Statesmanship in medicine

Soon, medical staff meetings devolved from case discussions and arguments about optimal medical care to analyses of the cost of care. Even the meetings within our four-person group began to focus more on increasing our revenues and reducing expenses than on challenging cases or medical innovations.

The Health Insurance Portability and Accountability Act was signed into law in 1996, increasingly burdening department chairpersons and administrators with demands for formal protocols and proof of compliance. Drilled into the minds of doctors and administrators alike were a litany of new regulations, cost-cutting measures, and warnings of the dire consequences facing us individually and as a profession for failure to toe the line. Never before had there existed such an atmosphere of onerous regulation coupled with the threat of professional annihilation.

And yet in 2004, with all these mandates securely in place and more coming in daily, with physicians across the nation relieved of the burden of self-governance, I was about to learn that statesmanship in medical leadership-a concept I had thought dead and buried-did, in fact, exist.

That year, I was invited to apply for a clinical teaching position at a major university's medical school. A clinician in private practice my entire career, I didn't think I had a shot at it. But the work being done by a respected colleague in her revolutionary midlife health center, and the prospect of practicing alongside physicians who merged clinical care with research and teaching at a venerated institution of higher learning, attracted the idealist that remained alive within me. I applied for the position and was accepted.

I met department chairman William Herbert, MD, now professor emeritus, in his office in a lovely old brick building-the original hospital-adjacent to the university's state-of-the-art medical center. Like Bill himself, the office was warm and welcoming. Resembling a study more than a formal business office, it was a testament to scholarship and invited conversation and debate.