MERCER COUNTY’S COMMUNITIES are a study in contrast. Trenton, the state’s capital, is a diverse community struggling with its identity and economic instability. Just a few miles away but at the other end of the spectrum is the Princeton area, a wealthy collection of communities that claim identity with the erudite borough of Princeton. Both areas have challenging opportunities for physicians, each with a distinct flavor.
Although they are located midway between New York and Philadelphia, within an hour of all the cultural and economic opportunities of those two great megalopolises, Mercer County residents find local culture and economic opportunity aplenty. Trenton offers a symphony, minor-league baseball, and the New Jersey State Museum with its planetarium and woolly mammoth - an Ice Age resident of the Garden State. The city’s Little Italy in the Chambersburg district often attracts out-of-state diners.
Ivy-covered Princeton, with its historic university, provides residents with a wide variety of educational and entertainment opportunities, including the Tony Award-winning McCarter Theatre and Princeton University Art Museum. Quality education, both public and private, gives the local chamber of commerce something else to boast about: high SAT scores.
Business is booming in Mercer County. Merrill Lynch is building a new corporate headquarters in Hopewell and Shiseido Co. Ltd., a global manufacturer of skin-care products, is opening a facility in East Windsor. In addition, Bristol-Myers Squibb, Co. has its headquarters in Princeton.
Colonial and Revolutionary War history permeates the county, with a history lesson behind the name of nearly every township, borough, park, and street, and historic sites enough to visit for a month of Sundays.
Golf courses abound, as do natural areas. Mercer County has preserved 7,500 acres of open space and farmland, the result of an active preservation program funded since 1990 by a voter-approved open space preservation trust fund tax. This tax funds the preservation of recreational lands, a stream valley and greenways with public access, environmentally sensitive lands, and wildlife habitats. Most of these areas lie north and east of the Trenton urban area, with the exception of a fishing warf on the Delaware River.
Mercer County also is home to state park facilities such as the D&R Canal, Washington Crossing Park, Princeton Battlefield, and the Assunpink Wildlife Management Area. The county’s many playgrounds, ball fields, and path systems fall under the purview of local municipalities.
A big-picture look at Mercer County reveals that even though it’s across the Delaware River from Pennsylvania and
80 miles southeast of the Pocono Mountains, it’s also only 32 miles from the Atlantic Ocean.
"In terms of lifestyle, it’s very pleasant," says Michael L. Somerstein, MD.
Somerstein, a nephrologist, accepted the invitation of Helene Fuld Medical Center in Trenton to establish the first hemodialysis center in Mercer County in 1970. He came gladly, leaving behind a practice and the hemodialysis center at Philadelphia’s Hahnemann Hospital for the potential Trenton held.
"At that time, it was very exciting," Somerstein says. "There was the need for services, and there was room for expansion for a practice because it was a new field."
Besides, he says, with family in the area, it was a homecoming. Somerstein grew up in Trenton and left to attend college and medical school at the University of Cincinnati.
Somerstein, now age 60, a former president of Helene Fuld’s medical staff and current second vice chairman of the Board of Directors of the new Capital Health System, continues to see potential in Mercer County.
"The combination of hospitals is making possibilities for new medical developments in the area," he says of the new system.
Capital Health System is the result of the December, 1997 merger between Helene Fuld and Mercer Medical Center, two century-old Trenton traditions. Described as a horizontal partnership since both entities deliver similar services and have common visions, Capital Health System is positioning itself to be a major health system in the state.
In the near future, says Celeste Montgomery, senior public relations associate for Capital Health System, the system could enter into vertical partnerships with tertiary care facilities to be able to provide more specialties. New services under consideration include a new breast biopsy system, new treatments for prostate cancer, and more cardiac care. Already in development is a modern patient-information system that will give doctors 24-hour access to patient information from their homes.
Still more improvements are needed, according to Somerstein. "I’d like to see modern facilities in one new hospital instead having two hospitals, and I would like to see some residencies offered to attract and help train young physicians," he says.
Clearly drawing-table ideas - whether they come to be depends on resources, Somerstein says. His big dream is a medical school for Trenton. "That’s something Capital Health System should do."
Somerstein knows the merged system’s resources and future rely not only on the savoir-faire of administrators operating in the shifting sands of medical reimbursements. It’s also linked to the well-being of Trenton, which has seen
"When I was growing up here, Trenton was an industrially based city," Somerstein says. "It had lots of industry and a strong middle class. Then, as time went on, it lost its industrial base, it became crime-ridden, had drug problems, and, basically, like a lot of other cities at the time, it fell apart. In the last few years, fortunately, its been improving - very slowly," he says.
"But Trenton used to be a great place, because it was in the center of everything."
Some cities don’t have historical roots to help them in their struggle to salvage their identities and overcome the urban blight that gnawed at their centers in the second half of the 20th century. Trenton, on the other hand, is appropriating some old-fashioned determination to gradually restore its economy and self-image.
After all, just north of present-day Trenton is where General George Washington made his valiant push across the ice-choked Delaware River to begin the slow reclamation of New Jersey from the British. Following that December 26, 1776 victory, Washington and his men pushed on to Princeton for another triumph that gave a crucial boost to the morale of the rag-tag Continental army and proved pivotal to the eventual end of British rule over the United States. Washington’s tactical maneuvers in Mercer County are still taught to officers in training as a textbook example of how to double back on the enemy.
Mercer County itself takes its name from Brigadier General Hugh Mercer, one of Washington’s most trusted officers. He died of British-inflicted bayonet wounds he received on his way between the battles at Trenton and Princeton.
New Jersey’s capital city is the namesake of William Trent, a Scottish-born immigrant who became a successful Philadelphia merchant. He purchased land and a log mill at The Falls, as the area was originally called, from Mahlon Stacy Jr., whose Quaker father was the first white settler of the area in 1679.
In 1719 Trent built a summer home, now the oldest residence in the city and in the heart of Trenton’s downtown historic district. His wealth, amassed from trading colonial products such as tobacco, flour, skins, and furs for wine, rum, molasses, dry goods, African slaves, and British indentured servants, launched Trent Town as a trade depot between New York and Philadelphia.
When Trent bought the Stacy property, he rebuilt the log mill and made other improvements on the river. That’s where major redevelopment projects are taking place today, recasting the city from a manufacturing work horse to an entertainment and tourism destination. Trenton, whose once-flourishing pottery industry produced the first American-made porcelain toilet in 1873, is spiffing up its historic buildings and working hard to keep its downtown commercial district viable beyond trade with state office workers.
Over three years, the city has put $170 million into redevelopment including $34 million for the Soldiers and Sailors War Memorial. Originally built in 1930 as a great community center with banquet halls, a concert hall, and a theater, it now serves as home to the Greater Trenton Symphony and is slated to become a center for the arts. Another $6.5 million was put into the Old Barracks, the colonial-era military barracks recently re-opened as a living history museum, and $12 million went to restore the golden State House dome, which can be seen glistening for miles outside the city.
Rising from an abandoned complex of industrial buildings that were once the Roebling steel yards is a $45 million hockey and basketball arena. Where blast furnaces once tempered cable for the Brooklyn, George Washington, and Golden Gate bridges, Trentonians will be able to enjoy sports, shopping, office space, and a park with access to the bank of the Delaware River.
In the works and much hoped-for is a Marriott hotel, proposed for a site next to the War Memorial. New Jersey’s capital has been without a downtown hotel since 1985.
Trenton’s central city also has a need for primary-care physicians. So, when St. Francis Medical Center recruited internist Jose Fuentes, MD, to launch the Centro Medico bilingual primary-care clinic in downtown Trenton in 1995, Fuentes eagerly accepted the challenge.
After graduating from medical school in his native Colombia in 1981, Fuentes ran two offices there until 1989. It was then he decided to come to the United States, his mother’s homeland, to live out the American dream.
"To practice in the U.S., live comfortably with my wife and kids, that’s everybody’s intent who comes here," 42-yearold
After passing the medical commission exams for foreign students, he did a three-year internal medicine residency at Mountainside Hospital in Upper Montclair, northwest of Newark. Upon completion, he faced the immigrant’s greatest challenge - to find work. He believes he simply could not compensate for his accent in the affluent greater New York suburbs.
"For foreign doctors, it’s difficult to work here," Fuentes says. "I decided I had to get my roots in front if I was going to succeed."
By the patient rosters, he did succeed at Centro Medico, building the load from nothing to 3,000 patients. But, by the bottom line, it was a disaster, Fuentes says.
"I was on a salary, so I was OK, but the hospital kept sending me a letter every week saying the clinic was losing money. I was a nervous wreck."
Many of Trenton’s Hispanics and his Centro Medico patients, Fuentes says, are the working poor. "They work in jobs that don’t provide HMOs or other insurance, but they make too much money to get Medicaid."
He says he also finds that caring for them is difficult . . . they often don’t get well. "They don’t have the money to buy their medicine, and the specialists refuse their referrals because they don’t have insurance."
In 1997 the hospital began to receive state funds to help subsidize Centro Medico and Fuentes joined a 16-doctor practice in the suburbs.
"I was covering for one of their doctors who’d had a heart attack, and then they invited me back. It’s amazing. A few years earlier I couldn’t get into an American clinic for an interview, and then they open the door and invite me in."
Fuentes moved in where three other doctors at Franciscan Family Care in Pennington either had retired or left.
"I’m happy; I’m doing well. In 1997, when I started here, I finally tasted the sweet taste of American medicine. I saw people actually getting better," he says.
His patient load is manageable enough that he still donates two days a week of his time to Centro Medico. "I didn’t want to abandon them," he says of his Hispanic patients.
Success came more easily for Louis Tsarouhas, MD, a family practice physician and native Trentonian. He attended medical school at the University of Medicine and Dentistry of New Jersey’s Robert Wood Johnson Medical School in Piscataway, New Jersey, about 25 miles northeast of Trenton.
"I did consider [practicing somewhere else], but it was too easy for me to come back to Trenton," says Tsarouhas, 37.
As the president of a private practice that has two other physicians, he boasts of being fiercely independent and having turned down several buy-out offers from investor-owned groups. "I think the word is out in the community that we’re not interested."
Tsarouhas says many of his patients come from his Greek Orthodox church and are more comfortable discussing their personal health in Greek. Another partner in the group cares for Italianspeaking patients. Tsarouhas believes being multilingual and privately owned are the trump cards for his Mercerville Medical Associates practice. "I think patients are saying, ’I am going to see you because you are not owned by a hospital that is going to keep changing everything,’" Tsarouhas says.
Joanne B. Kalish, DO, has found a different path to success in Mercer County. Kalish, an internist, has a private practice just outside the borough of Princeton and 11 miles northeast of Trenton. Working with Judith Loge, PhD, a psychoanalyst, she is beginning to specialize in weight management. Since opening her office in August, she estimates about 20 percent of their patients come for weight management issues.
A native New Yorker who attended the New York College of Osteopathic Medicine on Long Island, Kalish had her first year of residency at a Brooklyn hospital where she was "treating a lot of AIDS patients."
Then, she moved to New Jersey and completed her residency at Robert Wood Johnson University Hospital in Piscataway. She did an extra year of training as chief resident at the Medical Center at Princeton.
She began her career by working two years for an HMO in New Brunswick. Then she entered a contract with Mercer Medical Center to open a clinic in Hamilton, a township about four miles east of Trenton that closely trails the capital in population. After that, she moved to another clinic in Lawrenceville, a small suburb north of Trenton.
"In those years I saw it all and I decided I wanted to own my own practice and run my own business," Kalish says.
Princeton, she says, "is an oasis of oldfashioned medicine. Most of the doctors are American, Ivy-League educated, and older doctors."
Although Kalish has a number of contract- care patients, she says she has colleagues in Princeton who see only privatepay patients.
Being in a community with a median household income of $62,288, almost two-and-a-half times that of Trenton, helps. But since she is recently widowed with two small children, what Kalish likes most about Princeton is the lifestyle.
"The schools are wonderful and my children enjoy them, and that’s important when I’m away at work all day," she says.
"I’m a cyclist. I do about 20 to 30 miles a day, and the roads are good for that. We like to go to Princeton [borough] and walk around the university, and you can always find something going on at the university."
Kalish finds the social life attractive as well. "Now that I’m single, I’m finding there are plenty of restaurants, dance clubs, and meetings to go to. I don’t have to go to Manhattan anymore," she says. "In fact, the only reason I go there anymore is for my haircuts."
In many ways, Kalish, Fuentes, Tsarouhas, and Somerstein have found the medical opportunities and lifestyle of Mercer County surpass those of neighboring New York City and Philadelphia, whether it is in historic Trenton on the Delaware River or the well-heeled communities of the Princeton. n
Pam Prescott is a free-lance writer based in Roscoe, Illinois. This is her third Community Profile