Take Back Our FMA

Posted on Sun, Aug. 12, 2007
Med association slowly changing
BY JOHN DORSCHNER
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.

FIGHTING FOR CHANGE

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.

BREAK FROM TRADITION

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.

`OPEN PATHWAYS'

''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.