University Times

Twenty-one years after completing her medical degree at Pitt, Jeannette South-Paul has returned to chair the School of Medicine's family medicine department.

"To be honest, I never envisioned coming back to Pittsburgh," says South-Paul, 48, who was born in Greensboro, Ala., and grew up in Philadelphia. She was among the few African-American medical students at Pitt in the late 1970s, and while South-Paul says her educational experience here was "superb," she felt isolated socially.

"From a social perspective, it was not only unsupportive here for people of color, it was malignant," she says.

So, South-Paul was wary when invited to interview for the job of chairperson of Pitt's Department of Family Medicine — a department that didn't exist when she was a student here. After graduating from Pitt in 1979, South-Paul got her training in family practice at the Eisenhower Army Medical Center at Fort Gordon in Augusta, Ga. In 1986, she began work at the Uniformed Services University of the Health Sciences in Bethesda, Md., where she chaired that school's family medicine department.

"I was happy where I was," she says. "I wasn't looking to leave Bethesda."

But in revisiting Pitt, South-Paul discovered that her alma mater had undergone "a paradigm shift," as she saw it. Once passive in working with underserved communities and in recruiting minorities, the School of Medicine now was aggressively pursuing both goals, she concluded, and Pitt and UPMC Health System were recruiting family health professionals to their medical and teaching staffs.

On June 30, South-Paul retired from the U.S. Army as a full colonel. The next day, she officially became Pitt's new family medicine chair, her first civilian job in decades.

South-Paul is married to Michael Paul, an orthopaedic surgeon who is in private practice in Maryland. They have two sons: Augustine, 18, a freshman at Loyola College in Baltimore, and Benjamin, 14, a freshman here at Central Catholic High School.

University Times Assistant Editor Bruce Steele recently interviewed South-Paul.

UNIVERSITY TIMES: You're the first woman as well as the first African-American to serve as permanent chairperson of a department at Pitt's School of Medicine, and one of the few black women to chair a department at any U.S. medical school. Is that a source of pride? Do you feel you risk being pigeon-holed by your gender and race?

SOUTH-PAUL: I do have mixed feelings. When I accepted the position, I did not know that I would be the first African-American chair or the first woman chair. It did not come up in the discussion. If it was in the minds of those who were interviewing me, they didn't let me know about it.

Every day, I'm aware that I am an African-American woman. Every single day. But when I go to do a job, I just think: Does my skill-set fit appropriately with the needs of the particular job that I'm looking at?

Given your professional success, are you automatically seen as a role model?

I probably am. People look to me as being an example of what African Americans and women can do, and I'm prepared to accept that responsibility. It can be burdensome at times because it requires you to do more, be in more places and be more active, perhaps, than someone who doesn't have those same characteristics. Sometimes, I just have to say, "I can only be in so many places at once."

Do you think your presence here will help in recruiting women and African Americans?

I hope so. I hope that my being here will make a difference in terms of who is considered for positions at the student, staff and faculty levels. We have a responsibility in higher education to provide an experience that is welcoming to everyone who could possibly come to our institution, as well as to be inclusive as a resource for our nation.

This country has an emerging majority population that doesn't look like white middle America. If we don't attend to that, we are going to lose that segment of the population, who, by the way, now make up greater than 50 percent of new entrants into the workforce.

As a supervisor, it's very easy to hire the person that you're most comfortable with, and that's often the person who looks most like you in terms of race and ethnicity, gender, age, geographic origin and even religion.

Frankly, you don't look much like Chancellor Mark Nordenberg or Arthur Levine, dean of the medical school. What does it say about them that, nonetheless, they recruited you?

I think it says that those gentlemen are visionaries, that they share a vision of how this University can get better and expand its scope. Both have been quite supportive of me since I've come here. I've felt as if Dr. Levine has had an open-door policy for me. I try not to use it too much, because my responsibility as department chair is to take care of as many issues as possible and not bump them up to the dean.

How did you get into medicine as a career?

I grew up in inner-city Philadelphia. My parents were Jamaican immigrants who ran a rescue mission within six blocks of the Ben Franklin Bridge. Four nights a week and on weekends, we would serve hot meals to homeless people. On Saturday mornings I ran the thrift shop, where I would sell used clothing to people from the community. We were ministering to the physical and spiritual needs of the community, but what became apparent to me early on was that these people had terrible health. They were coughing, they had skin problems, they were weak.

When I was a middle school student, my dad approached several inner-city Philadelphia medical schools, struggling to convince one of them to establish a clinic in our mission. It was a large facility and we had the space, but no one was interested. These medical schools told my dad that their mission, when it came to the underserved, was to send their students overseas to see what life was like in undeveloped countries. They said there was no reason for people in the United States to be in the condition that [the poor in Philadelphia] were in if they didn't want to be. I was horrified to hear that. As an early adolescent, I thought, "When I grow up, I'm going to go into medicine so I can help to meet the needs of the underserved."

I was president of the Future Physicians Club at my high school. I went to Penn as an undergrad, majoring in medical technology because I wasn't convinced that I was going to get into medical school. I knew that, at the end of four years and all of the expenditures of going to college, I needed to be able to get a job. I worked part-time throughout my undergraduate career as a medical technologist at a research lab.

I'm one of six children, all born within a period of eight-and-a-half years, so we were struggling. Education was highly prioritized by our parents, but they told us we had to figure out how to pay for it. I decided I would join ROTC because that was a system that, for years, had served as a way for African Americans to get out of the ghetto. You could join the military, the G.I. Bill would help to pay for your education, plus you had a job with health benefits and work experience that would stand you in good stead for the rest of your life. Three of us six children went into the military. I am forever grateful for the opportunities that came to me through a military career. I came to the University of Pittsburgh on an Army scholarship.

What did you think of Pittsburgh and Pitt's medical school?

During the interview process, I was delighted. In Philadelphia, opportunities in health care education were divided among six medical schools. Here, I thought: The University of Pittsburgh is the only medical school in the city. It's the biggest health center in western Pennsylvania. What a wonderful opportunity!

Once I actually matriculated as a medical student, my vision changed. I realized I was an outsider, not just because I came from eastern Pennsylvania but because I was a person of color. And, by the way, there were no other people of color in my class besides African Americans. We didn't have Hispanics, Asians or Native Americans. There were seven of us African Americans in a class of 140 when I matriculated. By the end of the first year, three were already dis-enrolled.

It was difficult for me to find a place to live here. It was only because a classmate of mine from Penn was from Pittsburgh and lived on the Hill that I was able to get the room that I rented for my first two years. I tried to rent apartments in Oakland — that's another story, the things people said to me when I was trying to rent apartments. This was in the 1970s!

In general, it was not a welcoming environment for African Americans in the medical school then. I had faculty members tell me outright that I was only here so that Pitt could get state capitation funds. They had been required to enroll a certain number of African Americans and until they had that enrollment, they couldn't get capitation funds. Well, that's particularly malignant for a vulnerable student to hear.

On the other hand, I felt that the education I received here, especially in the clinical years, was superb. I said: "I'm going to graduate from this school with a good medical education but I don't ever want to see this city again."

Those faculty members you encountered as a medical student — are any of them still here?

None of the ones who were abusive to me are, fortunately! [laughing] A couple of the people who were supportive are still here: Dr. Robert Connamacher, in pharmacology, is still here, and Dr. Joel Marinstein, who is a clinical faculty member in family medicine. Dr. Bob Glew, who was a biochemist and was incredibly supportive of me and other students of color, has since left the University.

What are your goals for the family medicine department?

First of all, I'd like to see more medical students going into family practice. I think it's a wonderful discipline that is the best way to provide comprehensive, compassionate, continuous care for our patients. We should be more than just the access point into the system, we should be the way to provide long-term, ongoing care for our patients. If you take a population of 1,000 people, fewer than five will ever need tertiary care.

We can't just take care of the person who walks through our door. We have a public health responsibility to disseminate information about how to stay healthy — and if you do need to see a physician, to partner in assuring that you regain your health. So, I'd like to make sure that we teach that to our medical students, and that a large percentage of them go into family medicine.

If they choose to go into other disciplines, which are equally important, I want them to understand who family physicians are, that we can partner with our neurosurgery colleagues, with our pediatric and orthopaedic colleagues and so forth, in providing care to patients and continuing to provide care even while they are seeking consultative services from other disciplines.

Aside from our educational mission, we have a scholarly mission to add to the knowledge base of providing health care to our population. I think family physicians are uniquely positioned to do that. We can do research in public health, in the physician-patient relationship, in prevention — all of those things that are best-suited to our discipline.

In a larger sense, I'd like to see much more collaboration within the [Pitt health center] system. This is a system that has changed dramatically over the last few years. It's become more unified under the UPMC-HS logo, but there are many people in the system who are not accustomed to working together. As an outsider coming in, I'd like to see more collaboration so we can have economies of scale. If there are certain clinical or teaching models that work well, everybody in the system should be able to take advantage of them.

Who goes into family medicine?

We are a group of individuals who are comfortable with uncertainty. The majority of our patients don't come in and say something specific like, "I have acute hepatitis C and I may very well need a liver transplant but until that time I need you to help me stay healthy." The typical family medicine patient says, "I don't feel good, and I haven't felt good for a long time," and they tell you what's going on in their lives. We have to be comfortable hearing stories and we need strong interviewing skills. We have to be able to ferret out from a wealth of uncertainty what the particular issues that are most problematic to that patient are, and then to determine which priorities we can manage and which ones need more specialized management.

Do family medicine practitioners feel a kinship with public health practitioners, in favoring preventive medicine?

Absolutely a kinship. More than 90 percent of health care spending in this country goes to people with less than two years to live, because we can provide incredibly high-tech services to them. Yet, if we could concentrate more on prevention, we would save money in the health system. As we structure our curricula in medical schools and training programs, we need to attend to issues of community health as well as individual health so we can keep people from more serious conditions.

Pennsylvania, like most other states, has problems getting M.D.s to practice in rural and inner-city areas. Do you have any thoughts on solving that problem?

I think it's a multi-focal problem. We don't tend to value people who deliver care to the underserved. We tend to say that those in the bigger teaching centers are better docs and deserve to be paid more. Whereas, when you look at people who deliver care in underserved areas, they tend to work very long hours, to be juggling multiple issues with fewer resources. Don't they deserve adequate if not greater reimbursement? Money is not everything, but it is very important. I think we also need to link providers in rural areas with their colleagues so that when they have questions, they have a way of getting answers. Hence, the interest in tele-medicine and other communication technologies to help keep them linked.

Can the civilian health care system learn anything from the military's?

Absolutely. I was very comfortable practicing in the military, for a number of reasons. First, there is a team concept: We are here to help each other because we are all working for a unified mission, and our mission as medical corps officers is to take care of, and ensure the health of, the military community. Everything you do has to have that concept in mind. Your personal self-aggrandizement has to come second to ensuring the well-being of those you work with.

You are taught in military leadership schools: As a leader, you eat last, you do things last, you make sure that your team is cared for before you get your personal kudos. As a result, when you work on any project there is a natural collaborative environment. That doesn't mean there is not appropriate recognition for individuals who have demonstrated certain qualities and skills. But your ultimate goal is to care for the community.

Because of high turnover in the military and the need to respond rapidly to crises, you learn to think outside of the box. You can't say, "We've gotta do it this way because we've always done it this way." Rather, you say: "What is the issue now, and how can we most rapidly address those issues?"

Is there truth to the cliche that the military is the American institution that is closest to being color-blind?

I think there is truth to that. It's been said that the Army is the only corporation in the United States that has managed to thoroughly integrate African Americans with whites and members of other races. If you think about it, even when African Americans are employed by corporations, they tend not to be in charge. That's a commentary on race relations in this country, which are in pretty sad shape, to be honest. When Sept. 11 came, it was a tragic event but it pulled us together as Americans. I don't presume to think, though, that that feeling will last long enough to eliminate the racial struggles that have been typical of our country for the last 150 years.

Do you have any time frame in mind for how long you'd like to stay at Pitt?

I don't know. As long as I'm happy and feel that I have a mission I have a reasonable chance of accomplishing. If I feel as if it's going nowhere, I'm not the type of person who wants to stay and bang my head against the wall. I like to see progress.