Today’s blog is again a departure from prostate cancer. One can only blog about prostate cancer for so long you know. What I wanted to do today was to introduce to our Jewish Times community a personal friend and colleague who has taken over as the Chief of Urology at Sinai Hospital. He is just about to leave Chesapeake Urology, a large single specialty group in Baltimore, and is transitioning to being part of the Sinai community of employed physicians and the senior urologist in The Center for Urologic Specialties. Mark Redwood is an outstanding surgeon who is well known throughout the community at large, but more importantly from my perspective he is an outstanding person. Frankly, that to me is just as important as his surgical skill. And while I would not want to be seen by a surgeon who had no technical skill but was a “great guy,” I think that the era of the surgeon who has all the technical skill in the world but has no good communicative skills is rapidly closing if not already gone.

Dr. Redwood went to Pikesville Sr. High School and graduated in 1977. He lettered in football (where my Milford Millers routinely beat him black and blue), wrestling and baseball. He graduated from Johns Hopkins University in 1981 and completed Brown Medical School in 1986. In 1983 – 1984 he completed a one-year rotation in Tropical Medicine at the University of the West Indies. His General Surgery training was completed at Sinai Hospital in Baltimore and his residency at Mt. Sinai Hospital of NY in 1992.

He joined the Sinai group of Cohen, Berger, Jaskulsky and Epstein in 1992. 1996 started the mergers of the local Baltimore groups into what is now known as Chesapeake Urology, which is one of the largest single specialty groups in United States. In May 2009, he became the Chief of Urology at Sinai Hospital replacing Dr. Steven Cohen after 30 years of exemplary service. Knowing both of these urologists personally, I can say that Steve has left a rather large void to fill given his tenure and accomplishments and that Mark Redwood is one of the few urologists in our area capable of filling Dr. Cohen’s shoes.

Dr. David Gordon is joining Dr. Redwood in leaving Chesapeake Urology and becoming the basis of The Center for Urologic Specialties at Sinai Hospital. Our group, Advanced Urology Associates, also considered Chesapeake Urology. However, we decided in the long run that our small group interests were better served by merging our practice into Carroll Hospital Centers burgeoning group of hospital owned practices. This is a decision that many small and mid sized groups are strongly considering given the changes coming down the road with the passage of ObamaCare.

I asked Dr. Redwood what prompted leaving such a large group such as Chesapeake Urology and joining a hospital?

“It is very difficult to get forty urologists to consensus much less forty physicians to agree on a common approach. The result is that all decisions (both good and bad) are made by one or two governing individuals. The best analogy I can use is that the man who invented Haagen Dazs ice cream no longer runs the company. Why is that? He no longer felt that he could provide the same quality ice cream as he did when it was a much smaller company.”

“The misconception about mega-groups is that there are economies of scale and that in theory this should allow the group to save money and provide better service. In my experience over the last few years, this has turned out to be false. Chesapeake Urology is spread out all over the state. It has become very generic. Patients in Baltimore and surrounding counties like to get their care locally. They have never driven long distances for specialty care. Chesapeake Urology is becoming a franchise operation not unlike branch banking. But in my opinion, it has lost sight of the truism that it is not the doctors that make medicine special, but the relationship that the individual doctor has with the patient that makes the administration of medical care special and unique. I want to get back to a group that has a certain stature within the local medical community. There was an intimate relationship between the specialist and the referral physician. We need to return to that.”

Personally, I agree with Dr. Redwood, but on even a larger scale. I believe that the changes pushed on medicine by the passage of the recent health care legislation are detrimental to the personal relationship between the doctor and the patient. Medicine is becoming less an art and more like following a cookbook. The problem is that the government writes the cookbook and in a language that no one can understand.  For years the government has slowly insinuated itself between the doctor and the patient. The changes proposed in this legislation will not only codify this into law, but will make trust and honesty in the doctor patient relationship very difficult. The government will be giving strict guidelines on treatment patterns and options for various diseases, which were written into law by “panels of experts.” These “experts” are not necessarily physicians and are not necessarily experts in the field they are overseeing. Finally, these expert panels are more interested in cost containment than patient care.

As you can see, these “battles” are being played out throughout the field of medicine and across the United States of America. Whether it is within a small group such as Advanced Urology Associates becoming part of a community hospital like Carroll Hospital Center, a very large group such as Chesapeake Urology thinking that being larger will help them fight for better reimbursement, or between the federal government and states on how best to provide care for their citizens, these are the major issues dominating the discussion in medicine in today’s world.  The question of, “What will medicine in America look like in 10 years,” is not only a very difficult one to answer but one that will have far reaching implications in the delivery of care during the aging of the baby boomers. The age of the solo practice doctor is drawing to a close. The question is whether or not small groups will still be viable, or will we all either belong to a mega group or be part of a hospital physician coalition.

We will address some of these issues in the completion of our blog discussing medicine and urology with Dr. Mark Redwood next week. Thanks to Dr. Redwood for taking the time to answer my questions, and hopefully our reading group found the topic interesting and informative.