South Florida Hospital News
Tuesday June 18, 2019
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January 2019 - Volume 15 - Issue 7

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A Message from David N. Kenigsberg, M.D., President, Broward County Medical Association 2018-2019

The BCMA is an organization that I joined shortly after starting my practice in July of 2007. I was encouraged to join by physician colleagues such as Dr. Barry Galitzer and Dr. Nigel Spier.

Early on, I met Dr. Octavio (Tony) Prieto (who is no longer with us) who, in his very unique way, expressed to me the importance of organized medicine. To paraphrase him, he said, physicians need to stick together, because at the end of the day, no one else will stand up for us or our patients. At the time, I really didn’t fully comprehend his message, but as I get older, grayer and wiser, I have begun to understand what he was trying to express to me at that time.
 
In the more than 10 years I have been in practice, I have witnessed many dramatic changes:
1. The requirement for physicians to transition to EMRs, then HL7 compliant EMRs, forcing doctors to spend lots of money and resulting in hours sitting in front of a computer screen/a barrier between us and our patients
2. The annual reduction and bundling of our reimbursement
3. The passage and implementation of the Affordable Care Act aka Obamacare and its resultant high deductible plans
4. A movement away from private practice and toward physician employment models by hospitals, insurance companies and other corporations
5. The renaming of physicians as “Providers” while naming of nurses as “Doctors”
6. Constant scope of practice expansion threats like pharmacists who want to diagnose illness and recommend treatment, for example
7. The pill mill debacle and its repercussions felt to this day with the eFORCE mandate
8. Designer drugs ravaging our population, with our county gaining national notoriety for the FLAKKA epidemic
9. Medical (and recreational) marijuana legalization
 
Lurking on the horizon is the confusing alphabet soup of the new payment model acronyms: MACRA, MIPS, Advanced Payment Models
 
All of these occurrences and changes, many of them occurring within the past few years, have changed the face of medicine considerably and have introduced challenges to all of us who practice. They interfere with the traditional patient-physician interaction and have resulted in an increased incidence of physician burnout and physician suicide, both of which are at all-time highs.
 
Interestingly, physician burnout and fatigue are not new phenomena. An oft-quoted phrase from the Book of Ecclesiastes (written by Shlomo Hamaelach -- King Solomon) sums this up nicely: “Ain chadash tachat ha shemesh,” which means “There’s nothing new under the sun.”
 
As many of you who know me know that I consider Moshe Ben Maimon aka Moses Maimonides to be one of the most influential Jewish scholars of all time. He was born in Cordova Spain in 1135. Until his family fled to Fez in 1159, because of religious persecution, Maimonides was a pupil of the philosopher–physician Averroes (1126–98). From Morocco the family moved on to Egypt where he practiced medicine to support his family. In 1170, when he was 36 years old, he was appointed physician to the Court of Saladin and also became Head of the Jewish community.
 
In regards to physician burn out, Maimonedes recognized it as an issue for himself:
A typical day’s work as follows: “My duties to the Sultan are very heavy. I am obliged to visit him every day, early in the morning; and even if nothing unusual happens, I do not return to Fostat until the afternoon. Then I am fatigued and hungry. I find the ante-chambers filled with people ... I converse with and prescribe for them while lying down from sheer fatigue, and when night falls I am so exhausted that I can scarcely speak.”
 
So, many of you have asked, what do I propose that we do about these challenges and obstacles that we face together as physicians? What are my goals and what is my agenda for change as the BCMA President? In other words how can we affect change together locally?
 
First off, we need to increase physician involvement and membership in organized medicine in general and in the BCMA, in specific. There are currently almost 3,800 physicians in Broward County, about 1,000 are members of the BCMA. For us to remain relevant, for us to have a voice, for us to have the proverbial seat at the table, we need to increase membership and physician involvement. I have to mention that in the past year, under Dr. Pevsner’s reign, I have seen that female physician involvement has increased significantly. I would like to continue that momentum and see membership and involvement grow.
 
In addition, I would like to organize Broward physicians to get involved in local politics as they relate to the practice of medicine in the county, in conjunction with the BCMA. I encourage our physicians to participate in the PAC. The BCMA sends delegates to the FMA meeting annually, the experience is eye-opening and demonstrates that physicians from different back grounds, different parts of the state, different specialties share many commonalities, like dedication to our patients and to our profession. It would be wonderful to see some new faces at the FMA meeting, in addition to our veterans. I would tell those of us who have yet to attend, that your individual voice can be heard and you can make a difference, but only if you participate.
 
In order to increase physician involvement in the BCMA, we need to do a better job of showcasing the benefits of joining the BCMA. Doctors often ask why should I join? Why do you participate? What is the benefit in joining? Is it worth the time commitment?
 
Despite the fact that I believe, and I trust that many of you feel the same way, that the practice of medicine is the most rewarding career that one can pursue, I do understand that there are obstacles and many things to complain about in Medicine these days, as well. However, I also believe that we can look to these challenges as road blocks or we can look to them as opportunities. If we want to begin a process of improvement, you must get involved. And getting involved at the county level is truly grassroots and gives everyone of us the ability to affect change locally.
 
Secondly, I would like to re-establish the physician as “the physician” not as a provider and as the leader of the healthcare delivery team. Words are powerful. I encourage each of you to correct anyone who you interact with moving forward and insist that they refer to you as Doctor or Physician or even Surgeon, but not allow yourself to be called “provider.” However, regardless of who you want to attribute the quote to, Voltaire, Churchill or Peter Parker’s Uncle Ben (I thought my friend Stewart Slomowitz would enjoy the Spiderman comment), I truly believe that “with great power comes great responsibility”. We as physicians have the ability to be able to improve and affect positive healing in our patients, advocate for our patients, and do right by them. We must accept this responsibility and assume our roles at the top of the healthcare hierarchy.
 
Finally, I believe we need to do a better job to address physician burnout and suicide and promote healthy habits and lifestyles in our patients. As many of you know, I am on a health kick by doing cross-fit over the past two years and more recently complying with a healthier diet.  Medice, cura te ipsum, mā-ˈdē-kā ˌku̇r-ä-ˌtā-ˈip-ˌsu̇m, a proverb used from the time of Greek playwright Aeschylus, ES KUH LUS, meaning physician, first heal thyself, is more important now than ever before. We as physicians need to practice what we preach and be mentally and physically healthy to be the best we can be for our patients.
 
I know I took the BCMA oath before, but I will add to that words from the Maimonedean Oath that should be words of guidance and inspiration for all of us moving forward:
O God, let my mind be ever clear and enlightened…For great and noble are those scientific judgements that serve the purpose of preserving the health and lives of Thy creatures. Give me the strength, the will, and the opportunity to amplify my knowledge more and more. I prepare myself now for my calling. Stand Thou by me in this great task, so that it may prosper. 

Dr. David N. Kenigsberg can be reached at dkenigsberg@flahrs.com.

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