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PRESIDENT’S
MESSAGE

Physicians

Must Lead

By Gerald Q. Greenfield Jr., MD, PA, 2020 BCMS President

It is my pleasure to serve as the elected President of the bexar the hospital, is
County Medical Society in 2020. I wish to thank those who ex- an ongoing
pressed their confidence in me by electing me to this position. I challenge. While
will endeavor to provide my best efforts in leading this organization there is value in
during my elected year and leave a legacy of which you can all be managing clinical problems that occur after midnight, the oppor-
proud. The concept of leadership is very important to me. tunities to do this in residency training are more limited now than
Physicians must lead. We must lead intellectually, socially and in the past. In this quest for knowledge, books and computers
in work ethic. lately, we as physicians have abdicated our leader- should be adjunct but not absolute. Facts and techniques for patient
ship role to physician assistants and nurse practitioners. There care are honed by experience gained during residency training.
are many reasons for this situation. As payments by insurance There is the tendency, as physicians work with mid-level
carriers and other payors decrease there is a requirement for a providers, for the knowledge and skill levels to normalize. In this,
higher volume of patients to be seen. However, we must still the knowledge of the physician remains static or decreases in
strive to maintain quality. comparison to the knowledge of the mid-level provider. As this
We as physician leaders must provide direction for patient care. occurs, leadership cachet decreases as there is no perceived dif-
However, we must never neglect the hands-on requirements of ference in the skills of the physician compared to those of the
direct patient care. We must strive to be involved in this direct care mid-level. leaders must continue to train, educate and improve in
as often as possible. Advances in technology are an enticement to both knowledge and hands-on skills.
separate ourselves physically from the patients for which we pro- The mantle of leadership may weigh heavily on the shoulders
vide care. Techniques which are now becoming more popular, of physicians. It is, however, a weight whose rewards far outweigh
such as telemedicine, encourage care from afar. Care from afar, the strength required to carry the load. The skills of a leader must
when there is a choice, will continue to provide a basis for patient be constantly honed by both formal and informal education and
practitioners pay and will increase their separation. The end result training. Only through continued training can we as physicians
will be displacement of physicians and replacement by other so- continue to lead. Those who failed to take up the mantle of lead-
called mid-level providers. ership will be relegated to a position of lowered respect and low-
Medical and scientific knowledge is gained from experience oc- ered importance to society. Each of us have sacrificed to reach
curring over the breadth, and depth of involvement in direct pa- this level; let us all strive to continue to lead and to provide an ex-
tient care. Physician training occurs over 7 to 12 years after ample for those who follow.
baccalaureate completion. Training for mid-level providers is a 2
to 4 year process. This results in a difference in the knowledge Gerald Greenfield, MD, PA is an Orthopedic Surgeon in Bexar County
and skill level of the practitioner. The increased amount of knowl- and is the 2020 President of the Bexar County Medical Society.
edge required, coupled with the changes in physician training in

8 San Antonio Medicine • January 2020