92MD

What is your hometown?

Dubuque, Iowa

What is your official title?

I have several, Dad being the top one. I am also the President of Pikes Peak Urology, PC, in Colorado Springs, Colorado, President of the El Paso County Medical Society in Colorado and Chief Medical Officer of Codeone Inc. (a medical software and reimbursement specialty company).

How/when did you become interested in science and medicine?

My seventh grade science teacher, Mr. Miller, was a very funny, articulate guy who made acid-base reactions seem exciting. He showed me that you can combine science and fun.

What interested you to pursue a career in medicine and medical education?

I decided that I liked science and I also liked helping people. Being a doctor was the best way to combine those aspects of my life.

Please highlight your major career achievements, awards, discoveries, etc.

I find it hard to "toot my own horn". I do what I do not for any sort of recognition, but because I have the time, energy and ability to help.

Having said that, I have had the distinct privilege and opportunity to work with a number of people and organizations in Colorado Springs. As a result, I was selected as the El Paso County Volunteer Physician of the year in 2006, and had the pleasure and honor to serve on the Board and be the President of the El Paso County Physicians Foundation (the charitable arm of the El Paso County Medical Society) for six years, and then serve as the Vice President and now President of the El Paso County Medical Society. I am also a member of the Quality Improvement and Patient Safety Committee for the American Urological Association, which sets and guides national policy for patient safety in urologic care.

Also, as a practicing urologist, I need to run my practice as efficiently as possible. To that end, I have kept searching for better, smarter people than myself to help me run my practice. I was fortunate enough to meet some extremely bright, experienced people who run Codeone, a specialty reimbursement company in Monument, Colorado. Since I kept annoying them to add features or provide other services so I could better run my practice, they did what anyone does if someone annoys them enough - they put you in charge of something. So, I became Chief Medical Officer of Codeone. Really, I see our mission at Codeone as nothing less than enabling the financial survival of physicians. "Practice Viability" is a term that describes just how dire the financial situation of many doctors is in 2009.

But, the aspect of my life that I am most proud of is my family, including my wife, Cheryl Marcus (92MD) and our kids, Sarah, Will and Rachel. I try to live my family life around a quote by Jackie Kennedy:

"If you bungle raising your children, I don’t think whatever else you do matters much."

I try, but don’t always succeed, to be a good husband and dad. And, I thank my family every day for what they give me.

Is there a teacher, mentor or UI Carver College of Medicine faculty member who has helped shape your education?

Melvin Marcus, former University of Iowa Carver College of Medicine Professor of Cardiology and my father-in-law, now deceased, was a tough, demanding, funny, brilliant leader. Now, 20 years later, I still find myself quoting him on a daily basis. He instilled the ironclad principle in all his students to expect the best of themselves. In fact, my wife and I thought so much of Mel and his scholastic standards that for the past ten years, we have given scholarships in his name to senior UI Carver College of Medicine students based on achievement and academic career goals.

How or why did you choose the University of Iowa for your education and medical training?

When I was deciding to pursue either medicine or biochemistry as a career there were more diverse opportunities available at the University of Iowa, such as taking Spanish as an elective during medical school and having the opportunity to do research while working towards getting a medical degree at the same time.

What kind of professional opportunities or advantages has your University of Iowa medical training provided?

Having trained at numerous medical facilities around the United States, I can absolutely state that the medical education at the University of Iowa Carver College of Medicine is second to none. Also, the work ethic of Iowa students is incredible. My best students and residents always have had some University of Iowa education. I was as well trained coming out of the University of Iowa Carver College of Medicine as any medical student in America, at either public or private institutions.

Please describe your professional interests.

In addition to my scientific and surgical interest in kidney stone disease, I have a great deal of interest in the business side of medicine. With shrinking reimbursement and increasing costs, the doctor has to become ever more educated about the business side of medicine. Practice viability will affect access to care in an enormous way if more and more physicians cannot afford to "keep the doors open".

What are some of your outside interests?

Living in Colorado gives a lot of opportunity to do outdoor activities, so skiing, snowboarding and camping keep us busy.

Do you have an insight or philosophy that guides you in your professional work?

I have several. One is "How would I care for you if you were my father/mother/wife/etc….?" Another is "You never get in trouble doing the right thing."

Also, I try to use humor fairly extensively when I am chatting with patients. People in general when seeing a doctor, especially a surgeon, are not at their best. They are scared and anxious and even more so if I am seeing them for a potentially life–threatening condition requiring surgery. I have found that making people smile or laugh is a very simple way to help them feel better.

For instance, when patients ask me about whether a procedure will be done with general anesthesia I tell them that, for patients that we like, yes absolutely it is done with general anesthesia but for patients we don’t like, there is a bullet with a number of teeth marks that they can bite on during the procedure. Generally, a lot of nervous laughter follows. Then, I tell the patient that luckily, we like them.

If you could change one thing about the health care system in the United States, what would it be?

Incenting excellence, not volume, of care would cure most of the ills of our current health care system. I believe that doctors want to do what is right and best for the patient, but doing this can be financial suicide for their practice. Incentives are not aligned with best practices, and actually doing the right thing is financially disadvantageous in many situations.

What is the biggest change you've experienced in medicine since you were a student?

Probably the biggest change I have experienced in medicine since I started medical school in 1988 is the intense and comprehensive business education I had to undergo "on the job". The entire evolution of health maintenance organizations, Resource-Based Relative Value Scales, managed care, and cost control has occurred in the last 20 years. I have made significant mistakes due to my lack of business knowledge, but have tried to educate myself and improve my business acumen and my practice. Because the business of medicine has become such an essential piece of success in medicine, I am actually developing a "Business of Medicine" curriculum for medical students and residents that I hope will give new doctors all the tools, both medically and financially, to be successful.

What one piece of advice would you give to today's medical students?

Do what you love. Medicine is the absolute best job in the world, 12 hours a day. It’s the other 12 hours that can really impact your life. Manage your expectations and goals in such a way to leave yourself room for your own life.

What do you see as "the future" of the medicine?

Scientifically, I see a "personalization" of medicine as we will be able to differentiate subtle nuances in medical conditions, allowing us to personalize treatment on an individual basis. Also, a deeper relationship of general practice medicine with the research centers, like the University of Iowa, which has profound implications for patient safety, cost control and quality of care. The average medical practitioner is 17 years behind the ‘state of the art’. We must do better.

Socially, universal coverage for all Americans would be achievable at lower cost if inefficiencies in the underwriting, provision, coordination and reimbursement of care were corrected.

Fiscally, I do not foresee a universal payer system, like Canada or the United Kingdom, mostly because of the stubborn independence of the American people and their desire for choice, both financially and medically, for their health care. However, the current system will collapse under its’ own weight in the next 10 years, so rapid, comprehensive, simultaneous change will need to occur.