Phil Lichtenstein, MD, named Outstanding Pediatrician of the Year
It isn’t much of a stretch to imagine Phil Lichtenstein, MD, as the curious little boy who accompanied his maternal grandmother on weekly hospital visits to elderly synagogue members in Rochester, NY.
“We rode the bus, and she told me stories about the people we were visiting, the diseases that impaired them and what the doctors were doing to treat their condition,” he recalls.
He also spent many weekends at his paternal grandparents’ drugstore alongside his pharmacist grandfather. “It was neat to watch him count the pills and put labels on the bottles. He talked a lot about how medicine helped people.”
Small wonder, then, that Lichtenstein grew up to become a doctor. “My grandparents had actually saved money for my medical school education. It paid for my first two years’ tuition,” he adds.
Lichtenstein, who earned his BA from Harvard University in 1972 and his MD from Vanderbilt in 1976, still has that passion for learning. He was honored at the Cincinnati Pediatric Society’s annual spring dinner on April 30 as the Outstanding Pediatrician of the Year.
A holistic point of view
Long before “social determinants of health” became part of the lexicon, Lichtenstein paid attention to non-medical factors that affected a child’s well-being. His participation in a high school summer science program at Louisiana State University opened his eyes to social injustice.
“The South was an interesting place to be in 1967,” he recalls. “It was my first chance to see blatant racism in action. This exposure embedded in me a need to ensure rights were being extended to people who were denied access. It influenced the decisions I made as a physician.”
Lichtenstein’s aunt was the head of social work at Columbus Children’s for 25 years and another powerful role model in his life. “She knew I was interested in welfare and equity issues, so she taught me about family dysfunction and what happens when families have to break up,” he explains. “She told me I could play a big role as a pediatrician in rescuing kids.”
During his residency at Cincinnati Children’s, Lichtenstein was called to testify in court regarding a child abuse case. He realized then that he could be a useful voice.
Following a gastroenterology and nutrition fellowship here, he went into private practice with the Northern Kentucky Pediatric Group in 1982. He also worked with Nancy Kremer Barone, then CEO of St. Luke Hospital in Ft. Thomas, and Bob Shapiro, MD, a member of the Child Abuse Team at Cincinnati Children’s, to form the Children’s Advocacy Center of Northern KY.
“We were the first multidisciplinary treatment center in Northern KY and the only evaluation center in the state,” says Lichtenstein. “I served as part-time medical director, which meant I spent my day off working in the sexual abuse evaluation clinic. The Attorney General’s office would identify the most difficult cases and send them to us.”
Lichtenstein was fortunate to have the support of his practice partners, Fred Stine and Tom Heavern. “These two guys were heavily invested in the community and medical politics,” he says. “Fred taught me that a well-established pediatric practice gives you a big platform to advocate for patients and families.”
Lichtenstein participated in statewide committees to set up investigative protocols for the commonwealth. He gave lectures on the quality and usefulness of forensic evidence to attorneys, district court judges and state police. “About 15 years in, Bob Siegel joined me as co-medical director of the Children’s Advocacy Center,” he says. “This moved us to the next level of substance and sustainability. Now there’s a freestanding multidisciplinary center on the grounds of the old St. Luke Hospital in Florence.”
Behavioral health beckons
In 1994, Lichtenstein joined Northern KY Family Health, a federally qualified health center now known as HealthPoint. Most of his patients were on Medicaid, which required those who needed mental health services to go to Louisville or Lexington for treatment.
“We needed to do a better job for kids with behavioral health issues, especially ADHD,” he says. “The vacuum created by Kentucky Medicaid presented a tremendous opportunity to fill the void.”
Lichtenstein and John Brewer, MD, medical director of Northern KY Family Health, participated in NICHQ training – a one-year quality improvement initiative at Duke University that pioneered ways for pediatricians to do high quality, guideline-compliant ADHD work in their offices. Taught by ADHD “superstars,” the two worked on establishing better processes to improve outcomes.
“We piloted a project at John G. Carlisle Elementary in Covington,” he says. “We created an intervention team at the school and identified 25 kids with the worst behavior problems – 20 of whom fit the ADHD profile. We treated them aggressively and tracked them for two years. Their attendance improved by 50 percent, and disciplinary referrals decreased by 50 percent. Although we had no access to academic information, there were more promotions and fewer failures.
“At the same time, the number of discipline referrals in the entire school went down by 25 percent, proving that if you stabilize the sickest kids, the other kids behave better too.”
In 2004, Lori Stark, PhD, and Tom Boat, MD, recruited Lichtenstein to be the medical director of a new ADHD Collaborative. He worked closely with Manny Doyne, MD, to develop the Cincinnati Children’s evidence-based ADHD guidelines. Lichtenstein also insisted that they hire a full-time, research-oriented ADHD expert. About 1½ years into the project, Jeff Epstein, PhD, came on board. Says Lichtenstein, “I did all the teaching and clinical work, and he did the data analysis and paper-writing.”
The ADHD Collaborative trained 260 primary care providers in the Cincinnati area over a five-year period on how to manage ADHD competently and independently. “The quality of the response and the daily performance of kids being managed has improved substantially,” says Lichtenstein. “We are changing patient outcomes now in ways that are measurable and statistically significant.”
Going all in
Lichtenstein continued to split his time between Healthpoint and the ADHD Collaborative until about 2014. That’s when he decided to leave primary care and focus solely on mental health.
“I was on the board of the Children’s Home of Cincinnati, and it became increasingly apparent that we could do a lot to improve services there,” he says. “We presented our plan to management, and they offered me a job as medical director – a position they’d never had before.”
Lichtenstein assembled a medical staff to meet the demand. Today that staff includes 10 people – five part-time child psychiatrists, two full-time psychiatric nurse practitioners, one full-time and two part-time pediatricians. “We’re providing a huge amount of care to really complicated kids on our campus and in the schools,” he says.
Reflecting on his career, Lichtenstein is grateful for the opportunities he’s had. “I’ve been fortunate to have a wonderfully collaborative and productive relationship with Cincinnati Children’s. There has never been a time when the door wasn’t open. It’s part of the ethos of this place to encourage and collaborate with independent physicians in ways that benefit the community. I hope young pediatricians who graduate from here and stay in the area realize these kinds of opportunities exist for them too.”
