Sunday, August 12, 2007

Take Back Our FMA

Posted on Sun, Aug. 12, 2007
Med association slowly changing
When doctors get together, the political talk tends to the conservative and discussions are generally excruciatingly polite. That means Bernd Wollschlaeger stands out.

He uses the term ''ideological knuckleheads'' to describe some leaders of the Florida Medical Association, which represents the state's doctors. He says others ''resemble chieftains jealously guarding their tribal territory'' or are ``driven by libertarian paranoia.''

He says he's speaking up now because the shrinking FMA has lost touch with its members. He says its mostly white, male leadership doesn't include enough women, minorities and doctors trained abroad.

In fact, on some points, FMA leaders say they agree with him that the organization needs to change -- and they insist that it is changing, including a shake-up at the top as the executive vice president for the last eight years is leaving.

The issue may be, however, whether the organization is changing fast enough to suit mavericks such as Wollschlaeger, a North Miami Beach family practitioner.

He is not just a kook on the fringes. He is the president-elect of the Dade County Medical Association and a member of the House of Delegates, the legislative body of the American Medical Association.


Aimed at the FMA annual convention in Fort Lauderdale in two weeks, he has launched an e-mail and blog campaign ``Take Back Our FMA Now.''

''That's ruffling a lot of feathers, to put it mildly,'' says Arthur Palamara, a Fort Lauderdale surgeon who is also advocating change.

FMA President Patrick M. J. Hutton, a Jacksonville surgeon, didn't want to say anything about Wollschlaeger. ''At this point, it's up to the House of Delegates,'' the FMA's governing body, to comment.

However, incoming FMA President Karl M. Altenburger, an Ocala allergist, acknowledges that the organization is ''in a period of transition . . . the physician community is very concerned over the next five to 10 years,'' with a huge number of healthcare reforms being discussed by politicians and other leaders, ``and organizationally we're trying to position ourselves to assist members to meet these challenges.''

Among the changes: The exit of FMA's executive vice president, the leader of its full-time staff, Sandra Mortham, who is leaving after eight years. She's a former Secretary of State and was briefly a Jeb Bush running mate.

In an e-mail to FMA leaders, Wollschlaeger wrote: ``Removal (or would firing [be] a more appropriate term?) of . . . Mortham is being celebrated as a panacea of all our problems! How naive or stupid can a leadership be to make us believe that?''

Hutton and Altenburger refused to comment about the circumstances of Mortham's leaving, and she did not respond to three phone calls from The Miami Herald.

The FMA now has about 10,000 active members -- out of about 30,000 physicians practicing in the state. The organization has led a massive, generally conservative lobbying effort in the Legislature, particularly on issues that could reduce the oft-soaring rates of doctors' malpractice premiums.

Doctor organizations, headed by the AMA, ''have a history of opposing changes,'' says Gerard Anderson, a Johns Hopkins health policy professor. ``They were opposed to Medicare, Medicaid, and they're opposed now to a national health insurance . . .

''The best days of doctors were the 1940s,'' says Anderson, ''when they could treat patients without outside interference and charge them what they felt like,'' in the days before managed care and government programs. ``And in some ways they want to return to the 1940s.''

Not Wollschlaeger. He believes American healthcare needs a lot of changes, including universal coverage, but then in many ways he's not a typical doctor.


The son of a German tank commander in World War II who had a medal pinned on him by Hitler, Bernd Wollschlaeger learned at an early age to think for himself. After a medical education in Germany, he converted to Judaism and moved to Israel, where he practiced for some years before moving to Florida.

''I have never been afraid of ruffling feathers,'' he says. ``I have some political capital, and I'm burning it . . . This is an organization that does not allow open debate.''

He believes the FMA can grow and be relevant only if the organization's leadership becomes diverse and opens itself to more ideas.

When The Miami Herald asked a half-dozen leaders and former leaders of state and local medical associations about Wollschlaeger, none wanted to say anything negative about him.

Carl ''Rick'' Lentz, a Daytona Beach plastic surgeon and a former FMA president, said, ``Physicians come from all sorts of different backgrounds, but . . . the FMA is a really good organization that is doing great things.''

Michael Weston, an emergency medicine specialist who's head of the Broward organization, said, ''I think some of the points he makes does have merit . . . The board of the FMA may not be fully reflective of the diversity of physicians in the state, especially in South Florida.'' But he was skeptical about Wollschlaeger's frontal assault. ``I don't know if that's the best way to handle it.''

Palamara, the Broward surgeon, says, 'The FMA is in a transition . . . I'm the incoming chair of membership. I went to the board of governors meeting, and I was looking at a whole row of 25 or 30 white-haired Caucasian males, and two females, and I said, `That has to change,' and we're undergoing that change right now.''

Altenburger, the incoming FMA president, agrees. ``Yes, we can do things better. People have a little trouble with change, and we have people on all sides of this.''

He insists there is diversity at the top. He points to Madelyn Espinosa Butler, a Cuban-born obstetrician in Tampa who is speaker of the House of Delegates, and Alma Littles, a black woman who's on the board of governors. He notes that Weston, head of the Broward medical association, and Nelson Adams, current president of the Dade medical group, are both black.


''We are working very, very hard to make sure there are wide open pathways for leadership for anyone interested,'' Altenburger said, and he won't object to anyone speaking out.

''In science, feathers are ruffled all the time. That's how you make advances. You know there was once a knock-down, drag-out fight about washing hands before surgery. That went on for many years,'' the FMA exec said. ``In a democracy, you can argue both sides and that will make you strong.''

Wollschlaeger says he has ''the highest respect'' for Altenburger, who ''is a positive reformer in the organization.'' But they disagree on how to go about it.

One example: The nominating process for officers. Wollschlaeger believes all the members should have a hand in the nominating, rather than the present system, ''in which candidates are groomed from the elephant process,'' in which those who do the best are the ones who hook their trunks to the tails of the elephants in front of them.

Saturday, August 11, 2007

Physicians can Take Charge of Their Practice

Dear Friends and Colleagues:
Attached an article from Sunday's Miami Herald.
I have agreed to the story to demonstrate that we as physicians can take charge of our offices, if we are willing to embrace business principles, focus on customer care and patient satisfaction, competitive pricing and the utilization of medical information technology.
Don't get bamboozled by those who suggest that Electronic Medical Records are too expensive, too intrusive and allow the "government" to take over your office.Most of those critics don't even use such systems.
I am applying an EHR in my practice for 10 years now and have learned using it as a very sophisticated tool to assess the quality of care rendered, perform chronic diseases management and to connect to my patients.
Medicine has to move into the 21st century and information technology will play an important role in this transformation process.
Let me know your thoughts and I look forward to your comments which you can post on either one of my blogs ( or

Posted on Sat, Aug. 11, 2007
Dr. Wollschlaeger redefines care
Imagine getting sick, going online to see what time your doctor is available and booking an appointment for the same day. You might wait 5 or 10 minutes. Later, if you have a follow-up question, it can be asked and answered by e-mail.

This is the family practice of Bernd Wollschlaeger in North Miami Beach. What he is doing offers a window into the problems and prospects of primary care in America.

Is there a catch with his concept? Of course.

A growing number of doctors are offering such services as part of a concierge practice, in which patients pay an annual fee of perhaps $1,500 plus charges for the various visits.

That's not Wollschlaeger's model. He charges about $65 or $75 for a basic office visit. The catch: You have to pay in cash. He doesn't accept insurance, not even Medicare.

That eliminates a huge amount of paperwork and bookkeeping, allowing Wollschlaeger to work by himself in a storefront operation in a strip mall.

''He's an excellent doctor,'' says Chris Lamonica, a North Miami Beach resident who has been going to him for two years. ``He's very thorough, and he cares about his patients. I do all my appointments online, and it works out great. He's very hands on -- no assistants.''


In the medical community, Wollschlaeger is known as a progressive maverick, supporting universal healthcare and the movement to all-electronic medical records. But in avoiding medical insurance, he might seem in a certain manner to be returning to the 1940s, before employer-based health plans and Medicare, when nothing interferred with the doctor-patient relationship.

Wollschlaeger insists that's not the case with him: He's not being reactionary, but a pragmatist. ''I am adapting to a changing market environment,'' focusing on the ever-growing number of uninsured people, who account for about 75 percent of his practice. Most others have high-deductible policies or are foreigners whose insurance doesn't apply here.

''I'm not opposed to third-party payers,'' he says, if they pay a reasonable fee for performance without insisting on a lot of paperwork costs.

The problem is that insurers pay primary care doctors in South Florida about $40 to $60 for a basic office visit and insist on considerable justifying paperwork. Some doctors try to survive by hiring physician assistants and bookkeepers, and race between examining rooms seeing as many patients as possible to make the low pay work.

Wollschlaeger has gone the other way and simplified: ``I am surviving in a changing marketplace and waiting for a time when the pay structure has a reasonable price.''

After immigrating from Israel, Wollschlaeger did his residency in family practice at the University of Miami, was briefly the medical director of a homeless shelter and then went to work for a physician practices company that wanted to establish an office in Aventura.

That didn't work out. Wollschlaeger said the company didn't understand how long it took to build up a primary care practice. He bought the practice from the company. ``I didn't know how to run an office. I took management courses, read books.''

As both doctor and businessman, he believed the key question was ''how can I make medicine better? It's like asking how does Toyota make better cars.'' The answer, he decided: ``Pay attention to detail and pay attention to customers.''


While many physicians gravitate to upscale neighborhoods to get well-off clients, Wollschlaeger decided to move to a blue-collar section of North Miami Beach, to be closer to the under-served and the uninsured. He did, however, keep the name Aventura Family Health Center.

He sees 90 percent of his patients the same day they call up. ``Timely service with the right price -- there's nothing wrong with that.''

For him, better service often means the Internet, which he knows can often make communication faster and easier in answering routine questions and requesting refills of prescriptions.

If patients want, they can e-mail him through a highly secure server operated by Medem, a tech company ''connecting physicians and patients.'' For that, he charges $15 or $20.

But the vast majority of patients simply use regular e-mail, and for that he doesn't charge. Nor does he charge for sending a PDF file of lab results.

Underlying all these services is Wollschlaeger's belief in the absolute necessity for electronic medical records, which he has been keeping since the mid-1990s.

Electronic records can be sorted and measured in so many ways that he believes they take healthcare for a new level. When warnings went out on Vioxx, for example, he could do a simple sort on his computer to find patients taking the drug and alert them with e-mails or phone calls.

Gerard Anderson, a public health professor at Johns Hopkins, says many doctors are resistant to electronic records because they're required to take on all the costs while the insurers benefit the most, because of the ease of processing claims data. ``Buying the software, buying the computer and then there's the conversion from paper to electronic. That's a huge cost.''


Wollschlaeger acknowledges there are expenses. Last year, he spent about $6,000 to update his computers and software. But he insists doctors need to do that. ''You cannot whine. To make money you have to spend money.'' Postponing electronic conversion -- and many doctors are postponing -- ``your practice only gets worse.''

He believes the costs of conversion from paper are exaggerated. ''Look at the banking industry,'' once based entirely on paper checks. ``They went to online payments, online facsimiles of checks. If they can do it, why can't we?''

He says healthcare is ''generally an ineffective and inefficient industry,'' but he's not trying to change it in order to make a ton of money.

''I did not choose medicine to get rich,'' he says. His gross adjusted income in 2005 was $121,000. He drives a Honda Accord with an Obama bumper sticker. ``I have a very satisfactory lifestyle.''

Monday, August 06, 2007

Take Back Our FMA - Phase II

Dear Friends and Colleagues;
In my previous e-mail I summarily expressed my concerns about the state of affairs in our FMA.
Ever since I received many e-mails and the overwhelming majority of those responses were POSITIVE and SUPPORTIVE. I want to thank all of those who have come forward with their concerns and am grateful and honored to call you my friends. I forgive those who called for my immediate resignation from all FMA positions or cautioned me to keep my mouth shut. Obviously, I won't follow their "advice" but look forward working with them in the future cognizant of the fact that we can agree to disagree.
I also had the opportunity to speak with past and present senior FMA leaders and listened to their point of views and reaction to my opinions expressed
Based on all of the above and on the input provided by so many of you I can only reach the following conclusions:

1. The FMA leadership is embroiled in an intractable battle with its political action committee (FLAMPAC). Its a typical case of the " tail wags the dog" syndrome.This situation has to be remedied immediately! We elected our FMA leaders to lead the organization and NOT the FLAMPAC Board !
2. The termination of our EVP Sandy Mortham has been planned and executed by a small group of senior leaders. As a result of the premature termination of her contract the FMA faces ~ $650,000 in total expenditures to buy out her contract, which represent about 10% or our reserve fund. The other option would have been to work with Sandy until the end of her contract, allow her to participate in training a new EVP and to at the end to thank her for her years of dedicated services. I know Sandy for several years and I have the highest respect for her superb performance. Based on all of the responses I received and the facts provided I can only conclude that our Executive Committee and the BOG have violated the principles of their fiduciary responsibility and potentially have caused grave harm to our organization. They have to face the consequences of their actions and the HOD should reach a decision regarding their positions within our organization.
3. The leadership structure and the decision making process is obscured and clouded in secrecy. Several e-mail responses referred to it as follows "Those in leadership have lined themselves up for the FMA Presidency for about the next 6-7 years—and they do it by not challenging anything that anyone else does, no matter how egregious the activity might be.
"....this group does everything in the back room behind closed doors—snipe and gripe. They are unwilling to let their ideas see daylight until they have lined up a group of “yes” people on the BOG..."
4. Policies are not being determined by our FMA HD but the BOG and our leadership. Several e-mails referred to it as follows:
"...In our delegation we were told by leadership that the entire agenda and the leadership in the FMA the next 5 to 10 years has been decided. This was said as if this was a virtue with no understanding on how demoralizing it was to our members. The most common statement was "why am I participating?"


1. Our FMA must and will return to the following principles of organizational management:
* Accountability of its leadership
* Transparency of the decision making process
* System of checks and balances and reestablish democratic principles
* NO MORE secret deals and "behind the closed doors" decision-making.
2. Prior to upcoming FMA meeting I call for the introduction of the following resolutions:
* Creation of a Nominating Committee to provide a slate of qualified leadership candidates
* Creation of a committee investigating the circumstances and the impact of our EVP's termination . This committee should be comprised of senior CMS leaders from throughout the State.Current BOG or Executive Members or recent Past Presidents should be excluded.
Committee Task: Taking statements from Executive members, BOG members, review of internal audit committee material, etc.
A report should be generated and submitted to members prior to the HOD meeting. This committee should have top priority, work expeditiously and its recommendation should be binding.

I have initiated this discussion because I love our FMA, recognize its importance as an umbrella organization for doctors in Florida, and have been a humble servant for > 10 years.
But now its time to change and I call upon all of you to take collective responsibility in this herculean effort to reform and restructure our great FMA.
With your support we can achieve it. Each individual member will play an important role in this process and I hope by doing so we can send a signal to many other doctors to join or rejoin the FMA.
I will continue to fight for the interest of our docs in Florida and will continue to serve this organization.
Please help and support each other in this task. Its worthwhile the effort!

Yours truly,


Friday, August 03, 2007

Take Back Our FMA

Dear Friends and Colleagues:

As we are getting ready for our Annual Meeting in Hollywood I want to use this opportunity to share some of my frustrations and suggestions regarding the sad state of affairs of our FMA.

As a member and humble servant of our FMA since 1994, after years of service on several committees, Chair of the CME committee, Delegate to the AMA, and representing the FMA on state level and contributor to educational initiatives throughout Florida I have reached a point of where I cannot stay silent anymore.

Our FMA is in crisis! Those of us who do not want or cannot see it must wake up!

What are the problems?

1. Continuous and intractable infighting within our leadership which has shattered our FMA into factions spearheaded by “leaders” who resemble chieftains jealously guarding their tribal territory (FMA vs. FLAMPAC etc.). As a result our FMA has lost its standing among members and non-members alike.
2. A Board of Governors comprised of members who DO NOT resemble the face of our FMA. Women now constitute over fifty percent of all physicians but only TWO women are represented in leadership positions. International Medical Graduates and Minorities constitute more than thirty percent of all doctors but NO designated positions are allotted for them.
3. The leadership style of former and current FMA leaders resembles an authoritarian directive driven modus operandi. Critical, constructive and open discussion is being discouraged and even suppressed. Critics are being shouted down and criticism is being frowned upon if it does not represent the “official” party line.
4. Ideological knuckleheads are being promoted to leadership positions because they endorse a paradigm of political thinking that fits into the black-and-white world view of our leaders. For example, in a pamphlet authored by one of those “aspiring leaders” medical information technology is being depicted as the devils cure for our health care system because they “ provide easy to manage information to the government and others who use the data to rate doctor’s compliance.” I invite the clueless author to visit practices which have successfully implemented such systems and reaping the benefits. Furthermore the author alleges that “ real solutions to the economic problems of cost control may lie in economic empowerment of consumers through tax-protected HSA’s linked to high-deductible health insurance.” Such” solutions” may suit a certain segment of our populations but it will provide for most others the final nail in their coffin of financial unmanageability. Driven by libertarian paranoia such positions will move our FMA toward the extreme political spectrum unable (or unwilling) to reach consensus with other healthcare participants (i.e. employers, government, insurance companies)

5. Aggressive membership recruitment drives have been conducted within certain counties WITHOUT inviting or informing the local county medical societies. The intent was and IS to siphon valuable membership dues from local physicians into the FMA coffers. Now, with dwindling FMA membership we suddenly witness the revival of the “ unity principal” to reunify our organization. What’s the motivation? $$$$$ and not unity!
6. Removal of our EVP Sandra Mortham is being celebrated as the panacea of all of our problems! Interestingly, the details of her departure are still being concealed in a cloud of secrecy. How naïve or stupid can a leadership be to make us believe that? The above listed problems are related to the system and structure of our FMA and not the result of the action or inaction of ONE person! I want to thank Sandra for all the years of her dedicated services!

I guess the above litany of complaints is enough for now and will definitely provide sufficient gun powder for those who want to fire or neutralize a critic like myself.
Well, make my day and go ahead!
But I have not given up on our great Florida Medical Association still comprised of dedicated and hard-working men and women whom I love and respect.
CMS executives who have dedicated their professional lives to their organization.
Fellow colleagues who work hard to improve education and medical care within our profession. Committed doctors who silently but persistently work in various committees to improve the relationship with the Center for Medicare & Medicaid Services, the management of their respective hospitals, consumer and employer groups, unions and diverse state entities.
Let’s rise from the ashes and work together to accomplish the following goals:

1. Wrestle our FMA from those “leaders” who consider their leadership positions as the reward for time served.
2. Establish a “Take Back Our FMA Now” initiative to reform our organization and return it to whom it belongs: the members.
3. Force the present leadership to drop their photo ops and speeches and meet those they supposedly represent: our members. Compel them to meet with member and non-members throughout our State of Florida and LISTEN to their needs and wants.
4. Measure our leader’s quality by assessing their ability to tolerate criticism, their capacity to base their opinion(s) on facts and reason, and their willingness to reach a solution based on compromise.HOLD THEM ACCOUNTABLE FOR WHAT THEY DO NOT WHAT THEY SAY THEY WILL DO!!!
5. Restructure and rejuvenate our Board of Governors to reflect the diversity of the physician’s workforce.
6. Establish or re-establish relationships with other organizations and healthcare entities to influence their decision making and strive towards common interests based on practicality and reason and not on ideology and political correctness.
7. Reunify our FMA first before we consider reunifying organized medicine.
8. Demand the cessation of petty infighting and identify those who fan the flames of discontent.

Those proposals may be considered as the lofty ideas of an angry individual.

I want to emphasize that I am motivated by the dedication for the continuous existence of our great organization and not solely by anger.

But anger helps to express what I really feel.

If my suggestions fall on calcified and deaf ears then I will continue raising my voice!I will NOT STOP until CHANGE occurs

I know that colleagues and friends may hurry to distance themselves from me but some will stand by.

Some may call for my ouster from committee positions but I do not care. I care for the future of our FMA and not the bruised EGO of some FMA head honcho.

I urge you to start taking back our organization from the political apparatchiks and return it to the docs in the trenches.

Ask questions and DEMAND answers!

Now is the time to change. Are you ready?

And by the way if you choose to respond to this e-mail please have the virtual balls and integrity to identify yourself.

Yours truly,

Bernd Wollschlaeger,MD


Phone: (305) 940-8717