Installation Speech - April 2, 2011

Richard T. Scholz, M.D.

 I would like to welcome you to the Annual meeting and to the Fire Museum of Maryland.  Neilson and I canvassed the county last spring looking for a suitable place to hold the meeting and like buying a house, everything that we liked we could not afford and everything that we could afford we did not like.  I thought of the fire museum as I brought my children here when they were little, and my brother Bob and I attended elementary and high school with the Heavers who founded the museum.  When we saw this place, we thought that it was hot and it really set us on fire – If you are bored by my speech there are many interesting diversions for you. 

Of course the most thanks go to Neilson Andrews, the longtime executive director of the Association who is the driving force behind the entire Association.  The entry position as an officer on the board is that of secretary.  A few years ago I volunteered  to be the secretary of a community organization that met monthly – with pad and pen in hand, I jotted down notes at each meeting and spent considerable time the following day transcribing my notes into detailed minutes and emailing them to the organization.  As secretary of the BCMA, I would attend the meeting and receive an email from Neilson the next day with a copy of the minutes asking me to approve them.  She even offered to write this speech.  After you hear it, you will wish that she had. 

I want to welcome my family – my wife Kane and our children Elly and Taylor as well as my sister Martha, brother Bob and their spouses, Greg and Rebecca.  The usual lawyer jokes have to be omitted because my table looks the Maryland Bar Association annual meeting.  Both of my siblings in attendance are attorneys and Martha’s daughter is in law school.  None of them practice personal injury law and Martha’s daughter has demonstrated a commitment to advocating for the underserved.  I am sorry that my parents are both deceased as they were long term members of MedChi and the Baltimore City Medical Society.  My mother only missed this by a year having died last year at the age of 93.  It seems astounding that I was her guest at her 65^th medical school class reunion just a few years ago and that I graduated from medical school a mere 32 years ago.  I would like to welcome Alan and Claire Jensen who have been close friends of ours for many years.  I had the honor or practicing part time with Alan when I was first in practice.  Alan has been president of every organization worth being president of including The Baltimore City Medical Society and my specialty society, the American Academy of Ophthalmology. 

The first meeting of the BCMA was held in 1897 at the Grange Hall in Towson.  Thanks to Tom and Carol Allen, I found out that this is now the site of law offices at the corner of Bosley and Allegheny avenues only 1.2 miles from where we sit today and 500 feet from our Towson office.  The Hall was torn down in the early part of the 20^th century and replaced by a structure that was again torn down to make way for the current building.

They wanted to hold meetings in places that were accessible by steam or electric cars, obviously meaning the train or trolley, not the Nissan leaf. There were no medical hospitals in the county but there was a psychiatric hospital –Dr. Roca’s institution, the Sheppard and Enoch Pratt Hospital.  The dues were two dollars a year.   

I would like to address the reasons for such an organization.  The 18 founding members wrote the following preamble: 

"We, the undersigned Physicians and surgeons of Baltimore County, persuaded of the advantages of professional intercourse for the diffusion of knowledge, and the cultivation of friendly relations, hereby, constitute ourselves an Association for the Constitution and Bylaws, and by the Code of Ethics of the American Medical Association." 

Note that there is no mention of organizing for purposes of influencing legislation, fighting insurance companies or tort reform.  Ethics are mentioned which is something that I will return to. 

What has happened since 1897?  Advances in medicine and especially in technology have been both a blessing and a curse.  The increasing and complexity of delivering health care has led to layers and layers of accountants, lawyers, administrators and government officials between physicians and patients and even between physicians who compete with each other for the health care dollar.  This has led to a loss of the collegiality that once provided a driving force behind the practice of the art and science of medicine.  A collegium was defined in ancient Rome as any association with a legal personality – collegiality for our purposes refers to the responsibilities and obligations of physicians to one another and their profession.  In the words of The American Academy of Ophthalmology, such activity “promotes constructive interaction of physicians, defines and maintains performance standards, ensures high quality of medical care, creates technical and behavioral rules for the profession and requires close and continuing relationships with colleagues." 

This is from a course on ethics - collegiality is considered crucial to the individual’s understanding of how his and her profession operates, not just in an academic and technical sense, but also in the everyday relationship with patients and other physicians. 

It was once a matter of course to join one’s medical society.  I think that a variety of forces have contributed to the decline in membership – the balkanization of medicine into competing specialties and subspecialties, the involvement of government and business into the day to day practice of medicine and the rise to prominence of generation X, those who wish to have a less chaotic and unpredictable life style than medicine has had to offer in the past. 

Although one could argue that it is more important than ever that physicians unite as a voice in the ongoing debate over healthcare delivery in our country, it is also important that physicians engage in the activities described in the preamble cited above - close contact for the exchange of ideas and the development of friendly relations so as to develop common commitment to the health and well being of patients and the community.       

Our Association has a long and proud history of community service-volunteering to perform school physicals, volunteering at various clinics for the uninsured and being active advocates for patients and physicians in Maryland.  The list of such activities is long and I will not list them here but let it suffice to say that BCMA members volunteer in the community and internationally not only in medicine but also in lay organizations such as the boy scouts. 

While I cannot lay out a plan that guarantees’ increased reimbursement and reforms tort law, I do plan to encourage  membership at all levels, especially among those who are in the early years of their careers in medicine to support collegiality and to further the practice  of medicine.   

How can this be done?  I hope to follow the examples set by some other medical associations in the state that hold social and educational gatherings for young members so that they can develop collegial relationships and consider organized medicine as a noble and worthwhile endeavor.  This is consistent with the Baltimore County Medical Associations stated intention to encourage younger members to pursue leadership tracks.  It remains part of our agenda to codify a system of succession that allows younger, willing candidates to seek office in Med-Chi.  Hopefully it will follow that the more mundane and concrete responsibilities of advocacy for patients and physicians – for healthcare in general will follow. 

The practice of medicine is a wonderful profession to pursue.  I am not a physician who says that he would never encourage his son or daughter to choose a medical career.  I think that it is a profession that is always interesting and gratifying and one that offers an infinite variety of choices. 

Today’s medical students assume immense debt to pursue medicine – of those graduating in 2010, fully 30% have debt of $200,000 or more and 13% have debt that exceeds $250,000 not an obligation that one would take on lightly.  Obviously, it takes an idealistic view of the profession to enter it knowing that you will have no income at all until you are in your mid to late 20’s and that most of this will go towards debt repayment.  I have recently been shadowed in my office by a young woman who is several years out of college and is attending medical school next year.  As there are slightly more than two applicants for every space in medical school, she applied to numerous schools at a cost of $5,000 in application fees.  Her interest is genuine and heartfelt.  I have taught medical students at Hopkins for over 25 years and have been impressed by the students that I teach for the same reasons - they are pursuing something that they see as a calling.  It is actually their attitude and enthusiasm that makes teaching such an enjoyable experience. 

I hope that by cultivating camaraderie and involvement with the art and science of medicine as it proceeds through times of unprecedented change, we can uphold the words of Hippocrates Wherever the art of medicine is loved, there is also love of humanity.