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House Calls

July 16, 2001

Judith Zwolak
tulanian@tulane.edu
Michael DeMocker

Regina BenjaminIt wasn't the financial accounting or organizational behavior classes that most challenged Regina Benjamin (B '91) while she studied for her master's of business administration degree at Tulane a decade ago. What really baffled her was the concept of creating wealth.

"The accounting classes weren't that bad because I had had math and knew some of those principles," says Benjamin, who was a young family physician six years out of medical school when she started the Tulane Executive MBA program in 1990.

"But the idea of creating wealth--I didn't understand that. What do you mean creating wealth? Either there's wealth or there's not."

A natural disaster seven years after her graduation finally brought home the lesson. As Hurricane Georges ripped through the Gulf Coast in September 1998, the building that housed Benjamin's medical practice in the tiny coastal town of Bayou La Batre, Ala., became one of its victims. Five feet of water invaded her Bayou La Batre Rural Health Clinic, while waves from the storm knocked over the refrigerator and heavy diagnostic devices.

After the storm, she could not salvage one piece of medical equipment. For legal reasons, the clinic kept the 4,400 patient charts, mostly unreadable clumps of wet paper. Benjamin, the only doctor in the small fishing village of 2,500 made famous by a mention in Forrest Gump, thought she had lost it all. "I sent out letters to my patients telling them that we didn't have a building anymore, and they would have to get a new doctor," she says.

"But my practice didn't fall apart. It still existed regardless. People showed up in the emergency room where I was working and I visited patients in their homes. Even though I didn't have a building, the entire practice stayed intact." 

Only now reopening the building that will serve as the physical embodiment of her practice, Benjamin says she finally comprehends what her professors tried to drill home in business school. "I understand that 10 years ago I created something that wasn't there before, that was an entity that didn't need a building," she says. "That was a hard concept for me when I was in school and I really didn't understand it until Hurricane Georges. Then I thought, 'Now I know what they meant at Tulane.'"

A conventional measure of wealth comes in the form of dollars and cents, but Benjamin's yardstick seems to gauge a different type of affluence. Doctoring the working families of her native South Alabama was a choice she made not on the basis of possible income, but on the desire to provide her medical services where they were most needed.

In the process, she's made a name for herself on a national level, becoming the first African-American woman to be elected to the American Medical Association Board of Trustees, serving as a medical school dean and reaping accolades and awards from organizations throughout the world.

Over the years, the national media also has noticed her work. Benjamin was featured in a New York Times article, "Angel in a White Coat," was named "Person of the Week" on ABC's "World News Tonight," and Time magazine called her one of the "Nation's 50 Future Leaders Age 40 and Under." Not bad for someone who didn't consider a medical career until she was in college.

Benjamin was born in 1956 and grew up in then-rural Daphne, Ala., now a suburb of nearby Mobile. She was a good student from a working class African-American family. As a child, she had little contact with the medical profession. "I didn't see many physicians at all," she says. "I didn't see a black physician until I got to college. I didn't grow up thinking I was going to be a physician. It just wasn't in my thoughts."

She headed off to college at Xavier University in New Orleans, initially planning to become a pharmacist. Joining a pre-med club altered her plans, and Benjamin went on to enroll in the second medical class of the new Morehouse School of Medicine in Atlanta, which was then a two-year program. She finished her second two years at the University of Alabama School of Medicine in Birmingham and graduated with a medical degree in 1984.

Benjamin's introduction to rural health came after graduation, when she fulfilled her obligation to the National Health Service Corps, the federal program that provides medical education scholarships in exchange for a graduate's service in an area where other physicians have chosen not to go. After her residency at a family practice in Macon, Ga., Benjamin traveled back to the Gulf Coast of Alabama to fulfill her three-year commitment and worked in a practice in Irvington, about 10 miles from Bayou La Batre.

Benjamin's clinicAlthough her scholarship dictated that she would start her medical career in an underserved area, Benjamin says she likely would have worked in a rural area regardless. "I just like this type of medicine," she says. "I've always had this strong social conscience and sense of social responsibility."

In 1990, Benjamin started her own practice in Bayou La Batre, a town without any doctors in an area where about 60 percent of the working population, mostly self-employed in the seafood industry, has no health insurance.

Making ends meet required moonlighting in emergency rooms and nursing homes at night and on the weekends. Her own practice remained her chief devotion, however, due especially to the connections she developed with her patients and their families.

"I like getting to know my patients and making a difference in their lives," she says. "The little things: the hugs, the smiles. They are very precious. It's very rewarding to tell a mother that her child is going to be OK or to sit with someone and help them through a major illness or difficulty." These personal relationships with patients can also lead to some of the most frustrating times in her career, she says. After counseling a patient for years to quit smoking, Benjamin will find herself in the emergency room tending to his stroke. Or she'll prescribe a medication to a patient who can't afford to fill the prescription.

"These are the issues that got me involved in organized medicine," she says. "These are the problems that take more than a prescription pad to solve." Benjamin calls her participation on local and national organizations her "fun stuff."

Serving as a board member of the AMA, state and county medical societies and organizations such as the Kaiser Commission on Medicaid and the Uninsured is a way to take her concerns and add her voice to the national debate on health care and public health. She speaks for her patients, the working class, poor and elderly whose problems with health-care access and affordability rarely receive attention.

In the 1990s, long before it became part of last year's presidential election campaign, Benjamin was promoting such issues as prescription drug coverage for the elderly through Medicare. "This was a major issue for me and I'm happy that it's now being talked about," she says. "Five or six years ago, it wasn't on people's minds. I saw patients choose medicine over food--people who have worked all of their lives and had a Medicare card but still couldn't pay for medicine."

Benjamin is also a strong believer in the power of education to prevent future health problems. Through the AMA, she has worked on programs to promote the use of bicycle helmets and seatbelt use, but she remains most passionate about tobacco. She never misses a chance to counsel her patients on the dangers of smoking. "My mother smoked all her life and she died from lung cancer," Benjamin says. "Whenever I get a chance, I tell people not to smoke. But, unfortunately, my young patients are taking it up now. These are public health issues that we have to deal with."

Another critical health-care issue Benjamin has focused on is 44 million people without health insurance in this country. As one of 15 commissioners on the influential Kaiser Commission on Medicaid and the Uninsured, she has helped bring the issue to the attention of politicians and the media. "Our group has put out a lot of information on the uninsured," she says. "A lot of research went into coming up with that 44 million number, and I think it's making a difference. We've given legislators the facts and the numbers to support the case that we have a lot of uninsured people in this country."

Her practice, where more than half of her patients are uninsured, gives Benjamin firsthand knowledge of the problems faced by those without health insurance. "The very, very poor have Medicaid, but it's the people who work who are in trouble," she says. "The premiums are fairly high in our area, about $1,200 a month for a family. That's their whole paycheck or more. And they're working in the fishing industry, so insurance companies won't sell to them because they're high risk."

Benjamin will travel in her pickup truck to patients' homes to examine them and perhaps prescribe medicine--not expecting anything more than a hug or a plate of food for payment. But when this patient is hospitalized or needs diagnostic tests Benjamin can't provide, the lack of insurance becomes a major hindrance to getting the care he or she needs. "A lot of the uninsured are just hoping that nothing bad happens," she says.

Through her personal practice and advocacy work, Benjamin sees no easy solution to the problem, but hopes for a nationwide movement to provide universal health access for everyone in the country. "I think there certainly can be a minimum benefit that everyone could have and then you could buy more on top of that if you wanted it," she says. "It can't just be a government program. It has to be something that everybody is a part of--government, private industry, individuals."

Dr. Benjamin and a patientShe cites the Children's Health Insurance Program, a federal- and state-sponsored program that aims to provide insurance to all uninsured children in the country, as a step in the right direction. "Now, we need to cover the parents of those children," she says. "If we do that, we've come a long way toward providing universal coverage."

Benjamin says physicians have a duty to lead on this issue and advocate for a resolution to the challenge of providing health insurance for all. "It's part of the obligation of being a good citizen, being a good physician, to get involved," she says. "It's a way to make a difference."

As associate dean for rural health at the University of South Alabama College of Medicine, a position she recently left to focus her attentions on her practice, Benjamin has also noticed disturbing trends in access to health care in rural areas.

"Universal health care is not the total answer. You can have an insurance card and nowhere to go," she says. "I haven't seen rural hospitals close in the last year or two, but they're threatening to because they're facing such difficulties. And a lot of rural physicians are either retiring or closing their practices because of the time and money pressures associated with managed care. That's certainly decreasing access."

These are the reasons she continues to take on more "fun stuff," joining national and local boards and committees and letting her voice speak for her patients' concerns. It's a task she might not have felt as comfortable taking on without her business degree. "My MBA has really helped me on all those boards I serve on," Benjamin says. "I'm able to read a balance sheet much more easily and understand investments and planning. I don't know if I could have been as good of a board member or contributed as much if I didn't have the MBA."

When Benjamin opened her own practice in Bayou La Batre, the young doctor was a confident clinician with six years of doctoring under her belt and a devotion to her new patients who desperately needed a local physician. She moved into a small building and set to work designing the space. Her first meeting with an office supplies salesperson taught her how little she knew about the business side of medicine.

"He asked me where I was going to put the Xerox machine and my charts," Benjamin says. "I hadn't even thought about it. I had only thought about the clinical side. I decided I really needed to know something about business, particularly due to the fact that I had patients that I couldn't make pay what they didn't have. I had to find ways to be more efficient and to deliver health care in the most cost-effective way."

A brochure from the Executive MBA program of the A. B. Freeman School of Business arrived in the mail, and Benjamin applied and was accepted into the 18-month, intensive program. In January 1990, she began making the two-hour drive from Mobile to New Orleans every other weekend to take classes and meet with her study group. "It was a great experience," she says, "but it was pretty intense."

Started in 1983, the Freeman EMBA program is designed for mid- and upper-level managers who want to earn an MBA without interrupting their careers. Students move through the 24-course program as a group, meeting in class on alternate weekends and gathering in assigned study groups at other times.

"As opposed to the full-time MBA program, this program is designed more for executives and focused more on strategy and decision-making," says John Trapani, senior associate dean of the business school and professor of finance.

Trapani, who has taught in the program since its inception, says students such as Benjamin, who come to the program with a wealth of personal experience and a desire to learn more about business, rarely have problems with motivation. "You never have to explain to the executive students why something is important," Trapani says. "They really understand and appreciate management education because they see the applications of it immediately, whereas regular MBA students typically have less experience and sometimes a faculty member will have to motivate the topic."

The program also is designed for students to learn from each other through their participation in study groups, case studies and group projects. Trapani's description of a typical situation in the executive program almost sounds like the setup to a corny joke. "You may give a finance case to a group where you have a Catholic nun, an engineer, a cardiac surgeon and a business entrepreneur," he says. "You get some very different perspectives on how to come up with a solution."

Rob Hailey (B '91), a business-school classmate of Benjamin's who later became assistant dean and director of the EMBA program from 1993 to 1999, says learning from fellow students is one of the strongest draws of the program.

"To be in the same room with Dan Packer, president of Entergy-New Orleans, or Ray Nagin, president of Cox Communications, you learn a great deal about how to operate a business the way they would and their viewpoint," he says. "But you also learn a lot about yourself, in terms of your strengths, your weaknesses, how you fit in."

Hailey, now associate vice president for auxiliary services at Tulane, says he focused on recruiting students from different fields when he directed the program. "It was difficult because New Orleans is a big petrochemical community, so engineers usually make up the bulk of the students," he says. "But nearly every year there is at least one physician, and they are usually great students. They are very curious about learning a whole new way of thinking, and obviously they are smart enough to grasp it."

Students at the beginning of the program tend to label themselves as number-crunching "quants" or people-oriented "poets," he adds. "One alum told us that at the start of the program the quants were thinking like quants and the poets like poets, and at the end of the program the quants were thinking like poets and the poets were thinking like quants," Hailey says. "I think that if you can have an employee who can do both of those things, your company is always going to do well."

Somewhere between a quant and a poet stands Regina Benjamin, who admits that the going got rough near the end of her 18 months in the EMBA program. The long drives to New Orleans and Baton Rouge, where her study group met, and the demands of her practice nearly led her to quit. "I had gotten the concepts I needed and I didn't really need the degree, but my study group pulled me through," she says.

The first task she took on after getting her degree was converting her practice into a rural health clinic, a federal designation that made it easier for her to bill for her services under certain federal health programs. Completing the conversion herself and avoiding the cost of an attorney allowed her to plow more money into her practice, something she says she couldn't have done without her business degree. Currently, she is researching how to make her practice a non-profit organization, a unique designation for a medical clinic.

"I haven't come across anyone who has done this yet," Benjamin says. "If this works, I have to make the decision that if the practice ever becomes profitable it won't be my profit, it will be the organization's profit. To me, that's fine. If there is a profit, it should be reinvested into the clinic anyway. But I don't know if everybody would want to do that." Benefits of non-profit status include allowing Benjamin to apply for grants from foundations for her work in the community and to permit people who make donations to her clinic to deduct them on their taxes.

The work also continues on rebuilding the structure that houses her practice. More than two years after Hurricane Georges, Benjamin is busy shoring up a new office and looking forward to adding another physician to her current staff, which currently consists of a nurse and a receptionist. She also likes the notion of introducing Tulane business students to her practice and hopes to offer them a chance to "rotate" through her clinic and perform research projects delving into the business side of medicine.

In addition to her various jobs and her medical advocacy work, she serves on other community boards such as the Deep South Girl Scouts Council, finally fulfilling a childhood dream to be involved in the organization. Benjamin lives in her hometown of Daphne near her extended family and is "still looking for Prince Charming" to find her between meetings, house calls and clinic activities.

Claiming she never regrets her decision to work in rural health care, Benjamin says her friends from medical school who work in more affluent communities also face monetary challenges in their practices. Few, however, would likely go to the lengths Benjamin has to treat her patients after the loss of her clinic two years ago--traveling to their homes to see them without hope of payment or insurance reimbursement.

"It would be nice not to have the financial challenges," Benjamin says. "But there are lots of rewards that are not necessarily financial--the hugs and the smiles and sleeping well at night and enjoying what you're doing. If you had to put a price on them, they're worth more than a $50 reimbursement check. It's not all for free. I get a lot out of it."

A former editor at Tulane, Judith Zwolak is currently working as a free-lance writer in Magnolia, Ark. This article originally appeared in the Spring 2001 issue of Tulanian.

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