Abrams proved a perfect fit at Dorchester House- After 25 years at post, he is retiring in August

Joel AbramsJoel AbramsJoel Abrams, who has led Dorchester House through a transformative quarter-century of modernization and fiscally-responsible growth, will retire in August. The 69 year-old Brooklyn native arrived at the Fields Corner facility in November 1986 and replaced Jim Whouley, a Dot native who had become an icon in the still-adolescent community health center field.

For years, Abrams laughs, he was introduced around Boston as “the new Jim Whouley.”

Soon, the next chief of the Dot House will have to endure being called the “new Joel Abrams.”

“If you look at what the Dorchester House looked like in 1985 versus today, it’s an unbelievably dramatic difference,” said Bill Walczak, the founder and former director of the Codman Square Health Center. Walczak and Abrams were frequent collaborators and set up an innovative management partnership in the 1990s — DotWell— that continues to serve as an important bridge between the two Dorchester centers.

Walczak says that Dorchestre House’s unique mix as a settlement house combined later with a health center made it “the ideal model” of how health care could be delivered at the local level.
“Joel preserved that model and he enhanced it,” said Walczak.

Abrams came of age immersed in the anti-poverty, organizing work of the late 1960s. Highly influenced by community-based youth programs in his Brooklyn neighborhood, he attended Brandeis University and developed a Boston connection that would later lead him back to town. He took a degree in community organizing from Columbia before returning to Boston for a job developing a first-generation computer-based management tool for community health centers. Later, Abrams would lead the state’s Medicare office before leaping at the opportunity to run Dorchester House upon Whouley’s departure.

“The Brooklyn neighborhood I grew up in was not much different from Fields Corner,” Abrams told the Reporter. “It was a working class, lower middle class, very nice area. A semi-urban experience but a neighborhood-based experience. So I remember when I first was interviewing for the job here the neighborhood itself felt familiar. I always felt comfortable here, even though I’m not an OFD.”

Abrams, an anti-poverty warrior at heart, thrived in the “family” environment that he discovered upon his arrival. But he also understood that the Dot House needed to modernize— and quickly— to survive in the high tech era that he saw on the horizon.

“When I got here we had, I think, two word processors and telephones and a few electric typewriters,” Abrams says. “To be able to create so much self-sufficiency through technology, I believe we have become – along with Codman and Dot Well— one of the most highly capable tech organizations. I’m very proud of that.”
Abrams also realized that the business model of all community centers needed to adapt to their emergence as important players in the marketplace nationally.

“I knew that Dorchester House, financially,was a product of financial support from the city and grants and it was starting to move into the era of operating like being a self supporting business. I felt like that was the challenge I was facing, to make it work under a different set of rules. That felt pretty awesome. I looked forward to it, but it certainly had its challenges,” he recalls.

Navigating the changing tides with Abrams all along has been a community-led board of trustees that — as mandated by federal license— is dominated by local members, with at least half of its number being consumers of the center.

Kevin McDermott, one of several longtime board members at the Dot House, says that Abrams was and is a true believer in that model of governance.

“I’ve most of all respected Joel for understanding what we are on the board for,” says McDermott, who lives in Clam Point. “He’s been true to that mission, working with the board and he taught me a lot about the different roles we have. Joel is sort of our employee, but he’s done it very well.”

Abrams says that more companies — especially ones in the health care space— would benefit from such a model.

“I’ve come to understand over the years how much guidance you get from consumers and from other people of the board but particularly from people who use the services,” says Abrams. “It’s something that’s really survived in health centers—and its why I think health centers are so successful around the country, is that they’re really overseen by consumers. The policies they create are reflective of what they need and want and it makes us all accountable to the people who use the services in ways that a typoiucal health care facility would not be otherwise.

“I really have respected that and over the years for me one of the challenges has been to work with the chair of the board and the members of the board to have them become more and more involved in the oversight of the center. We learn a lot from each other--- and not just the health services, we continue that settlement house tradition. It really managed to reinforce that tradition right here in the building.”
In the mid-90s, as the Dot House emerged along with everyone else from a grueling recession— Abrams led his team into a new collaborative management experiment with Codman and Walczak. The partnership — known as DotWell— was intended to eliminate back-room redundancies and leverage the buying and selling powers of both facilities. It turned out to be a unqualified success, with each center benefiting from the depth and range that came from sharing talent and resources.

“One of the immediate results was that we both got capitol funding for our building projects,” notes Abrams. “Our first major infrastructure build-out was the result of our ability to get funding from Boston Medical Center and Partners to modernize our building.”

Abrams has just overseen a second major modernization build-out, this one financed mainly thanks to a $7 million infusion of federal stimulus dollars. The now-completed projected that he dubbed “The Doctor Will See You Now” will allow the Dot House to accommodate an additional 5,000 patients per year in a state-of-the-art urgent care setting, along with other new amenities like a pharmacy and eye care.

This latest build-out sets that stage for even more growth under Abrams successor, who will be chosen by the board.

Abrams says the new building wing reflects the confidence in the health center movement and the local marketplace.

“You can try to read the tea leaves based on what’s happening in health care reform and payment reform. We know there’s inappropriate use of hoispital ERs and we know that there are many people who could benefit from having a primary care relreationship that haven’t developed one.

It makes more sense and we believe people ultimately have the confidence that they can get the same quality care right in their own community through highly qualified medical professionals who can take care of them every bit as well in their own neighborhood than in an outpatient setting where they might have to wait. Health centers were formed to respond to that in the first place.”

The challenge, as Abrams sees it, will be to continue to attract and maintain talented medical staff to meet the “pent-up demand” that he sees locally. It’s always been tough for urban health centers to compete with downtown hospitals and suburban office parks for doctors. But that has become even more difficult thanks to a shortage of doctors in the primary care field.

“That’s going to be our biggest challenge: we haven’t seen the same immediate bump in volume yet, because we haven’t recruited the personnel we need yet,” Abrams says. “Whether there’s as much of that breed of provider these days as there was back in the day, I don’t know.”