By Robert F. Granacher Jr., M.D. M.B.A.
Stephen Hawking famously said, “Science is not only a discipline of reason, but also, one of romance and passion.” When one first meets Ralph Alvarado, M.D., he or she is struck by his passion for the practice of medicine and his quest to improve politically the practice life of physicians.
I met with Dr. Alvarado recently in the physician’s lounge at St. Joseph East in Lexington. I learned that he was born and grew up in Pacifica, California, near San Francisco in the Bay area. He and his family later moved to the San Jose area of California. After finishing high school, he noted that San Jose was drastically changing. It was morphing from farming to high-tech. His interest and skill in science were fostered by the environment in which he found himself as a high school student.
Dr. Alvarado is a pediatrician-internal medicine specialist practicing in Winchester, Kentucky with hospitalization privileges in Lexington at St. Joseph East. He is currently a member of the Kentucky Senate, and is one of only three physicians in the Kentucky Legislature. He is the first Hispanic person to become a member of the Kentucky Legislature.
I had the privilege of first meeting Dr. Alvarado when we both served on the Board of Directors of St. Joseph Healthcare. Dr. Alvarado was a physician representative, and while he was very interested in politics at the time, he had not yet been elected to office. His energy and passion for the practice of medicine and the attempts to improve the practice life of physicians were immediately apparent during our interactions. His energy and pursuit of goals is infectious to those around him.
Ralph obtained much of his political acumen from listening to stories from his father about the local politics he pursued in his native country of Costa Rica. His father left Costa Rica for the United States in 1963 and was sponsored by a University of California at Berkley entomologist to come to this country. Dr. Alvarado’s mother is a native of Argentina, and thus, Dr. Alvarado has Central American and South American cultural heritage. After high school, he attended college at Loma Linda University and completed college in three years. By then, he had decided to attend medical school. One hour after receiving his notice of acceptance to UCLA Medical School, Dr. Alvarado received a call from the dean of the medical school at Loma Linda University offering him a place, and he chose that position over the one from UCLA.
After completing medical school, he decided he needed a different perspective on medicine. His roommate’s girlfriend suggested that he look at the University of Kentucky Medicine-Pediatrics program (her father was born in Lexington.) Ralph got a “gut feeling” about Kentucky when he visited Lexington for interviews. He matched at the University of Kentucky, and the rest is history. He and his wife, who is a practicing occupational therapist, had their first child at the end of his residency. Dr. Alvarado received financial assistance from Clark Memorial Hospital the last year of his residency in 1998, and he entered a solo practice in Winchester. He hired an APRN after his first year and has been the manager of his practice since. In 2001, he obtained a new partner, and they now have a practice with three physicians, three nurse practitioners, and one physical therapist-nurse practitioner. In 2002, he moved his admitting privileges to St. Joseph East due to the superiority of neonatal services offered there. His partners have a satellite office at Hamburg in Lexington.
In 1797, Thomas Jefferson wrote to A. Campbell that legislators should be “not office-hunters, but farmers whose interests are entirely agricultural. Such men are the true representatives of the great American interest and are alone to be relied on for expressing the proper American sentiments.” While farming clearly is not the principle occupation of citizens of the United States presently, it is clear that Jefferson believed that the best political representation for citizens was that of the non-career politician. Dr. Alvarado follows this admonition and was called to politics by the medical tort reform bills, which came up in the 2003 Kentucky Legislature. He felt he needed to be more involved in the political process as a physician in order to make change. The Clark County Republican chairperson invited him to get involved in the local political process. He ran for the Kentucky House in 2004 and narrowly lost. He reran in 2006 and lost badly at the end of President Bush’s term. He was a bit amazed at the challenges of the process when signs were placed on his lawn referring him as the “N”-word. This caused him to develop cold feet for politics for a period, until he was asked to run for the Senate in 2010. He and his wife looked for counsel within their faith, and he decided to run. He won the primary, but in the general election, he ran out of T.V. advertising money. He lost that election to R.J. Palmer, a Democrat. He was asked to run again in 2012.
His greatest challenge came prior to winning his first election. His wife was diagnosed with breast cancer, and she underwent reconstructive surgery and chemotherapy. They both met the challenge, and he also won his current position in the Kentucky Senate.
As a freshman senator, he has distinguished himself as the first Hispanic person to serve in either House of the Kentucky legislature. Evidence of his political skills occurred when he attended a caucus where Medicaid insurance representatives were the speakers. He publically debated with these persons, and the room exploded in applause for his skilled arguments. As a result, he was asked to be the point on Senate Bill-6. He also spoke in favor of Senate Bill-4 (the Informed Consent Bill). Dr. Alvarado has become the go-to-guy in the Senate on medical issues.
One of his future political goals is to develop a plan wherein the governor will be required to choose nominees presented by the Kentucky Medical Association, to sit on the Kentucky Board of Medical Licensure. (Currently, the governor can select entirely physicians not selected by the Kentucky medical profession to serve on the board for the KBML if he chooses.) He also plans to push for SB-83, which will require peer review protection of physicians practicing in hospitals. In addition, he will be working on SB-87, which is the Fair Contracting Bill for physicians. He now feels himself fully prepped for the next term in the Senate. He has learned how his leadership operates, and he feels that his experience was very much like his first year of residency, which was about learning how the processes in the hospital worked in order to improve the efficiency of his educational experience and care of patients.
I asked this physician citizen legislator how he maintains balance in his life. Ralph is so imbued with energy and passion that it begs the question of whether he can balance as many plates as he appears to be doing. He has become very supportive of his wife and her advocacy for all cancer, and particularly breast cancer, in women. He has great physician partners in his medical practice (one is a Republican, and the other is a Democrat). When he is in the legislative session, his partners cover for him, and then he covers their nursing home patients on weekends when he returns from Frankfort. He also has found ways to assist himself financially that do not require the continuous call demands and structure of medical practice. For instance, he is the state medical director of the new Medicare Advantage plans. He is still practicing three clinic days weekly, and he makes hospital rounds at St. Joseph East. He attends rounds in the nursing home he covers on Wednesdays and Saturdays.
He has had to reduce time demands somewhat. For instance, when he was elected to the Senate, he had to resign himself from the Kentucky Medical Association Board of Trustees. When I asked him what he intended to have as his major focus for his next Kentucky Senate term, he told me it would be the Maintenance of Certification Bill that he hopes to bring forth, as he sees physicians being at risk of having their Kentucky medical licensure tied to whether or not they are completing maintenance of certification. His goal is to forestall this nexus through the legislative process.
Overall, Dr. Alvarado presents a remarkable picture of a family man of faith, as a passionate physician providing the best of pediatric and internal medical care to his patients, while improving the political health of physicians in Kentucky through his efforts in our state legislature.