As many longtime Westchester residents can attest, “a doctor in the city” is historically where we’ve turned when the diagnosis is dramatic. Mine is a family with 30 years’ worth of life in Chappaqua, and we’ve received wonderful medical care close to home. But whenever a crippling injury or something serious came up, we’d inevitably find ourselves tearing down the Saw Mill Parkway, looking for a physician affiliated with a Manhattan teaching hospital.
Yet, over the past several years, there seems to have been a sea change in the Westchester medical scene. Local hospitals have teamed up with highly regarded medical centers in the city, and big names from Manhattan are spending at least some of their time in suburban offices.
So, the question is: Has the supremacy of Manhattan medicine become a thing of the past?
“If a patient has had a pre-colonoscopy prep, they really don’t want to be driving into Manhattan for an hour, dealing with traffic and looking for parking.”
—Dr. Shireen Pais, gastroenterologist at NewYork-Presbyterian Hudson Valley Hospital in Cortlandt Manor
According to a large and varied cross-section of suburban physicians, patients, and hospital administrators, the answer seems to be a resounding “yes,” although there is a variety of opinions on what has caused this change and how far it actually goes.
One clear reason for Westchester’s improved health services are the partnerships that have formed between community hospitals and large medical centers, such as Montefiore Health System, NewYork-Presbyterian, Yale New Haven Health, Northwell Health, and Memorial Sloan Kettering.
Dr. Peter Semczuk is the senior vice president and executive director of two Montefiore Health System campuses in the Bronx and has been intimately involved with the expansion of Montefiore Health into Westchester. A New Rochelle resident, Semczuk reports that in the past five or six years, he has noticed a dramatic increase in the number of Westchester residents looking to have local medical care. “Healthcare should be local,” he says, adding that “for years, patients from Westchester were bypassing the Bronx and going straight to Manhattan for their medical care. We realized that if we could build a major health system in the Bronx, we could replicate it in Westchester.”
Along with an extensive network of physicians, Montefiore is affiliated with four local hospitals: Burke Rehabilitation Hospital, Montefiore Mount Vernon Hospital, Montefiore New Rochelle Hospital, and White Plains Hospital. According to Semczuk, the key to attracting both patients and well-regarded physicians is being connected to the Albert Einstein College of Medicine. As he explains: “Highly regarded doctors want to be associated with research and a world-class medical school. They want to be part of an organization that has the expertise and resources to conduct research, offer clinical trials, and improve the quality of care available to patients.”
photo courtesy of Montefiore health system
“We realized that if we could build a major health system in the Bronx, we could replicate it in Westchester.”
—Dr. Peter Semczuk, SVP and Executive Director of two Montefiore Health System campuses
Being connected to a large teaching hospital is also an integral part of the appeal of Greenwich Hospital, which is affiliated with Yale New Haven Health. “I don’t think there are many stand-alone hospitals left in Westchester,” says Norman Roth, CEO of Greenwich Hospital, which despite its Fairfield County address draws 54% of its inpatient population from Westchester. According to Roth, “Greenwich Hospital has expanded and elevated its services across a broad spectrum of specialties,” including oncology, stroke treatment, neurology, endocrinology, and orthopedics.
Roth has seen a dramatic change in the attitudes of suburban patients in terms of where they go for healthcare. “Suburban hospitals are elevating their level of care; they have improved their services and facilities while recruiting high-caliber doctors,” he says. The hospital has many highly regarded physicians — there are many new physicians who are full-time Yale faculty members who spend one day a week at Yale New Haven Hospital, where they can refine their techniques while staying in touch with research and clinical trials. This practice, says Roth, “enables many Greenwich-based physicians to offer the same level of care one would expect to find in any academic hospital.”
photo by Ken Gabrielsen
“The majority of doctors who work for CareMount have NYC and Ivy League training and choose to work in Westchester for the quality of life offered.”
—Dr. Lisa R. Bardack, Chair of the Department of Internal Medicine and the Medical Director of CareMount Medical
But hospitals aren’t the only place to find high-quality medical care in the suburbs. With major campuses in Mount Kisco, a newly expanded 40,000 sq. ft. location in Yorktown, and offices in NYC, CareMount Medical is the largest independent multispecialty medical group in New York State, providing care to at least 640,000 people in more than 45 offices throughout the region. Dr. Lisa R. Bardack, chair of the department of internal medicine and the medical director of CareMount, believes that patients no longer find it necessary to go into Manhattan for high-quality healthcare.
According to Bardack, “Larger teaching hospitals in New York City have expanded into the suburbs, creating the perception among consumers that there really isn’t a distinction anymore in the care you receive in the suburbs as opposed to Manhattan. This has ended the bias Westchester residents previously had about the superiority of care elsewhere.” Bardack goes on to say that without the “Manhattan mystique,” patients can focus on simply finding the best physician, many of whom now practice in Westchester. “The majority of doctors who work for CareMount have NYC and Ivy League training and choose to work in Westchester for the quality of life offered.”
Dr. Daniel Wang is a highly respected physician who chooses to work in White Plains despite living on the Upper West Side of Manhattan. As the director of cardiac electrophysiology at White Plains Hospital, Wang performs cardiac procedures that were previously only performed in large teaching hospitals. One reason he left a Manhattan teaching hospital and came to White Plains was “to join a medical center on the way up,” and he credits WPH CEO Susan Fox with having a vision to “transform White Plains from a community hospital to a premier tertiary medical center.”
photo by John Vecchiola
“I’m finding that…people who had been putting off cardiac procedures because they didn’t want to deal with the city are now saying ‘Sign me up!”
—Dr. Daniel Wang, Director of Cardiac Electrophysiology at White Plains Hospital
Part of this transformation was the hospital’s investment in two new cardiac cath labs, advanced technology and equipment, and the addition of key personnel. Wang felt that these changes gave him the opportunity to “get onboard with something exciting and to help develop an electrophysiology program that was built from scratch.” Wang agrees that the classic thinking used to be that if you needed serious care, you had to go to the city. But, he says, “I’m finding that patients are thrilled not to have to go to Manhattan; people who had been putting off cardiac procedures because they didn’t want to deal with the city are now saying ‘Sign me up!’”
Lisa Rainey of White Plains is a patient who signed up for a catheter ablation with Dr. Wang in June of 2019 to treat supraventricular tachycardia, a debilitating condition that causes a very rapid heartbeat. Rainey appreciated Dr. Wang’s knowledge and kind demeanor, as well as his willingness to explain things thoroughly and take her concerns seriously. As she says, “Ten years ago, I would have immediately thought about going to Manhattan for this procedure, but I think I got better care in Westchester. I never felt like I was just one more person in a huge crowd of patients; it was much more personal care.”
Personal care — otherwise known as “the patient experience” — is often cited as a key reason patients prefer local hospitals, many of which are known for private rooms, upgraded food services, and attractive, up-to-date facilities. The patient experience is certainly top-of-mind at Greenwich Hospital, which recently received a Patient Satisfaction Score of 99% (for inpatients) from Press Ganey, a company that analyzes and reports on the performance of healthcare organizations. In addition, CEO Norman Roth leads a weekly meeting to discuss and address the feedback received from patient surveys. According to Roth, “Warmth is part of the culture at Greenwich Hospital; the patient experience is as important as the quality of care.”
“If you live in Westchester, there is no need to go to the city for the highest level of care.”
—Dr. Alice Police, Regional Director of Breast Surgery for the Western Region for Northwell Health in Westchester and a 2019 Castle Connolly Top Doctor
A positive patient experience is something Dr. Shireen Pais, a gastroenterologist at NewYork-Presbyterian Hudson Valley Hospital in Cortlandt Manor, strives for. In her practice, Pais recognizes that patients want well-versed and well-trained physicians, but they also want to have diagnostic procedures such as endoscopies and colonoscopies performed close to home, in a pleasant atmosphere. As she says, “If a patient has had a pre-colonoscopy prep, they really don’t want to be driving into Manhattan for an hour, dealing with traffic and looking for parking.” Pais also believes that while the overall healthcare quality in Westchester is better than ever before, patients still have the option of having surgery done at NYP in Manhattan and continuing with any necessary follow-up care or treatments at an NYP Westchester facility.
photo by Saadia & Maha Naeem
“I understand traveling to get the best care; we have patients who come here from North Carolina, Georgia, London, and Dubai.”
— Dr. Haroon Choudhri, neurosurgeon at St. John’s Riverside Hospital
Michael Fosina, SVP of NewYork-Presbyterian and president of NewYork-Presbyterian Lawrence Hospital, agrees with Pais’ assessment. “With three NewYork-Presbyterian Hospital campuses in Westchester County, residents have access to the number-five hospital in the nation [according to U.S. News & World Report], in their backyard. Our connections to Columbia Doctors and our state-of-the-art facilities make it possible for patients to receive the same specialized care they would at our major academic medical centers in Manhattan, with all of the familiarity and convenience of a community hospital.”
But just how high does the level of care go in Westchester? Can even the most serious illnesses be treated equally well in our own backyard?
When people mention “serious illness,” they are often referring to cancer, and a cancer diagnosis used to send people straight to Manhattan. Dr. Oren Cahlon is a radiation oncologist, as well as the deputy physician-in-chief of strategic partnerships for the Memorial Sloan Kettering. He sees patients in Manhattan, but as a member of MSK’s senior leadership team, he also collaborates with administrative and clinical teams across MSK, including the MSK Regional Network, which comprises its industry-leading facility in West Harrison. According to Cahlon, “Cancer patients are often scared and willing to do anything to get the best care. Patients frequently tell me they are willing to come to Manhattan for radiation, but I talk them out of it. People need to understand that they can stay in their communities and have less disruption of their lives. With very few exceptions, the same technologies, treatments, and access to clinical trials can be accessed locally.”
“With very few exceptions, the same technologies, treatments, and access to clinical trials can be accessed locally.”
—Dr. Oren Cahlon, Deputy Physician-in-Chief of Strategic Partnerships, Memorial Sloan Kettering
For some patients, receiving care close to home is not about convenience: It’s the only realistic way they can be treated. As Cahlon explains, “Cancer often requires a lot of treatment; you’re seeing surgeons, getting chemotherapy, as well as radiation that can require five weeks of daily treatments. It’s incredibly disruptive and difficult to commute on top of that.”
That level of disruption was not an option for Jacquelyn Chantel, a Yorktown Heights mother of two young children who was diagnosed with colorectal cancer when she was 38 years old. Faced with this diagnosis, Chantel recalls that “Some people, mostly older people, did urge me to get treatment in Manhattan.” But except for the surgery, which she had at MSK’s New York City location, Chantel was treated in West Harrison, which she describes as “wonderful.” She goes on to say, “Being treated in Westchester let me live my life in a normal way. Since I didn’t have a ridiculous commute, I could go to my kids’ functions and pick them up at the bus stop. The care was just as good as what I would have received in Manhattan.”
photo by John Vecchiola
“Anyone who would have sought out my services in Manhattan is getting the exact same surgeon they would have gotten in the city, just closer to home.”
—Dr. Sasan Roayaie, physician and surgeon, White Plains Hospital
Statements like those would not surprise Dr. Renee Garrick one bit. For more than 30 years, Garrick has been a clinical leader at Westchester Medical Center in Valhalla and today is the chief medical officer of the 10-hospital Westchester Medical Center Health Network (WMCHealth). Arguably, few have tracked the evolution of the county’s healthcare landscape more closely and for a longer period of time than she has, and from Garrick’s point of view, the Westchester region’s relative parity with its vaunted urban counterpart to the south is not only unequivocal but also nothing new.
“Since the 1950s, Westchester Medical Center has been providing state-of-the-art quaternary care [often an extention of tertiary care, it represents a very advanced and highly specialized level of healthcare service] for the citizens of the Hudson Valley,” Garrick says. “In fact, in the Hudson Valley region, we’re the only academic medical center that even provides quaternary care. We’re also the only Level I trauma center, as well as the regional head and only Level IV neonatal pediatric center for the entire Hudson Valley, stretching into Connecticut.
“Did you know,” Garrick adds, “that we are in the top five percent in the world for the number of cardiac transplants performed last year and that our outcomes exceed the outcomes of the Society of Heart and Liver Transplantation? So we not only do a lot of transplants, we do them very well. All of that world-class healthcare, and more, is available right here, in the Westchester region.”
Garrick, who is also vice dean of New York Medical College, WMCHealth’s academic affiliate, continued by pointing out that one of the most reliable barometers of a healthcare institution’s reputation and credibility is when other medical centers turn their patients over to it. A prime example of this, she says, is that “we routinely get called to tertiary care hospitals to transport their patients with right ventricular failure to our hospital, using our portable ECMO [extracorporeal membrane oxygenation] technology to save their lives. What’s more, I truly believe that we have an endovascular team here that may be second to none in the nation.”
In terms of overall numbers, Garrick states that Westchester Medical Center receives about 9,500 transfers from other hospitals each year — that’s one patient every hour of every day for 365 days. “So when I hear people say that you have to go to New York City for state-of-the-art medical care, I honestly don’t know what they’re talking about. They’ve been coming here all along.”
photo courtesy of WMCHealth
“When I hear people say that you have to go to New York City for state-of-the-art medical care, I honestly don’t know what they’re talking about. They’ve been coming here all along.”
—Dr. Renee Garrick, chief medical officer, WMCHealth
If those reasons weren’t enough for Westchesterites to address all of their healthcare needs locally, consider that for some patients, Manhattan physicians never show up on their radar to begin with. Dr. Haroon Choudhri, a neurosurgeon at St. John’s Riverside Hospital, reports that patients frequently travel to Yonkers from Manhattan so that he can perform their surgeries.
“My sentiment regarding the big-name centers is that not all physicians there are leading figures in their disciplines,” he says. “New patients are often diverted to recent graduates, who are building practices, not to the superstars, who are already busy.” Choudhri specializes in complex surgeries of the spine and is known for taking on surgical challenges, patients whom other surgeons have deemed “too old, too fat, too sick, or those who have had too many prior surgeries.”
Choudhri has developed strategies to care for these patients and says, “I understand traveling to get the best care; we have patients who come here from North Carolina, Georgia, London, and Dubai. The spine program we’ve developed at St. John’s Riverside is a destination for people looking for top-quality care.”
But while there is widespread agreement that Westchester medical services are more advanced and sophisticated than ever before, not everyone agrees that the highest level of care is available in the burbs. Dr. Arthur Klein, president of the Mount Sinai Health Network, believes that where patients go for treatment should depend on the level of service they require.
Says Klein: “There’s no need to travel to the city for less-acute issues, but some highly specialized services can only be provided in Manhattan most safely.” In addition to heart transplants, which are generally not performed in Westchester hospitals, Klein cites “open-heart surgery, specialized cardiac services, the highest level of neonatal care, and the most advanced cancer care” as some of the medical services he thinks patients should receive in Manhattan teaching hospitals or at academic medical centers elsewhere.
Klein goes on to point out that “U.S. News & World Report rates [more than 4,500] hospitals, and the top 20 are considered to be the ‘honor roll.’ Three out of those 20 honor roll hospitals are in Manhattan: NewYork-Presbyterian, NYU Langone, and Mount Sinai. These hospitals are very special, and what they offer is not going to be replicated in Westchester.”
photo courtesy of NewYork-Presbyterian Lawrence Hospital
“[O]ur state-of-the-art-facilities make it possible for patients to receive the same specialized care they would at our major academic medical centers in Manhattan, with all of the familiarity and convenience of a community hospital.”
—Michael Fosina, SVP of NewYork-Presbyterian and president of NewYork-Presbyterian Lawrence Hospital
While Dr. Michael Palumbo, EVP and chief medical officer at White Plains Hospital (which is affiliated with the Montefiore Health System), acknowledges that there are certain specialized services that are more commonly available in Manhattan than in Westchester, he points out that among Westchester hospitals, “there’s a range in the levels of care they can provide, and I think [White Plains Hospital is] different than the rest. We are equipped to do more complex things. Ten years ago, there were 500 members of the medical staff at White Plains Hospital; now there are 1,100. We are the only hospital in Westchester to be named a Best Regional Hospital by U.S. News & World Report. We are far from the sleepy community hospital we once were.”
What is safe to say is that cases don’t get much more complex or serious than those handled by Dr. Sasan Roayaie, a White Plains Hospital physician and surgeon who treats patients with complex liver, bile duct, and pancreatic cancers. When asked about Westchesterites’ perceptions of healthcare in the county, Dr. Roayaie, who previously worked at two large Manhattan teaching hospitals, responds by saying, “It’s hard for me to know the pulse of the public, but I’m treating the same conditions [here] I treated in New York City. Anyone who would have sought out my services in Manhattan is getting the exact same surgeon they would have gotten in the city, just closer to home.” As for the facilities at WPH, Dr. Roayaie says, “The ORs are nicer and better-equipped than what we had in the city. The hospital recently invested $500,000 in a guidance system to help destroy liver tumors in a minimally invasive fashion with high accuracy. There’s an investment in the facility and personnel to ensure that patients get the same outcome they would expect in a large medical center. And all things being equal, patients like to avoid large medical centers.”
But are all things ever equal when it comes to healthcare? Perhaps not, says Klein of Mount Sinai. “You can’t define healthcare globally as just one thing,” he says. Referring to highly specialized health services and those geared to a lower level of acuity, he adds, “There are two systems of health services, and they are complementary, not competitive.”
Ultimately, everyone seems to agree that healthcare is about providing the best services for patients and not about competing locales. Those of us who live in the suburbs may still seek out some medical services in Manhattan, but the consensus is that we need to do so far less frequently than we used to. With medicine, as with many other aspects of life, Westchester residents enjoy the best of both worlds: excellent yet constantly improving hospitals and healthcare close to home, with world-class medical centers an hour or less away. Though we’d all prefer never to need these services, we are nonetheless lucky to have them. All of them.
Susan Goldberg is Westchester-based writer and editor.