd Row: Suresh Patel, MD; Kiran Mehta , MD; Sharmila Mehta; Kiren Mathur; Krishan Mathur, MD; Ila Shah, MD; Neelam Shah; Vinod Shah, MD; Nayan Shah MD; Jayu Shah; Dhiren Shah, MD; Avani Shah, MD; Umed Shah, MD; Shakuntala Shah; Suresh K. Gupta, MD 3rd Row: Samish Shah; Nila Patel; Kirit Patel, MD; Sushila Shah; Tarun Mehta; Sanjib Mishra, MD; Rahul Jindal, MD; Shambhu Banik, MD; Suresh C. Gupta, MD; Pankaj Lal, MD; Rakesh Sahni, MD; Raj Samtani, MD; Pushma Samtani, MD; Bhasker Jhaveri, MD; Rita Jhaveri, MD; Beena Shah, MD; Anil Shah, MD; Arpana Shah, MD; Amish Shah , MD; Dhara Desai; Minal Shah, MD; Madhu Mohan, MD; Mahesh Chandra, MD; Anantha Rao, MD 4th Row: Kishor Shah; Amit Sheth, MD; Milan Sheth; Sheriar Demehri, MD; Anil Kankaria, MD; Sushil Jain, OD; Genny Demehri; Asha Jain; Pradeep Simlote, MD; Anu Simlote; Parvathi Mohan, MD; Madan Mohan, MD; Smita Patel, MD; Atul Shah, MD; Aruna Shah; Mukesh Mathur, MD; Nelson Benjers, MD; Naresh Patel, MD; Adinath Patil, MD; Sukatu Shah; Aruna Patil, MD; Raj Patel; Shalin Shah; Vidya Sagar, MD; Megha Sagar; Savera Sehgal; M.F.O. Lafeer, MD; Ajay Sehgal; Devendra Desai
On the occasion of completion of his one eventful year of fulfilled promises, Dr. Shah spoke with NRI Today and shared his views on milestones achieved.
"I had specific targets lined up to achieve during the year. The first was to make sure that we made enough funding available for
increasing the Residency slots for Medical students and communicate the need to the concerned authorities clearly," he says. Dr. Shah. In order to make that possible, he met President Barack Obama personally before the end of the first three months of his tenure and submitted him the document requesting increase in funding for the same. Increasing the participation of young physicians in AAPI was the second major agenda on hand. Hence he had a series of leadership seminars conducted throughout the years and recruited new AAPI members, doctors who were born and brought up in the US, the next generation of torchbearers who would take the mission and activities of AAPI forward. In this process he also got senior AAPI members involved at personal level to introduce and recruit the new members.
Dr Vinod Shah, Dr Illa Shah Dr Amish Shah standing in right Dr Arpana Shah, Dr Meena Shah and Dr Nick Khatri along with Sameer and Neelam
Third on his list was the idea of organizing a "robust convention" with maximum participation. "We gave incentive for early registration along with industry partnership program. And I am proud to say that first time in 28 years, we received full registration four months prior to the convention. More than 2000 members have already registered, which has never happened before," Dr. Shah says.
Next, the team under Dr.Vinod Shah’s leadership developed a theme for each day of the convention. So on June 23, the first day, they have a cruise along the Potomac river to promote the theme of "Friendship and Camaraderie" among its members. "We decided to have a ‘Unity in Diversity’ as the theme for day two. In India people live in harmony despite the diverse cultural backgrounds and our members are representatives of the same diversity. Hence to celebrate the same sentiment we will have cultural programs which will bring the best of all the states," says Dr Shah.
Ba and Dadaji
Day three of the convention is devoted to public private partnership events that will have leading personalities and White House Representatives speak.
"We have also invited the President but for security reasons we wouldn’t know until last few days if he will grace the occasion. We will take 550 doctors to the US capitol to have a dialogue and reception with the Senators and Congressmen," he says. These are just some of the firsts, which have and will take place in the history of AAPI.
Brothers, Sisters , Sister-inlaws and Brother-inlaws
During the year, Dr.Shah personally visited a list of pharmaceutical companies and initiated a dialogue to explore ways in which doctors, institutions and pharma companies could work together for the betterment of the community at large.
Life will continue to remain increasingly active for Dr.Vinod Shah even after the completion of his tenure. When asked how he plans to remain involved in the initiatives undertaken as AAPI president, he says, "The incoming President Dr.Ajit Singhvi and I have worked closely together. I had also organized a global health care summit in New Delhi where people from as far s Dubai, UK, Australia, New Zealand, Canada and the US had participated and the entire program was drafted by Dr.Singhvi. I will now be working with him on following the same line of thought process of increasing participation of young doctors. We are likely to add 2000 new members this year and plan to have another 1000 in the next year. We want to have a unified body by bringing the young doctors under the same umbrella."
Philip J. Bean Center
Mumbai office
Chartable Activity in Medical College
Earthquake Relief Work
View more Photos in PhotoGallery
The passage of the Health Care Reform Bill has given a boost to the health care sector and Dr.Shah believes most should be made out of the Accountable Care Organization provision where a group of physicians either come together as individual practice association or a large multispeciality group and find a relationship with a large hospital for a unique area. "It is a very strong provision for people to work together," he says. Secondly Dr.Shah wants more work to happen in the area of Malpractice Reform. "Currently the laws are set by individual states but not centrally. In USA litigation is common. That is one of the nightmares that all physicians face in a country where it is very easy to sue. The second problem is escalating costs – the cost of doing business is going up – and that includes malpractice insurance, health insurance, the benefits we give to our staff, salary and wages. So you have escalating cost and declining reimbursement, which is a double jeopardy. Also, the average doctor comes out with $130,000 – $150,000 debt that they have to pay off. So a lot of these factors can lead to people losing the passion that is so necessary to practice medicine.
Surgery in Rural Village
I honestly do not think that people go into medicine just for money. With the rigor of training, the amount of money that goes into education and practicing, there is a greater passion that is there. Due to the current system in the U.S., more and more physicians are retiring and telling their children not to go into medicine. This needs to be addressed effectively. Because if you take the incentive away of being a doctor, in the end it’s the people who are in need of care that ultimately suffer."
However, Dr.Shah believes that the US has the best health care system in the world. "Being doctors of Indian origin we have a very critical role to play between the two governments of India and America. Currently both the countries have best relationship in the last 30 years. I was fortunate to be at the First State Dinner, which significantly was in honor of Prime Minister Manmohan Singh and even President Obama is likely to visit India later in the year. It will further strengthen the ties. We as doctors are in a position to play goodwill ambassadors with our dedicated services and relationships, which we build with average Americans as well as the legislators. We need to cultivate relations beyond medicine."
And that’s the principle Dr.Vinod Shah and his wife Dr.Ila have lived by all along. This Maryland-based doctor couple has several firsts to their credit. At a time when no one was willing to move to the rural American county of St.Mary’s they decided to start a medical practice there. Despite being just 50 miles south of Washington DC the community was in acute shortage of medical specialists with not even a pediatrician to name. So the Shahs decided to work at St.Mary’s Hospital, where Richard Martin, head of the hospital at that time, described them as "answer to his prayers."
Feeling at home in Southern Maryland, Shahs along with brother Dr.Umed K Shah, a gastroenterologist initiated a group practice in 1974. Members from their extended family apart from friends joined in years to come and today the two generations of Shahs serve several generations of Southern Maryland families that account for a majority of the county’s 1,10,000 residents.
Of course the going wasn’t easy. The Shahs faced a lot of prejudice from the community initially and local doctors were hesitant to join them. With dedicated medical care and efficient management they could win over both. In mid-90s they consolidated much of their practice in a 60,000 square feet facility and named it Philip J Bean Medical Centre after a country doctor who practiced in the county for 66 years. "During those days there was a lot of discussion about gatekeeper concept where a primary care physician would direct a patient to specialist who would further decide what diagnostic care the patient needed. We thought it would be a good idea for us to develop a center of excellence instead where all kinds of specialties and facilities would be available under one-roof," says Dr.Vinod Shah. The concept proved successful and at present 90 doctors from 21 specialties work under the umbrella of Shah Associates across 14 locations.
In order to provide comprehensive clinic services the Shahs also set up a BPO in Mumbai where all the billing and recordkeeping is done electronically overnight. "President Obama wants to encourage use of electronic patient record by 2011 but we did it six years ago. Even though we are in a smaller area, we implemented electronic health records. When people were not even considering it, we invested a lot of money in order to have a connection to each office and electronic access to each patient’s record even from home. We are a very forward-thinking group and focus on identifying what’s going to make a real difference."
The Shahs are keen on focusing on disease management protocol where the doctors take advance care of patients. "In a traditional system you approach a doctor if you fall sick but in advance care doctors will focus on preventive health care," says Dr.Shah.
Born in Ranpur near Surendranagar and raised in Mumbai, Dr.Vinod Shah, a cardiologist, met Dr. Ila, a pediatrician at Seth GS Medical College in Mumbai. The couple came to US in 1967 to pursue further studies. When he came down, his immediate plan was to return to his home country after all of five years. But upon completing prestigious fellowships in internal medicine and cardiology at Georgetown University Hospital in Washington, D.C., Dr. Shah had a choice: either return to India or use the resources he had gathered over the years since his arrival to do something truly revolutionary in the U.S. Dr. Shah chose the latter.
Dr.Shah has been a member of AAPI from the inception. "When Dr. Kiran Patel was president, he had asked me to chair a legislative conference and it was one of the best legislative conferences put together by the group. We had 51 congressmen and senators and among our speakers were Senator
Biden, Bobby Jindal and Congressman Steny Hoyer. The conference really showed the ability for us to excite people and invite them to come and be a part of what we were organizing. There was a crowd of about 250 people, and the idea was for us to really show our involvement in the health care dialogue moving forward. Because of that effort we got a $500,000 grant from the U.S. government to study diabetes amongst Indians, which was yet another landmark."
So, what’s the best part about being a doctor, we ask before he signs off, "The best part is I think I’ve made a difference in the lives of many, many people. It’s the most rewarding field. When you care for people and you come through for them, and they tell you "You know doc, you saved my life," it’s an indescribable feeling. That is what is motivating us to be hardworking doctors. I am very fortunate with the grace of God that I’ve never faced litigation in my 30+ years of practice. That is the nightmare, if you do honest and hard work and someone questions your integrity. But the joy of medicine is so much more that everything else is not important."
Dr Shah lives in Mechanicsville, Maryland with wife Dr.Ila. His son, Dr.Amish is a cardiologist, daughter-in-law Arpana is a dermatologist. They have two children, Samir and Neelam. Dr.Shah’s daughter Meena is a cardiologist fellow at Georgetown and son-in-law Nimesh will be gastroenterologist fellow at Georgetown. All his brothers, brothers-in-law and sisters-inlaw are doctors and live in Southern Maryland. Their group now has 102 physicians and network of additional 350 doctors.
Lexingon Park, MD - 7/18/2011
By Dick Myers
Courtesy of the Baynet.com
He has been a family doctor for thousands of St. Mary’s County families for more than 50 years. Dr. J. Patrick “Pat” Jarboe’s contributions to the community were recognized on Saturday with the dedication of a new medical center named in his honor.