She Learns from Her Patients... Old Town Clinic

Monday, July 14, 2014

by John Rumler
Reprinted with permission from the Portland Physician Scribe

The idealistic medical student at Dartmouth College yearned to work as a family doctor in the underserved backwoods of Maine. Instead, she found her calling working with underserved people in the heart of a big city.

Rachel Solotaroff, MD,medical director for Central City Concern (CCC), which serves about 13,000 people annually with health care, housing, peer support and employment, received the Karen Rotondo Award for Outstanding Service at the National Healthcare for the Homeless Conference last month. Rotondo, who died earlier this year of cancer, was an RN who was instrumental in building the nationwide health care network that exists for the homeless today. (photo by Heidi Hoffman)

The award recognizes hands-on caregivers who demonstrate vision and creativity in advancing the goals of ending and preventing homelessness, and who have made a significant contribution to improving the health and quality of life of people experiencing homelessness.

Solotaroff, who still spends 18 to 20 hours a week seeing patients, is credited with transforming CCC’s Old Town Clinic into a patient-centered primary care home model and was recognized last year by the Robert Wood Johnson Foundation as “a national exemplary practice of patient-centered health care.” In addition to leading the Old Town Clinic, which serves about 4,000 patients yearly, Solotaroff has championed the development of a chronic pain program, which has become a national model for its innovative and effective approach to addressing chronic pain among homeless patients with histories of addiction.

Her unique dual role as CCC’s medical director and faculty member at Oregon Health & Science University has brought dividends: Solotaroff helped develop the social medicine curriculum for OHSU residents, and now all internal medicine residents rotate through Old Town Clinic twice.

Chief Medical Officer of Health Share of Oregon David Labby has known Solotaroff since she started at CCC in 2006. “Rachel listens very deeply to the community she serves. She seeks connections, she learns from her patients and is guided by their experiences,” he said. “We’ve all gained from Rachel’s commitment and passion for helping others, and she can be counted on to add a perspective you didn’t think of yourself, which is wonderful.”

Solotaroff’s father was an English professor at the University of Minnesota and her mother was general manager of the St. Paul Chamber Orchestra. Her parents divorced when she was 8. Her stepfather, Bernard Mirkin, MD, PhD, was a neuropharmacology researcher and founded a research institute at Childrens’ Memorial Hospital in Chicago. “It would be nice to say that Bernard affected my decision to go to medical school, but that wasn’t the case,” Solotaroff said. “His line of work was so different than what I do. I’ve tried research and I am terrible at it,” she said.

The decision to become a doctor came to Solotaroff in an odd way. After graduating with an English degree from Brown University, she lived near Swans Island, Maine, a tiny fishing community where the family had spent summers vacationing. She lived deep in the woods in a shack without heat or running water and happened to read “Heirs of General Practice,” an article in the July, 1984 New Yorker by John McPhee. “I read it with the zeal I usually reserved for their movie reviews and when I put it down I thought: ‘This is what I want to do with my life,’” she said.

But it was five years before she returned to New England to study medicine at Dartmouth, where she graduated with honors. In between, she worked for City Year, a cutting-edge youth service organization.

“I cut my teeth on community service and learned about diversity, idealism, organizational culture and visionary leadership,” she said.

Humble, approachable and compassionate, Solotaroff has benefitted from many mentors over the years, but two stand out. Alan Khazei, one of the founders of City Year, encouraged her funny and creative side. “My father is very gifted comically and he taught me a love for impersonation and performance, but that desire to be onstage seemed selfish to me. Alan encouraged me to nurture and develop that part of me, and he taught me that leadership can be charismatic without being self-aggrandizing.”

The other mentor, Michael LaCombe, MD, she met during her third year in medical school when she was doing an internal medicine rotation. Solotaroff was struggling, wanting to stay true to her goal of becoming a family physician, but feeling that the internal medicine experience challenged and engaged her in a whole new way.

“Dr. LaCombe gave me the most valuable advice imaginable when he told me, ‘You can always step down and work anywhere you want, but when you have the option to learn and train, pick the most rigorous option, because you may never get that chance again.’” LaCombe continued to mentor Solotaroff personally and professionally through med school, her residency and beyond, and he officiated her wedding in 2005.

Solotaroff was an internal medicine resident at the University of Virginia when she met Tony Iaccarino, her future husband. A teacher at Reed College, he happened to be doing a research fellowship in Charlottesville. That brought Solotaroff to Portland, where she garnered a fellowship at the VA hospital.

Executive Director of the Oregon Primary Care Association Craig Hostetler has known Solotaroff for seven years and describes her as humble, approachable and compassionate. “But when it comes to her patients, she’s very smart and aggressive,” he said. “We need more doctors like Rachel who factor in the psychological and socioeconomic issues her patients face and make greater strides to improve their health outcomes while lowering the overall cost of care.”