[July 2008] Richard N. Formica Jr., MD, has the kind of practice where patients may need to get in touch with him at all hours. With his surgical and medical colleagues, he works up patients before they have a transplant, manages their care for the three to five years they’re on the waiting list, and monitors and adjusts their immunosuppressant medications post-transplant.
“It’s a field that’s on the cutting edge of medicine,” he said. “You treat someone who has a fatal disease—organ failure—and manipulate the immune system to keep them alive with somebody else’s organ.”
Formica also manages the medical care of those who donate a kidney to a friend or relative. “The donors are the smallest part of our practice but cause the most anxiety because you’re taking an organ out of a healthy person. There is no room for excuse or error,” he said. With the help of the donor advocacy team, he not only ensures that donors are healthy, but tries to look 30 or 40 years into the future to project their medical history and tries to ensure that donating a kidney will not put them at risk for long-term health problems. He also calls upon colleagues in social work and psychiatry who make sure that donors are mentally prepared and aren’t being coerced or paid for their participation.
The kidney and pancreas transplant unit oversees about 100 patients each year, most of whom suffer from kidney failure, usually due to diabetes or high blood pressure. A small number undergo a pancreas transplant, a more delicate undertaking due to the greater difficulty of transplanting the organ, which has to come from a donor under 45 who is neither overweight nor diabetic.
Because his relationships with patients last for years, he gets to know them very well. “We follow them so closely and intimately that they become like family members,” he said. He covers weekend call and gives most of his patients his cell phone number because there’s so much at stake. None have abused the privilege. “I’m usually glad when they call me because it’s usually something that needs to be dealt with quickly and then it doesn’t become a huge problem,” he said.
- Originally published in the July/August 2008 issue of Yale Practice.
Title: Associate professor of medicine and surgery, director of transplant nephrology, medical director of kidney and pancreas transplantation, Yale- New Haven Hospital Transplantation Center.
Area of expertise: transplant nephrology.
Place of birth: New Haven, Conn.
College: Boston University College of Arts and Sciences.
Med School: Boston University School of Medicine.
Training: Boston University Internal Medicine Residency, chief resident at Boston City Hospital, nephrology fellowship at Yale.
Family: Married to Trudianne Formica, extended family lives in New Haven area.
What is most challenging to you in academic medicine? Currently it is balancing the three jobs of clinician, educator and administrator during the course of a single day.
What is most rewarding? The feeling that my getting out of bed in the morning has importance to someone.
What do you like most about your practice? The people I work with.
Personal interests or pastimes? Sailboat racing. I race in either the Marion/Bermuda or Newport Bermuda yacht race each year. I crew on different boats during the Eastern Connecticut Sailing Association season on Long Island Sound. During the winter I ski and race dinghy sailboats on the Connecticut River out of Essex. For relaxation I build dry stack stone walls.
Last book read: In Cold Blood by Truman Capote. Currently reading Rising Tide by Michael Shaara. “I always have a book going.”
What would you do to improve our clinical environment if you had a magic wand? Build a properly designed clinical building where the entire Yale faculty could practice and thrive in a collegial environment. This building would be constructed in such a way to insulate the faculty from the taxation structure that discourages the creative and energetic practice of medicine. It would also have a faculty dining room so we could get to know each other.