COURTESY OF DR . ENAS TUPPO

“ I graduated in 1995 , and even then they were saying this ,” she says .

She came to New Jersey asafamily medicine resident at Overlook Hospital , part ofthe Columbia Presbyterian outpatient system , and fell in love with the state .“ Iammore of afervent admirer of New Jersey than people who were born and grew up here ,” she says , “ especially in Bergen . Idon ’ t know if Icould live anywhere else .”

After graduating , Tuppo went into private practice with another doctor at Hawthorne Family Practice . When he died in2004 , she became she became its sole proprietor ( she is also part ofthe Valley Health System ’ s independent medical staff ).

Tuppo , who lives in Franklin Lakes , says she enjoys the diversity she experiences in her job , both in the population she serves and the ages of her patients . “ Everyone from the very underprivileged to the extremely wealthy fit together inmywaiting room ,” she says . “ A patient can be someone from Saddle River , or from Paterson .”

She says she feels as though she

grew up with many of them . “ I ’ ve had four generations of the same family in my practice ,” she says .

Being familiar with extended families is an important part of keeping them healthy , she says . “ I know their cousins , their aunts and uncles , so Ican see the dynamic that can be underlying a medical condition . If I know how they cook , Ican see why they might be diabetic .” This gives her a diagnostic advantage to someone who only sees apatient once , or only occasionally , she says .

Tuppo says that in her experience , geography determines the way family medicine is practiced . Though family physicians are trained to treat everyone , they ’ re more likely to deliver and tend to children in rural settings , where doctors are scarcer . Here in the Northeast , it ’ s more common for family doctors to see patients starting at 16 .

Many of the challenges of Tuppo ’ s job — the hours devoted to maintaining records and billing , the endless faxing — are common to the way medicine ispracticed today . But they ’ re compounded because she ’ s a solo practitioner , she says . Before doctors pooled their practices so they could better bargain with insurers , it was more common for them to work on their own . Now , she says , “ We ’ re

dinosaurs , because you have no negotiating power . It ’ s like being a small mom and pop convenience store .”

But on the positive side , not being owned by another entity allows her to spend more time with her patients . “ I can enjoy my patients and ask about their lives , as opposed to having someone buzz me every 10-15 minutes ( to see another patient ),” she says .

She has made a personal concession , and joined a billing group so she doesn ’ t have to handle it herself . But this , too , limits her in the way she chooses to practice .“ Before I could easily write off if someone can ’ t pay ,” she says . “ Now it ’ sharder to keep a handle on that .”

Tuppo says she would consider merging her practice with another if she felt she could still have enough independence . In the meantime , she concedes that she works long hours , but the joy she experiences in her job makes up for it . “ When Iwalk into the office , I smile ,” she says .“ Prior to COVID , when I would see my patients outside the office , they would tell my kids ‘ She ’ s my doctor .’ They let me hold their babies . What other job would allow me to take someone ’ s most precious assets , for them to give them to me like that ?”

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( 201 ) HEALTH 2022 EDITION 11