Three life lessons

By George Hruza, MD, MBA, April 1, 2019

I am honored and humbled to lead this great organization. I want to thank Dr. Suzanne Olbricht for her strong leadership over this past year and for being the force behind the Academy’s new strategic plan. It is a superb plan: Timely, focused on the big issues, and I look forward to bringing it to life.

For me, serving as the Academy president is a culmination of years of working to strengthen our specialty — which has grown in importance dramatically over my career. I’ve progressed through leadership roles at the St. Louis Metropolitan Medical Society, the American Society for Laser Medicine and Surgery, and the American Society for Dermatologic Surgery. At every milepost, the AAD was there to amplify our voice on behalf of our professionals, our specialty, and our patients. 

But there’s something I believe is even more important than my 30 years as a dermatologist — 21 years of teaching dermatologic surgery and two decades in leadership roles. After all these experiences, I still love taking care of my patients and I want to help all dermatologists continue to have a fulfilling professional life in dermatology. It may sound corny, but I believe in the joy of dermatology!  

Through its educational programs, practice management support, and advocacy, the Academy is here to help us maintain, increase, or recapture that joy. It does that by helping us make the absolute most out of those moments when we’re with our patients. I intend to keep it that way!

I’m very sensitive to anything that intrudes into the doctor-patient relationship. A couple of years ago, I told you about my experience with my adenoids. Let me tell you about another. I grew up in the Czech Republic under government-controlled health care. I have vivid memories about how such a system operates. My uncle, a prominent attorney in Prague, developed renal failure at age 51, and died from renal failure at age 52, because the government refused to pay for dialysis for anyone over age 50. With that memory vividly in my mind, I firmly believe that health care decisions should be made between a patient and their doctor.

I would not be here were it not for many powerful lessons throughout my life and my career. I’d like to share three lessons that stand out – from my mother and from one of my greatest teachers and mentors.

My mother survived the Holocaust through a death march, concentration camp, and typhus. Her parents and all four grandparents were gassed in Auschwitz. At one point in her ordeal, she had forgotten what her mother’s face even looked like, and she wished to live for just 20 more breaths to try to remember her mother’s face. That determination to live allowed her to survive and has always served as inspiration for me to never take life for granted. 

So, my first lesson is to try to live every day to its fullest with no regrets. That’s the spirit I will bring to this job. And for all our strengths as an organization, we need to build on the work of Dr. Olbricht and my predecessors to modernize the AAD. We’re viewed, not unfairly, as a supertanker: Good once we get up ahead of steam, but not so easy to turn. We need to be more like a speedboat: More nimble, more responsive, and more proactive.

Part of our work on the Strategic Plan is to go through every single AAD program, deciding:  if it’s great, put more resources behind it … if it’s ok, maintain it … and if it’s neither, deemphasize it or, dare I say, “sunset it”. I look forward to working with Dr. Henry Lim, who will lead this effort. That kind of periodic pruning is critical, because we all know that in big organizations, it’s hard to change course.

At the same time, our website has built up a lot of barnacles over time. It can be difficult to navigate so we are in the process of modernizing and relaunching the AAD website. We are also reimagining our Summer Meeting.  We’ll take more risks — moving from traditional lectures, to trying more entrepreneurial things — all to help us be more nimble and relevant. The more we can increase our pace, the more responsive we can be to our members.

The second lesson I want to share is from my laser fellowship director, Rox Anderson. Rox — the Godfather of modern laser and light technology — is a human “Google.” His enthusiasm for anything in science and medicine is infectious. He taught me to believe that no problem is unsolvable. You just need to think creatively. That’s why I want to reinvigorate our state efforts, because so many things that affect our day-to-day practice are at the state level, such as scope of practice, truth in advertising, badge laws, prior authorizations, and step therapy.

These are not new issues. We know that non-physician clinicians are an important part of the dermatology care team, and we also know that the unsupervised non-physician practice of medicine poses a growing threat to patient safety. I know you have your own horror stories.  I saw a patient who went to a medispa without any physician supervision to have her tattoos faded. She was treated with the wrong light source at the wrong settings, resulting in third-degree burns complicated by infection that required hospitalization. She was left with tattoos that have numerous hypertrophic scars superimposed on them.

That was 10 years ago, when I was president of the St. Louis Metropolitan Medical Society. So, although we’re a national organization and these are state issues, we can and will encourage and help our state societies to do more. I’m going to hold a retreat of state dermatology society leaders to get them excited about taking on these issues.

Becoming engaged in the process — and especially getting our patients involved — is a force-multiplier. In St. Louis, UHC Medicare Advantage decided to narrow their network and terminated 60% of the independent private practice dermatologists — leaving many patients stranded without the physicians that they have seen for years or even decades. With the help of my patients, I was able to get front page coverage of the issue in the St. Louis Post Dispatch and on local TV and radio stations. A number of my patients wrote to UHC, CMS, and their members of Congress. When I visited my members of Congress that year, they were keenly aware of the issue and had introduced legislation to address some of the most flagrant abuses. Some of the terminated dermatologists in St. Louis were even reinstated into the network.

It’s through speaking up and becoming involved in the process, and getting our patients involved as well, that we can have a meaningful impact. 

As my colleague Dr. Brett Coldiron likes to say, “We can be seated at the table when key decisions are being made, or we will be on the menu.” The choice is up to us.

Finally, you’re going to hear me talk a lot about unity, because I believe it’s the linchpin of our success. As Abraham Lincoln said, “A house divided against itself cannot stand.” We have many debates — even some conflicts — within our house. Of course, debate is healthy, as long as it’s in our house and not in the face we show to the public.

Perhaps there’s no debate more fundamental than whether we’re an organization for dermatologists or dermatology. Of course, each of us wants to know that the AAD is working for us. But in survey after survey, members say the reason they belong is to feel part of something bigger than themselves. We feel pride in being members of the AAD — not because we can get good bills passed, but because of the good work we do for our patients.

Another challenge on the horizon is the arrival of artificial intelligence (AI) in our space. A recent paper suggested that an AI computer program can identify whether a lesion is benign or malignant as well as a dermatologist can, maybe even better. I know many people view this as a threat, but I believe we should embrace it as a tool that can help us provide better care to our patients. Because regardless of how much AI advances, it will not match our experience, our judgment, and the human touch we provide that patients crave. Most patients will want their care from a dermatologist, not a machine.

I will make sure that the AAD is there to support our members not only through reinvigorated advocacy at the federal and state level, but also through a beefed-up practice management center. Another initiative is a new quality improvement center that will help our members improve the care they provide their patients and help us to build or recapture our professional satisfaction and fulfillment in the quality work we do. 

We have a secret weapon in all these efforts: The fraternity and the professionalism of the AAD and our members. The AAD is here for you. All of us are stronger than each of us. I am asking you to give your time by volunteering for an AAD committee, task force, or work group, to come to the AADA Legislative Conference and to give generously to support our charitable and advocacy efforts.

One thing we really need to address as a specialty is that dermatology has the fastest rate of burnout increase in medicine. At times, it seems we’ve lost the joy that brought us to this profession.

Which brings me to my greatest life lesson: To never forget that we work in a field that brings real joy not only to ourselves, but also to so many others.

My mother came to understand this when she was 19 — in a concentration camp, of all places. One day, they got called out of their barracks for roll call.  Everybody went out to line up except for two people: A doctor and another prisoner who the doctor was performing surgery on. An SS guard came up to him and barked, “You have to go outside for roll call.”  The doctor calmly replied, “but I’m in the middle of a surgery.” The guard said, “I’ll give you a choice: Go outside and I’ll let you live or finish your surgery and I’ll shoot you.” Without hesitation, the doctor turned and went back to his surgery, sacrificing his life for his patient.

My mother saw this and said to herself, “I don’t know if I would be this courageous, but I want what this doctor has.” And she decided to become a doctor.

Fortunately, we don’t have to make such choices, but our profession is all about putting our patients above ourselves — applying all those years of study, all our hard-earned experience, all our judgment — all in the service of helping them. When we do — whether it’s removing a challenging skin cancer with certainty and reconstructing the defect with a barely perceptible scar or helping a teen at the most sensitive age clear up their acne — we provide something that can only be called “joy.”

It is a privilege and honor to represent a team of professionals who have devoted their lives to providing that joy. I'm planning on having a great, dynamic year. I invite you to join me for the ride.

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