Long-time PCMS member now heads state medical association

The Arizona Medical Association (ArMA) Annual Meeting kicked off on June 2 with the President’s Awards Banquet and the inauguration of ArMA’s new President and Pima County Medical Society member, Michael Hamant, MD.

The following are comments delivered as the inaugural address by Dr. Michael Hamant at the Arizona Medical Association President’s Banquet on June 2, 2017:

It is my honor and privilege to be this year’s President of the Arizona Medical Association (ArMA). I want to thank all my fellow physicians at ArMA for entrusting me with this responsibility, particularly in this year of transition.

I am able to stand before you as the new ArMA President only because I stand on the shoulders of the previous Presidents, some taller than others, but none the less all giants. If all the Past-Presidents could please stand and be recognized for their service. I will be calling you all frequently in the coming year for your good counsel. Dr. Alexander and the other distinguished Presidents have left me with a leadership legacy that I hope to be able to emulate.

I am here tonight before you because of two mentors, Mr. Steve Nash formerly the Executive Director of the Pima County Medical Society, and Mr. Chic Older, the Executive Vice President of ArMA. They both encouraged my involvement in organized medicine and have offered me sage advice over many years.

It would not be possible for me to be here tonight before you without the unwavering support of my wife, Dr. Lynnell Gardner, a gynecologist. They say behind every successful man is a strong woman. Well in my case that is an understatement. Her support has been immense and greatly appreciated. We have practiced together in Tucson since 1989 in the same office. So, we are partners in more than one sense of the word.

I would also like to acknowledge my two children who are both here tonight: Richard, an IT consultant, and Laura, a third-year medical student here in Phoenix at the College of Medicine.  I am so proud of their accomplishments.

I would like to take a few moments to tell you something about my personal history. Everyone in the room I am sure has a unique and interesting story to tell but I would like to take this opportunity to give you a sense of where I come from.

I was raised as an Air Force brat. If you have served in the military you have an idea of what that means. I found the experience of living all over the world and many parts of the U.S. to be quite formative. Moving frequently, I had the opportunity to attend three high schools (and I thought of it as an opportunity not a burden) which forces one to become quite adaptable. I also became a “joiner” in order to fit into my new surroundings quickly.

Growing up in a military family had another influence on my personal philosophy. Living with government employees is Washington for five years left me with an appreciation for government and the positive effect good government has on civil society. I appreciate that my idea of a good government protection might be considered someone else’s onerous government regulation. I don’t think I would feel safe flying without the FAA, drinking water without the EPA, or filling prescription medication without the FDA among many government protections. Although I know my opinion is a minority one, I support HR 676, the “Improved Medicare for all Act” that now has 111 co-sponsors in the House.

My father’s experience growing up poor during the depression, then getting his college degree in architecture on the GI Bill after serving in WWII, was my families personal experience of what a great government policy can accomplish.

I came to Arizona at age 16, so I am a semi-native, finished high school in Flagstaff, then went to NAU for college, but could not get into medical school upon graduation. So, I completed a master’s degree at NAU, but still could not get into medical school. I then decided to enroll in medical school in Guadalajara, Mexico. Former ArMA President Dr. William Thrift, was a classmate of mine there. We were both able to eventually transfer to the UA College of Medicine in Tucson and graduated in 1983. What are the odds of two former Guadalajara students both becoming ArMA President? Probably has something to do with how badly we wanted to be physicians, our perseverance in obtaining our goals, and how much we appreciate the opportunity to practice medicine.

After completing my family medicine residency, I returned to Tucson and Lynnell and I opened our solo private practices. We are both dinosaurs, but still going strong despite all the changes and challenges of practicing medicine today.

So now you have an understanding of my background. Although I am in solo practice, I have spent my career as a “joiner.” I became involved in my hospital medical staff eventually becoming a member of the hospital board of directors. I became involved with a large physician run IPA and served a term as the President of its board. Eventually I found organized medicine at the Pima County Medical Society which led to my participation with ArMA – culminating with my role this year as President.

Dr. Alexander and I were able to attend the Leadership Academy as guests of the California Medical Association last month. I have been thinking about leadership for some time as my term for President was coming up – much too quickly I might add.

What makes a good leader? We can all name good historical leaders from political life, but what makes a good leader in other circumstances, in business, not-for-profits, or professional societies? Are there commonalities?

Identifying and nurturing leaders within organized medicine should be encouraged and not left to chance. Nor should we solely depend upon our society executives to find our future leaders. I think we need a more systematic approach.

Some leaders may be born, but most are mentored, trained, and learn to lead through experience, as in my case. Most of those in this room are leaders and the collective wisdom is evident. Think of what constitutes a good leader. Who were the mentors and leaders in your experience? Who were effective and admired? Now that you have that leader in mind, consider what he or she is like. I am sure that most of us will come up with characteristics that are quite similar. Leaders are first of all competent in their field, and physicians are highly competent, but many physicians do not have natural leadership qualities. (Studies show humility is a trait common to effective leaders, but many physicians seem to lack the gene for humility.) Leaders are almost universally people of character and high morals. Leaders are good listeners as well as communicators, consensus builders, and provide goals and expectations. Some leaders are bold visionaries, some risk takers, others show flexibility and adaptability. What steps can ArMA take to identify and mentor the future leaders of organized medicine? With your assistance, I hope to spend some time this year addressing this goal.

ArMA this year of course is going through a leadership change with the retirement of Chic Older, who has not only been the face, but the heart and soul of ArMA for three decades. He will not be easy to replace but this transition will offer the opportunity to ArMA for re-evaluation and a new leader will build upon Chic’s legacy and I am sure take ArMA to new heights. The work of many in this room on the Board of Directors, the Executive Committee, the Search Committee, the Finance, Legislative, Public Health, and Medical Education Committees among others have shown a dedication and engagement with ArMA that is really impressive so I know that the future of ArMA is strong.

We need to identify and nurture future leaders. But there is an apathy and frustration with the practice of medicine that has led to an epidemic of burnout. Too many of our colleagues are unhappy, which effects patient care, and can result in leaving clinical practice or early retirement. The average PCP now retires at age 60! The average PCP now spends more time documenting in the EMR and other non-compensated activities than in face to face patient care.  There is no question that the work environment for physicians has changed dramatically and will continue to change. This combination of factors has led to burn out rates reported to be between 35 and 55% depending on specialty.

Physician organizations like ArMA need to develop programs to help physicians combat burnout. The collegiality of ArMA is my personal antidote to burnout and my involvement gives me professional satisfaction outside of patient care. In my opinion, too many physicians blame the evil insurance companies, their damn EMR, the horrific government regulations, or the difficult patients for their unhappiness. One of my goals this year will be to develop programs to help the physician healers help heal themselves and treat burnout before it becomes entrenched.

Burnout is evidenced by cynicism, hostility, decreased productivity, increased errors, and increased patient complaints. If not turned around burnout can lead to impaired physicians, divorce, early retirement, or tragically suicide. There are strategies to combat burnout and it is important to identify the signs in ourselves before it becomes critical. Time management, taking vacations, CME on burnout, leadership training, and learning to say “no” can all help in avoiding burnout and returning the joy to practice.

The causes of burnout including the bureaucratic hassles, too many hours, too many patients, uncompensated tasks, working harder to make less, which added on to family stress, can be overwhelming. Physicians who practice in groups or hospital settings may be identified in their systems as potentially suffering from burnout. But what of physicians like myself in private practice who may not have the same institutional support systems?

One of the propositions under consideration at the ArMA House of Delegates is to re-institute the medical student and resident and young physician sections. I commend Dr. Ross Goldberg for spearheading that effort. That idea and the work that Past President Dr. Zuhdi Jasser has done at the AMA with the private practice section, has led me to believe that we need to approach the organization of ArMA in a new light. Not based on geography but instead based on practice setting.

I have more in common with a solo or small practice physician in Phoenix or Flagstaff, which are now in the Maricopa and Rural Caucuses respectively, than with a large employed group practice across the street from me in Tucson. So, I would propose to develop within ArMA six different interest groups:

1. small practice
2. large practice
3. employed physicians
4. academic physicians
5. residents and young physicians
6. medical students.

Each of these groups have unique needs and experiences. For instance, small groups have great difficulty with the IT reporting requirements of MU and now MIPS. Employed physicians have contract and compensation issues that are unique to their setting. We are already targeting membership strategies differently for these groups, but once they are in ArMA they are not differentiated. I envision that each group will have separate web blogs and eventually tailored CME activities. I believe that this will create a new synergy and enhance membership growth. Further, leaders will emerge from these sections who will become the backbone of ArMA in the years to come.

To summarize, my three goals for ArMA this year are: 1. develop a leadership training program; 2. develop programs to address the epidemic of physician burnout; and 3. to establish the interest group sections within ArMA based on practice setting and not geography.

I again thank you for this opportunity to be your President. I welcome the many challenges in the year ahead. We will be selecting our new EVP, continuing the process of selling our building, and reaching out to many new potential members with the interest groups. Of course, ArMA will continue to have our historically strong advocacy agenda at the legislature under the stewardship of Pele Fischer and Steve Barclay. Our number one priority is to continue to grow membership so that the financial resources are available for ArMA to be the best run and effective organization that works for all the physicians and our patients in this great state.

Thank you.

Hamant, a board-certified Family Medicine physician also holds a Certificate of Added Qualifications (CAQ) in Sports Medicine. He has been in private practice in Tucson since 1989. His focus during his presidency will be on promoting physician leadership and countering burnout, through establishing better community connections.

In addition to the installation of the new ArMA President, the following officers were elected to serve one-year terms: president-elect – Traci Pritchard, MD, Phoenix; vice president –  Susan Whitely, MD, Phoenix; and at-large members, Brenda Gentz, MD, Tucson; Ross Goldberg, MD, Phoenix; and Thomas Hicks, MD, Tucson.

Miriam Anand, MD, Phoenix, was elected treasurer, a two-year term. Also serving on the Executive Committee are Jennifer Hartmark-Hill, MD, Phoenix, secretary; Ronnie Dowling, MD, Show-Low, AMA Delegation Chair; Immediate Past President Gretchen Alexander, MD, Phoenix; and Outgoing Past President Nathan Laufer, MD, Phoenix.