Longtime pediatric surgeon in Syracuse ushers in new era of care

By Lou Sorendo

Being a pediatric surgeon is far from child’s play. For Michael Ratner, a pediatric surgeon who directs the new surgery center at the Golisano Children Hospital, it’s been his lifelong calling.

And he knew it right from the start.

Ratner earned his medical degree in 1968 at SUNY Health Science Center at Syracuse after pulling down his bachelor’s at Johns Hopkins. It was not until his first year of residency, however, that he decided he would focus on pediatric surgery.

“Two fellows who were here at the time got me interested, and I knew from day one that this was what I was going to do,” he said.

Ratner was then called into the Air Force during the Vietnam War, and came back and finished his residency in Syracuse.

He then went to Philadelphia for pediatric surgery training, and later would receive a job offer from SUNY Upstate Medical Center.

“I really liked it here and definitely wanted to come back. It worked out great,” he said.

“It’s funny, but I can never go back to taking care of adults. Kids are just fantastic,” he said. “People ask, ‘How can you take care of those little kids?’ But they are fantastic. They listen to you and do everything you tell them to do. They get better amazingly fast.”

He said children also tolerate a tremendous amount of setbacks but still bounce back. “It’s striking,” Ratner said as to their resiliency as patients.

Ratner added that another gratifying aspect of working in pediatrics is attending events such as weddings and graduations involving people he has related to in his practice.

“The lifelong relationships you build with these families is terrific,” he said.

However, the job is not without its downsides, such as dealing with high levels of stress.

“We see a lot of fairly sick kids, and you know sometimes it’s hard to take care of them.

“You do the best you can, but I think occasionally your outcome is not as good as you would like surgically. That certainly causes a significant amount of stress.

“I think over time as a surgeon and as you get more experienced, the stress level goes down a little bit, but it never goes away. That’s not a bad thing, because you always need to be on your toes and thinking ahead. Sometimes in the middle of the night, you have to make some decisions and you’ve got to stick by them. From that standpoint, it can be pretty stressful.”

Bond with Salt City — “I really love it up here. When I retire, we are not going anywhere,” he said.

An avid hiker, Ratner has always been drawn to the challenges that the Adirondacks pose.

“I’m big into outdoor sports, and that’s one of the things that has kept us here,” he said. “I’m also a big sports fan and enjoy going over to the dome to see Syracuse University games.”

Ratner did require a knee replacement about nine years ago, so he is limited in what he can do physically. However, he does enjoy golf and even shelves the cell phone and beeper when he does so. He also goes for walks with his wife Rissa. The couple have two grown children, Beth and Todd.

“Physical activity is an advantage for anybody,” he said. He characterized himself at one point as being an “inveterate gym rat,” working out three days a week.

However, an exodus of pediatric surgeons at University Hospital several years ago meant Ratner’s recreational time was severely restricted.

In fact, Ratner is one of a very few pediatric surgeons in the Central New York area and has delayed his retirement as a result.

“When I retire, I assure you I will be right back in the gym. I’ll be walking until my last breath,” he said.
Ratner grew up in Brooklyn, and recalls when his father would spend 90 minutes commuting one way to work.

“Here, 10 to 12 minutes and I’m at work,” said Ratner, who resides in Manlius.

Ratner also said cultural amenities such as the symphony and theater are sufficient for his tastes. He also noted the centralized location of Syracuse and its proximity to major cities as another advantage.

Much Needed Upgrade — Ratner, 66, said his legacy is having played a significant role in the development of the new $50 million Golisano Children’s Hospital.

Ratner said the Syracuse community has always had a strong pediatric medical community, but facilities became dated.

Prior to the Golisano Children’s Hospital, the most recent pediatric facility was constructed in 1965.
“At times, we had to have parents sleep on a mattress under the crib,” he said. “We were able to provide good care, but the facilities for patients and their families were miserable.” Besides poor lighting, double rooms were small compared to standard sizes and some rooms housed four or five young patients.

Ratner also noted that poor bathroom and shower facilities existed for parents, who oftentimes wanted to stay with their children.

In addition, pediatric care at the hospital grew to the extent that beds were spread out throughout the entire hospital, he noted.

“We basically stole beds from other services that didn’t need so many beds,” he said.

By the time the move was made to the new hospital, Ratner said pediatrics was spread out over five locations at University Hospital from the original one floor.

“It was just untenable,” he said.

“We couldn’t duplicate play rooms and all the other things that you need to take care of children,” he said.

“The experience for the kids and their families was terrible and the facilities certainly hampered the physicians.”

On top of that, Ratner said, the former facilities served as a “big recruiting liability.”

“When you had a new physician come that you would like to recruit, it was very difficult showing that person around,” Ratner said. “You tried to stay away from certain areas.”

“This new facility really gives us a leg up in that it’s a brand new, state-of-the-art facility, but also basically puts us on a level playing field with almost every other city in the United States that has a children’s hospital,” he said.

“At least now we can recruit and say, ‘Listen, Central New York really values taking care of children,’” he said.

Ratner said it would be difficult to find a community the size of Syracuse that would be capable of drumming up the necessary funds to make the new children’s hospital a reality.

The facility was paid for primarily through private sources scattered throughout the 17-county region that Upstate serves, Ratner said.

The children’s hospital is the product of more than 8,000 big and small donors.

“It was fantastic,” he said.

Ratner directs the pediatric surgery center, which is basically an operating room with facilities specifically designed for children and their parents.

“This is a family centered institution,” he said.

Ratner said entire families are taken into account when care is provided to children.

The hospital features a child life specialist in the operating room to assist with the needs of youngsters.
“When kids come in there, they are really nervous. And I can assure you, their parents are probably more nervous,” Ratner said. “We have trained specialists to help families get through this.”

The new hospital features 71 spacious rooms, each with a private bath, pullout bed for family sleepovers, PlayStation video game console and a flat-screen television.

“It’s a big difference in taking care of the children and families in that situation vs. the way we used to,” he added.

Future Concerns — Ratner said he believes the new children’s hospital will be in need of more space.
University Hospital was only allotted a specific amount of beds for the new children’s hospital based on state-generated population projections.

“My feeling is those projections are not going to play out in the long run,” Ratner said. “We’re going to fill up that hospital and we’re going to have no open beds very shortly.”

The reason, Ratner said, is because surrounding communities are having difficulty with certain specialties, including general surgeons.

“As general surgeons age, a lot of young general surgeons don’t feel comfortable seeing an 8-year-old with appendicitis,” Ratner said. “That patient is going to come here from a city like Auburn, which has trouble covering its emergency room as far as general surgeons are concerned.”

Many Upstate communities are suffering the same consequence, and more young patients end up at University Hospital as a result, he noted.

“I think it’s going to put pressure on the facility very quickly,” Ratner said. “I think we all tried to get some more beds, but we were not successful. That’s going to be a challenge.”

He said recruitment is a challenge, not only for University Hospital, but for every institution across the state and Northeast.

Looming physician shortage has top doc concerned

Syracuse pediatric surgeon Michael Ratner is scared to retire.

It’s not because of the standard reasons, like those related to financial need or a stinginess to hang up the stethoscope.

It’s because there is a shortage of pediatric surgeons at SUNY Upstate Medical Hospital.

Ratner, 66, originally planned to retire once the Golisano Children’s Hospital opened.

However, a lack of qualified physicians has delayed that process.

“I just can’t because we don’t have the people. It scares me to think of retiring now,” he added.

The first patients moved into the $50 million hospital on Sept. 23.

One of Ratner’s foremost challenges is recruiting needed specialists.

“We are still short on several surgical specialists, including general pediatric surgery, which is my own specialty,” he noted.

Ratner characterized the push to recruit much-needed pediatric surgeons to SUNY Upstate.

“As far as the administration at University, I don’t know whether it’s the No. 1 priority, but it is way, way up there as a priority for Upstate Medical University,” he said. “A lot more has been done than people realize,” Ratner said.

He said many administrators—including doctors David Smith, SUNY Upstate president,  and Paul Kronenberg, president and CEO of Crouse Hospital—are all heavily involved in addressing the issue.
Efforts at using two recruiting agencies have gone for naught, Ratner said.

At present, SUNY Upstate is working on an affiliation agreement with Cincinnati Children’s Hospital.

The affiliation will hopefully help University in terms of recruitment, student education, having the availability of surgeons to transfer back and forth, and residency training.

“Right now, it’s just in pediatric general surgery,” Ratner said. He noted that additional help may come in other areas, including urology, an area that SUNY Upstate is also shallow in.

“We actually signed an agreement recently to help us,” he said.

Ratner characterized the Cincinnati Children’s Hospital as being “fantastic.”

SUNY Upstate is the largest employer in Onondaga County, employing approximately 6,600 employees. Meanwhile, Cincinnati Children’s Hospital, a not-for-profit freestanding institution, employs 11,000 workers.

Ratner noted that Cincinnati’s human resource department features eight people who focus solely on recruiting.

“They think of everything, including the spouse and family,” he said. “They are very professional.”
“I was really blown away when I spoke with them,” he noted.

Despite media reports to the contrary, Ratner said he wants to assure the public that SUNY Upstate is “really working hard on this.”

The lack of help on the pediatric surgery end extends beyond University Hospital. In fact, the Buffalo Children’s Hospital, which has one of the few fellowship training programs in pediatric surgery, has gone from five to two pediatric surgeons.

Ratner said his Buffalo colleagues have called SUNY Upstate looking for temporary people to work there.
“People should realize there are some issues common to a lot of other places,” he said.

Poor calculations—Ratner said the root of the looming physician shortage began in the early 1970s. That’s when the government along with major surgical organizations such as the American College of Surgeons made a prediction that would have far-reaching repercussions.

The study done indicated that by the year 2000, there would be anywhere from 100,000 to 200,000 excess surgical specialists in the country.

As a result, a number of surgical residency programs were shut down and restrictions went into place for many years.

By the time 2000 rolled around, it was evident that a projected shortage of physicians would exist at the same 100,000 to 200,000 level.

“The population in the United States has grown significantly,” Ratner said.

This costly miscalculation is now sending tremors rippling through the healthcare industry.

Another costly oversight involved the gender breakdown in medical school classes. Today, the ratio of male to female medical students is about 1:1, Ratner said.

“Many less women choose surgical specialties,” Ratner said.

He noted that University Hospital has always featured some women in surgical specialties, but there are other facilities that don’t.

“In my day, it was like 10 percent” women in medical class, Ratner said.

“Since that has happened, there is a big difference in the number of people choosing surgical specialties,” Ratner said. “Now we are struggling.”

Ratner said the country has become dependent on foreign medical graduates who fortunately come to the U.S. to practice.

Surgeon reflects on healthcare, career

Michael Ratner is certainly an “honorary” Syracusan after having resided in the Salt City since 1964.
The renowned pediatric surgeon, instrumental in the creation of the Golisano Children’s Hospital at SUNY Upstate Medical University, recently shared some thoughts on the state of healthcare as well as himself.

• On whether high malpractice insurance premiums in New York state discourage physicians from choosing pediatric surgery as a specialty:

“High malpractice insurance premiums are not the reason why doctors are not choosing pediatric surgery as a specialty.

“We are about in the same category as general surgeons. It’s expensive in New York state; it’s certainly high. It’s twice as high in the New York City area as it is up here.

“But I don’t believe that is a deterrent because a lot of other states have the same issues. We need (healthcare) reform, there’s no question, but I don’t believe that is a deciding issue.”

• On the need to accommodate the needs of parents as well as young patients at Golisano Children’s Hospital:

“We allow one parent to come with the child right into the operating room until they are asleep. The child can stay on a stretcher with a parent holding their hand, or if the child is smaller, he or she can sit on their parent’s lap.

“However they feel comfortable, we’re going to do it. “It’s much easier for the kids, particularly when you have a child there 10 to 15 times. This is a big thing.”

• On personnel being the key to running the pediatric surgery center successfully:

“Even our housekeepers interact with the kids in a way you would want them to interact with your own children.

“Everybody who works here wants to work here. We have a waiting list for all different fields, from surgical technicians to nurses. Everybody is very focused on taking care of those kids. That makes a difference.”

• On a personality trait that aids him in his role as leader of the pediatric surgery center:

“I’m a very good listener, and I tend not to shoot from the hip. Before I stick my foot in my mouth, I think about things first.”

• In terms of his legacy:

“I would like to be remembered for playing a significant role in making the children’s hospital happen.

“Furthermore, I have been working diligently on forming a firm bond with Crouse Hospital’s neonatal intensive care nursery.”