The perks of practicing medicine in Madison, WI.
The perks of practicing medicine in Madison, WI.

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Community profile: Madison, WI

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Madison Wisconsin

Cities sometimes pop up in strange ways, but few municipal birthings could be more unusual than Madison, which was named the Wisconsin territorial capital before a single building stood on the land.

The credit goes to James Duane Doty, a suave transplant from upstate New York who has been described by one historian as “one of the slickest grafters and lobbyists in early Wisconsin politics.”

By the time the first territorial legislature met on October 25, 1836, then in another town, Doty had bought some 1,300 acres of forest and swampland on an isthmus between two large lakes—Mendota and Monona—in central Wisconsin, naming his non-existent town for America’s recently deceased fourth president.

Dane Dances is an annual event created to help break down racial barriers and bring people of diverse backgrounds together.
Dane Dances is an annual event created to help break down racial barriers and bring people of diverse backgrounds together.
Dane Dances takes place at the Monona Terrace Community and Convention Center.
Dane Dances takes place at the Monona Terrace Community and Convention Center.

Sixteen communities vied to be the capital of the newly established territory, but Doty had an edge on all of them: He offered free plots for voting in favor of his non-existent city. Then, as now, enticement worked well. The first structure in the new capital, a log cabin, went up in March of 1837. At their first assembly in November, legislators found a dubious welcome, as described by historian H. Russell Austin in his book, The Wisconsin Story, published by The Milwaukee Journal, 1964.

Icy desks and seats, one fireplace, ink that froze and hogs in the basement was the setting of the new capitol. Delegates could see the hogs in the cellar below through holes between floorboards built with green wood that shrank as it aged. “When the legislators got sick of a long-winded speaker, one of them stirred up the hogs, which squealed down the speaker,” Austin reports.

Little did Doty know what a gold mine his land would become, the home not only of the state legislature but also the huge University of Wisconsin, a creditable number of major industries, and a center of superior medical care and research that includes three hospitals. UW Health is the hospital arm of the university, whose large related complex encompasses a medical school, research establishment, a network of clinics, a children’s hospital and a cancer center. Its transplant program is the third largest in the country.

Excellent facilities

Meriter Health Services represents a 1987 merger of the 1898 Madison General Hospital and the 1919 Wisconsin Methodist Hospital. Today Meriter, among its many services, is remodeling its birthing center. In 1989 it was the first of its kind in the state and now boasts the second highest number of deliveries from 3,000 a month in 1989 to 3,800 today. The new “flex space,” says spokeswoman Mae Knowles, “allows for continuing growth and better accommodations for moms no matter how their babies are born.”

In a recent “exciting stage of renewal,” operating rooms are increasing from 14 to 18. The design, says Knowles, is “rather unique.” Each OR complex is shaped like a racetrack.The ORs themselves line the outer “lane” and have windows on the world. The inner part of the “track” is a supply corridor. Cabinets are custom built to ensure that specific supplies can be delivered to each OR, even during surgeries.

Hip resurfacing, an innovative procedure now being done by one of the practitioners at Meriter Health Services, is attracting patients from around the country. An attractive alternative for athletes, the surgery involves inserting new sockets while preserving the bone structure. This allows young sports heroes, for instance, to return to their athletic activities with fewer, if any, complications.

“Building on a Vibrant Legacy,” a 10-year, $174 million upgrading project of St. Mary’s Hospital, was completed last year, with a new inpatient building incorporating a streamlined cardiac center, more patient rooms, improved surgical suite, and state-of-the-art imaging equipment. Two new tasks have been added for the OR’s DaVinci robotic surgical knife—performing partial nephrectomies and adrenolectomies.

St. Mary’s, which was founded in 1912 by eight German nuns from St. Louis, today offers 440 licensed beds with services of 466 physicians. It’s also part of a three-legged healthcare stool: St. Mary’s (hospital), Dean Clinic (doctor visits) and Dean Health Plan (insurance) that make up the Dean Health System.

The now ubiquitous Dean has grown from a minuscule practice opened in 1904 by Dr. Joseph Dean to a clinic that employs more than 500 physicians in every area of expertise except transplants, and an additional 4,500 employees at satellites in 33 cities throughout southern and central Wisconsin. It’s also among the pioneers in developing a hospitalist system. According to one of them, Ibuki Kimura, MD, “We have 17 doctors now, and only two have left. One was because of a promotion, and one moved out of town,” a tribute to Dean’s concerted retention efforts.

Outdoor fun

New doctors in town soon learn that residents exude Midwestern friendliness, and the legendary cold winters seem more like motivators than downers.

“I like winter,” testifies Anne Weiss, DO, whose practice is with UWMF Neurology. A former U.S. Navy doctor stationed in Pensacola, Fla., she is also a clinical associate professor of neurology at the University of Wisconsin School of Medicine and Public Health. “My husband complains that [the season] isn’t long enough. There’s excellent cross-country skiing in town, and my daughter and I like ice skating at night.”

The list of winter activities seems unending. Kimura cites cross-country skiing as “huge, huge, huge!” Kimura’s husband, a venture capitalist, takes it a big step further. Every year he joins thousands of other avid skiers in Hayward, about 300 miles north of Madison, to compete in the 50K Birkebeiner marathon, an American tradition since 1973.

It’s hard to live in Wisconsin without knowing about another perennial winter activity: ice fishing. In the capital city it takes place on Lake Mendota. “Shanties and shacks are all over the place,” reports Kimura, but, she says, “half of the entertainment is drilling the hole and sitting there” and waiting to spear any unfortunate sturgeon that might swim into sight. Not to mention the camaraderie with fellow spearmen and a swig now and then of good Wisconsin brandy.

On the other end of the spectrum, “I like to stay warm. I definitely enjoy summer fishing more than winter fishing,” says Kimura. “Every summer, by the end, we usually have a good couple of meals’ worth of bluegills,” she says. That means going for bluegills and walleye in the remote lakes of northern Wisconsin for some dedicated sportsmen, although the five lakes of Dane County make good “hunting” grounds themselves. In fact, water covers 19 percent of the county.

The watery ambience suits Justin Sattin, MD, very well. His preferred form of recreation is canoeing. “We live half a block from Lake Monona,” he says. “There’s a park, a playground and a beach there, so I can put the boat in at the lake. I’m looking forward to camping and hiking and traveling with the canoe.”

“Warm” is a word with great appeal for James Levin, MD, too. He’s the chief of infectious diseases with Dean, who focuses on HIV/AIDS patients, an interest he developed because early cases were discovered on his turf when he was in the UCLA San Fernando Valley Residency Program. “From an intellectual standpoint it was a fascinating disease,” he remembers, “and I was on the ground floor of a new disease process and management. Through the years I’ve seen the whole epidemic.”

But he got his start as a cheese head —slang for a Wisconsin native—growing up in Milwaukee, earning an undergraduate degree in Madison and an MD at Milwaukee’s Medical College of Wisconsin. “At that point,” he says, “I needed to get out of Wisconsin. I wanted to live somewhere warm.” That somewhere was California where he and his wife took their
three children to live. Yet after two years he was back in the Midwest with a fellowship at Chicago’s Rush Presbyterian St. Luke’s Medical Center. Despite the fact it meant giving up that California sun, “When a job opened at Dean, I said, ‘Yeah! I can live in Madison. We’ll see how it goes.’ And we haven’t moved since we came in 1993.” His fourth child was born in Madison.

Levin is a believer in adapting to one’s surroundings. He likes to use his medical partner, a Haitian, as an example. “When I recruited him, he came here in the dead of winter. There was a big snowstorm, of course. I told him the winters are very tough, but if you adapt to them you’ll be fine. Seven years later he’s still here. If you can handle the winters, you’re going to find a wonderful community.”

Levin’s version of adapting was to teach his entire family how to ski, which they do locally and in northern Wisconsin, where they have a cabin. “Northern Wisconsin is gorgeous,” he proclaims. “In summertime we have the lake, and in the wintertime we have the ski hill.”

Spring in the capital brings out the bicycle throngs—and the city is ready for them, big time! Whether it’s the long-cultivated spirit of preserving resources, like petroleum, or a heritage of healthy living likely inspired by German immigrants, biking has become what sometimes seems like the universal transportation of choice. There are more than 100 miles of bike paths and street lanes in the city, and it’s possible to circumnavigate Lake Mendota, 22 miles total, and Lake Monona, 12 miles. According to Levin, who lives 17 miles from work, “I could take my bike four miles to the Military Ridge Trail, just one of 11 designated routes. It connects to the Capital City Trail, which I can take all the way to my clinic.”

There is no surprise that cycling magazines have cited this as the number one bike-friendly city in America. In fact, an annual biking event practically shuts the city down. Multitudes turn out for Ride the Drive, characterized by its promoters as “car-free, carefree city streets—a celebration of anyone who wants to run, ride, skate, or stroll. This is a celebration of Madison’s commitment to healthy, active lifestyles.”

Ride the Drive has mushroomed into a full street festival, complete with bike decorating, a bike parade, music and food, including Oscar Mayer hot dogs from the company that’s been a city fixture since 1919. Another large area employer, the Trek Bicycle Corporation, with plants and offices in 15 countries, sponsors the bike “segment.” About 800 employees work in its nearby Waterloo plant. This year’s festivities have been scheduled for two days—June 6 and August 29, 2010. In August, Trek’s most famous protégée, Lance Armstrong, will lead the opening ride for the public.

On an everyday basis, local businesses place red-painted bikes throughout the city. Anyone is free to “borrow” one for transportation any day of the week, leaving it at his or her destination for someone else to use when needed.

Madison stats
Madison stats

A healthy future

Even with the healthy life commitment, there’s a growing need for health care, and Madison is well prepared, not only with physicians and hospitals, but also with a research behemoth, the University of Wisconsin. According to Lisa Brunette, director of media relations for UW Health, research at any given time often includes as many as 1,500 protocols.

Among current projects: (1) Tobacco researchers are trying to match ways to quit to characteristics of individual smokers, such as demographics, social class, age and ethnicity. (2) Sports medicine teams are studying rates of knee and ankle injuries to determinif ankle braces can prevent them. (3) In multiple sclerosis tests, researchers are administering solutions of worm eggs suspended in warm liquid as possible palliative measures for newly diagnosed patients.

A much different “experiment” quickly produced dramatic results. As the country’s third largest transplant center, UW Health experiences high demand for donor organs. Recently, the state launched an online donor registry. Within a week, 7,000 people had added their names.

Sattin signed on as medical director of the UW Health Comprehensive Stroke Program three years ago with a directive, among other things, to develop a more robust care system for stroke patients. “We’re on call for basically the whole state,” he explains. A native Philadelphian, he had been with the University of California San Diego stroke center.

The leadership opportunity in Madison was too tempting to pass up. “Most other  pportunities,” he says, “would have made me more of a soldier in someone else’s army.” Also enticing was the fact that his boss, who heads the neurology department, has been a friend for several years. Sattin himself was soon able to recruit two former San Diego colleagues to develop “a more robust system to care for stroke patients,” he says. Besides continuing research, he and his colleagues work to increase stroke awareness locally with programs labeled Folks Against Strokes. These include a 5K run, walk or wheelchair event in a local park, statewide lectures for hospital and nursing home employees, and various public programs.

The state capitol building illuminates the heart of downtown in February as it stands tall, lit for American Heart Month.
The state capitol building illuminates the heart of downtown in February as it stands tall, lit for American Heart Month.
The Overture Center for the Arts is a spectacular landmark in the heart of downtown Madison's thriving cultural arts district.
The Overture Center for the Arts is a spectacular landmark in the heart of downtown Madison’s thriving cultural arts district.

In a city where “green” is the color of preference, Sattin has joined the club by walking to work or taking a bus “if the weather’s bad. We sold one of our cars when we got here,” he says. “We went from putting about 30,000 miles a year total on the two cars to 3,000 a year on our one car. That’s a huge impact compared to Southern California.” He has other kudos for Madison, such as “a good place to raise a kid.” His own daughter is now a year and a half old. “The cost of living is a little lower than other places, compared to San Diego. We never would have been able to buy a home there,” he adds. “In San Diego the pay scale is lower, because everyone wants to live there. It’s a sunshine tax. Here, I can walk to the grocery store, the hardware store, to get a haircut. Yet it’s still a pleasant neighborhood.”

Although neither Sattin nor Kimura have children of school age, Kimura has developed an insight into educational quality in the city. Part of her status as a Harvard alumna involves interviewing students who have applied to her alma mater. “I see a lot of kids who come out of the Madison and Middleton school districts, and they’re all excellent students. They are all coming from a public school background. The public schools are good enough that you don’t need to do private schools,” she says.

An added serendipity for Sattin, he says, “We can walk to the farmers’ market on Saturday. My wife and I like that.”

The wildly popular market, held every Wednesday and Saturday on the capitol grounds, is yet another proof of residents’ commitment to nature. Some 300 vendors offer fresh vegetables, flowers and other items. Another long-time Madison “institution,” L’Etoile Restaurant, is among strong supporters of local growers. It features local, organic and naturally raised ingredients on its menus. It’s also been cited by Gourmet magazine as one of America’s top 50 restaurants.

Sattin’s observations add punch to the city’s claim of its commitment to sustainable living and environmental responsibility, both dating back decades to the influence of such Madison leaders as Aldo Leopold, father of wildlife management, and Governor Gaylord Nelson, principal founder of Earth Day, who also engineered acquisition of some 600,000 state acres of land for parks, forest recreation, wildlife habitats and fish management lands, among other preservation actions. The number of “green” meetings in the city in the last 10 years is also illustrative. It includes such groups as wetland scientists, water quality monitors, fish and wildlife agencies, landscape ecologists and even the International Ecotourism Society.

You could say Madison’s spirit of environmentalism was sparked by the rise of the dynamic Robert M. LaFollette, Sr., a.k.a. Fighting Bob. He appeared on the state’s radar in 1880, when he flaunted the “invincible” lumber barons and their cohorts by winning an election for Dane County district attorney. He believed that “for the first time really in our politics, money has taken the field as an organized power,” and was determined to take it back for the people of Wisconsin. He became governor for 14 years, setting progressive policies carried out by 15 successors, one of which was his own son.

Using his gubernatorial influence, he ushered in reform measures previously unthought of, such as establishing a direct primary, a railroad commission as well as rate regulation, a state civil service, and a graduated inheritance tax. He would probably be pleased with some current unusual services offered by today’s city government.

Two years ago, Mayor Dave Cieslewicz established the Pothole Patrol so that residents could call in reports of streets damaged by ice and snow. The patrol promptly fills in the holes. The police department has added new dimensions to crime prevention, including what public information officer Joel DeSpain calls “report cards for cars in parking lots.” Patrol officers check cars for tempting articles easily seen in them, then place warnings on the windshields suggesting that drivers hide valuables in their trunks. Perhaps most of all, a reincarnated Fighting Bob would believe that the Dean health organization is an extension of his Wisconsin dream.

In fact, CEO Craig Sammit, MD, believes that “the recent health reform debate has underscored how well positioned organizations like Dean are to make a difference. Dean’s focus, especially because we are so integrated, has been for years all about value to the patient—better care at a lower cost. Our concentration on good care, service and finding opportunities for efficiency and improvement are highly consistent with where we think the health care system is going to get.” He compares Dean to such similar U.S. groups as Mayo, Cleveland, Geisinger and Kaiser. “We’re skating where the puck is going to be,” he says.

Dean’s staff organization is also appealing to physicians —and designed to retain them. The business setup makes every practitioner a shareholder and an active participant in decision-making. Doctors are the predominant members of the board. “And we listen to physicians about opportunities to do better, as well as provide support in staffing, training and management,” adds Sammit. As for patient care, “We want to give physicians the tools they need to do their jobs,” including full implementation of electronic health records.

The organization, he adds, also invests “a great deal in physician recruitment and physician orientation.” Good news for job seekers. The other good news is that, for several reasons, the need for medical care is growing in the Madison community.

Sattin is one among many satisfied participants. His sentiment about work, activities and general atmosphere is succinct—three little, but potent,
words: “We’re thrilled here!”


Eileen Lockwood

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