Saturday, October 14, 2017

Budd's Encomium

Budd's Encomium

Usually, Budd's Blog is for droll stories illuminative of the human condition, analysis of health care policy, trenchant political insights, and analogies involving sports. And predictions, of course, predicated on establishing the subsequent right to exclaim, “I told you so!”

But today is different. Today, I am posting an encomium I received from the Chairman of the American Academy of Pediatrics Section on Administration and Practice Management (the hallowed SOAPM), along with some other comments from SOAPM members. Paraphrasing Erica Jong, I have to say I have been well and truly honored. As they say, my father would be so proud, and my mother would believe it. And adding to that, my brother Bob said that if the encomium had been declared publicly at the award ceremony rather than posted on the listserve, he would have been compelled to have asked for equal time for a rebuttal. That's what brothers are for, no?

So, here it is:

Hi All
Yesterday, at the NCE here in Chicago, the SOAPM Executive Committee was pleased to recognize Budd N. Shenkin, MD, FAAP with the Charles “Buzzy” Vanchiere award.   The Vanchiere Award, presented annually since 2001, is SOAPM’s highest honor.  It recognizes outstanding contributions in the education of pediatricians in administrative pediatrics, practice management, and payment.    Nominations are submitted annually in the spring by SOAPM members and then selected by the SOAPM executive committee.    
Budd is a native of Philadelphia but has lived and practiced in the San Francisco Bay Area for the past 40 years.  Even in the population of SOAPM overachievers, his credentials and achievements are impressive.  A third-generation physician, he attended Harvard University for undergraduate and medical school.  His postgraduate education includes residencies and certifications in both pediatrics and preventive medicine, a Master of Arts in Public Administration from UC Berkeley, a position as visiting researcher at Sweden’s Stockholm School of Economics, and a Robert Wood Johnson fellowship at UCSF.  In 1979, he founded Bayside Medical Group as a solo practitioner.  Over the next 33 years, he grew his practice to become the largest privately held primary care pediatrics group in the Bay Area, with 10 offices, 35 clinicians, and 150 staff. 
Budd has served the Academy in a variety of roles.  He was on the Committee on Child Health Financing (COCHF) for six years, and recently completed an important role on the Task Force for Pediatric Practice Change, a diverse group of AAP leaders with experience in practice change.
Budd is a deep thinker and an articulate, thoughtful writer and speaker.  He’s authored textbooks and textbook chapters, served on the editorial board of no fewer than five peer-reviewed journals, and gave Congressional testimony to the House Ways and Means Committee in 2009 about health insurance reform.   His style blends medicine, history, management, philosophy, economics, wit, and wisdom, calling on both his impressive academic background as well as his practical life experience in primary care pediatrics.   He is both prophetic and visionary. He advocated for patients taking ownership of their medical records in the New England Journal of Medicine as early as 1973. and wrote an article on the importance of fathers being equal parents in 1992.    He’s sustained that prolific pace of writing. editing, and blogging at <>, more recently as the lead author on the AAP’s policy statement on high deductible health plans. 
Budd completed his six year term on the SOAPM EC last year.  He represented our Section well up to the AAP executive board, inward to SOAPM members, and outward to pediatricians everywhere.  His remarks yesterday at the award presentation reflected his vision for SOAPM taking a deeper and broader role in the AAP.  You can find him this weekend in the SOAPM booth, enthusiastically and energetically encouraging others to join SOAPM, and, of course, every day here on the listserv.
Please join me in congratulating Dr Budd Shenkin, the 2017 recipient of the Vanchiere award!
Christoph Diasio MD FAAP

Suzanne Berman

Hear, hear!

I had forgotten how much stuff Budd has done.

I will add personally that Budd has inspired me in terms of policy writing:

Shortly after I joined COCHF (Committee on Child Health Financing), I offered to write a paper on alternate payment models.  At 5 pages, I thought I had a pretty good summary.  Budd pushed me and stretched me and added little query boxes like "What about this [good idea] or this other [policy consideration]?"

At first I was getting a little irritated with Budd about how much "extra work" he was generating for me.  But at the end of the day, after his last suggestion for clarity or word choice or Daniel Kahnemann reference was satisfied, I had a much better paper.

Thank you, Budd, for kicking my butt towards excellence.


Suzanne Berman, MD, FAAP
Plateau Pediatrics
Crossville, TN 

Brandy McCray

Besides all the fantastic qualities mentioned about Budd above, I would like to mention one of my favorite qualities of Budd - his generosity.

He is generous in his time - offering his thoughts and experiences to anyone that will ask (see Suzanne's example above).

He is generous in spirit - offering his emotional support and examples of his life experiences for those in need.

He is generous in friendship - hosting many for dinner and drinks in his hometown.
And, he is generous as a pediatrician and mentor - sharing many ideas, templates, patient handouts, etc, with anyone that asks.

I am grateful for the opportunity to know him and SOAPM is blessed to have him,
Hear's to Budd!

Brandy McCray, MD
San Antonio, TX

S.F. Khan, MD, FAAP

I have had the most privileged position of being the SOAPMite who lives closest to Budd and have access to tap his wealth of knowledge & expertise amytime, all year round.  And I have exploited that opportunity more than once.

Budd introduced me to a colleague at UCSF with whom I subsequently crafted the series workshop program I am currently teaching there, to an elite (in my opinion) group of residents dedicated to pediatric leadership in underserved services and who could not be more custom designed to eat advocacy for breakfast, lunch & dinner.  That colleague has since become a dear friend.  

Thank you, Budd, for thinking of her and me in the same thought and immediately acting on it.  You are a genuine sage.


Tuesday, October 10, 2017

The Virtues of Professionalism

When you get older you have to be more watchful. You have to think, what could go wrong? Visit the doctor more faithfully, don't drive when you're tired, be more organized so the chance of error is reduced. And, most importantly, beware of falls. Look before you leap. Keep yourself poised carefully on your haunches as you push that trash can down those three steps toward the street on Sunday night for the trash collectors on Monday. Falls are far and away the most looming hazard as you get older.

And I should add that as you get older, you get smaller as your spinal discs shrink as you lose muscle mass and other mass. You lose one inch per decade, we were told at our med school 50th reunion by our classmate Don Smith. I tell people that I myself used to be 6'4” and played shooting guard for the Warriors, although who remembers that now?

But I digress. I was talking about falls, and prevention. Falling is an ever-present danger. My new Blue Hen friend Jim Dean told us that every time he goes to the doctor, the doctor's first question is, “Have you fallen?” It is that present a danger. And we also know that most accidents occur in the home – not surprising, since that's where we are most of the time.

That was when I noticed how dangerous our bathroom is. We have a deep tub, and that is where we shower. Since the tub is deep, we have to perform a balancing act as we get in and out. Stand on left foot, raise right foot high to get over tub wall, stick right foot over tub wall to bathroom surface, place it on floor, shift weight from left to right foot, pick up left foot while balancing on right foot, pull left foot over wall, and place left foot by right foot, at last standing on two feet. Perhaps easier done than said, but still, imagine the hazard.

We were forethoughtful enough to have made the surface of the tub slightly gritty, so that the danger of slipping is minimized. But, and this is a big but, while you are doing all this, there is nothing at all to hold onto. Well, there is the sliding glass partition that keep the shower water from splashing over the bathroom floor, but the frame for those two sliding doors is fragile. If we were to slip and grab the glass doors, they would likely fall down with us and probably shatter. Not much help there.

So I went down to our neighborhood kitchen and bath rehab place, Custom Kitchens, and presented the problem. My idea was that as we climbed in and out, we should have a little grab bar on the counter surface just by the sink, which is very close to where we step in and out. It would be unsightly, it would take space, it would be hard to squeeze the grab bar into that small surface, but it would be safe. The guy at Custom Kitchens thought it could be done, I convinced Ann it was the safe thing to do, and although it took months for the guy at Custom Kitchens to actually get it together, we were ready to go. Safety over style.

Then, and this is the point of this post, there was a switch of personnel assigned to our project. Instead of Eric, Karmela came out to our house and was looking to match colors and surfaces for the grab bar. And then, as she was looking over the project, Karmela said, “You know, there's another option here.”

She looked up from where the grab bar would be and saw that the wall just beyond the end of the tub was just close enough to where we stepped out that she could bolt a retractable grab bar right into it. This retractable bar, or rather a swiveling bar, would be vertically parallel to the wall when in repose, but then when we were ready to use it, we could pull one end of it down so that its length was now perpendicular to the wall – that it, it stuck out from the wall just where we could grab it as we exited. Then it would unobtrusively pivot back up vertical again when we had stepped out, unobtrusively out of the way. Saving the counter surface where the original grab bar would have been, making it look much nicer, preserving precious space in our small bathroom.

Now here's the point. Believe it or not, there is a public policy aspect to this short story. When I exclaimed wonderously how great Karmela was, and she felt proud of herself for coming up with this graceful solution, she told us: when she had gone through her testing to get her license as an interior designer or whatever her qualification is, she had had a task: design a bathroom for a handicapped person. And that is where she had come across a similar solution that she was now applying to us.

A certifying board? Qualification for this rather mundane near-profession? Isn't that just more bureaucracy, designed to keep competitors out, to glorify a job? Isn't this one of those 500 plus boards that have proliferated in the state, that supply sinecures for political supporters to be appointed by the Governor? Isn't that the waste of big government? Haircutters, nail polishers, things you've never heard of, all certified with so-called standards?

You might well say so. I might well have said so. But no more. Sometimes, just sometimes, things work the way they are supposed to. Bless you, Karmela, and bless the board which qualified you. We will now step in and out with both safety and style.

Who says the days of big government are past? Not I.

Budd Shenkin