I worked on the frontlines of medicine for 24 years in private practice as a head and neck surgeon. After spending a career looking for ways to innovate on the delivery side, I gave up. Reengineering the delivery of care in private practice is not profitable in the current payment model.
During the pandemic, I decided I needed a change. I figured the place for innovation would be a hospital and clinic system affiliated with a medical school/residency program. I happily joined one and became an employed physician for the first time in my career. After 2 years of same old same old, I jettisoned the productivity treadmill for life balance. I still hold on to hope. Thankfully, I had success on the innovation front in the regulation of medicine.
Around 2001, after completing business school, a colleague suggested I apply for a seat on the Minnesota Board of Medical Practice. The purpose of the medical board is to protect the health, welfare and safety of the citizens of the state from substandard medical care. I demurred thinking why anyone would want to waste their time doing that. Selfishly, I asked myself what was in it for me? It wasn’t the money, which was a whopping $55 per meeting.
His response to my hesitance, “Jon, I think you’d really like it.”
I applied. My colleague suggested I contribute to the Governor’s campaign just to grease the skids. I didn’t. Where was the return on investment?
After interviews with the Governor’s office and the Executive Director of the Minnesota Medical Association, I finally got the nod. I was appointed to the Minnesota Board of Medical Practice in 2001 by none other than Governor Jesse “The Body” Ventura.
My colleague was right. I loved the work and surprisingly, I loved the law. I was reappointed by Governor Tim Pawlenty in 2005. After two terms the law requires at least a one year hiatus before reappointment. Governor Mark Dayton reappointed me for an additional 2 terms in 2011 and 2015.
Interesting fact. I may be the only medical board member in the country to have been appointed by Independent, Republican and Democratic Governors. Interesting fact number two. I served for a total of 16 years, the longest duration for a board member in Minnesota.
As a result of my activity and leadership at the state level, I had the honor of leading the Federation of State Medical Boards (FSMB) nationally. It was a heady time, hobnobbing with leaders in the House of Medicine.
I’ll never forget one evening. We were sitting on roof of the Association of American Medical Colleges‘ new building on K Street in DC, which had a beautiful view of the US Capitol dome just blocks away. The sun was setting and the weather was perfect. Vivek Murthy was an invited guest and was being introduced as the future Surgeon General.
I was a little down. I had been traveling for a few weeks and upon my return home I would be on call every night for a week, which meant little sleep. Everyone was having a good time. As I was scrolling through my calendar on my phone, someone saw me sitting alone and asked, “Hey Jon, what’s going on? Come join the party”
“Ugh, I’m going to be on call for a straight week when I get home.”
Someone blurted out, “Hah, Jon still sees patients for a living.” Teasing laughter erupted. It was comical. I was always the one non-academic practicing physician still working in the trenches surrounded by executive physicians, many of whom gave up practice decades ago. It was kind of like being the only black guy in a room full of white guys. Wait. I was that too.
During my tenure as Chair of the FSMB, I helped innovate how we license physicians in the country. For over 100 years physicians obtained licenses one state at a time. We created a pathway for licensing in multiple states with one application. The effort began with a conceptual meeting in Washington, DC in September of 2013. It ended with the inaugural meeting of the Interstate Medical Licensure Compact Commission (IMLCC) in Chicago in October of 2015.
The multiyear advocacy process meant crisscrossing the country, meeting with US Congressional leaders and state legislatures. We received a letter of bipartisan support from a group of US Senators. The high point of the effort was leading the newly created IMLCC. The low point? Leading the newly formed IMLCC. We had no staff, no money, a few intransigent states and a burning need for an IT infrastructure to support the online process. I learned a valuable lesson. You have to market good ideas.
A handful of Executive Directors of State Medical Boards and myself did most of the heavy lifting in those fragile first few years, when the process was still vulnerable to opposition. We argued with FBI lawyers, stubborn commissioners and an Attorney General from one of the states who was hellbent on killing the legislation.
Behind the scenes and with the gracious assistance from the FSMB, I was able to secure a grant from the Health Resources & Services Administration (HRSA). Without fanfare, I announced it an IMLCC meeting. One of my colleagues, sensitive to the politics, confronted me during a break, “Nice job. Better to ask for forgiveness than seek permission.”
It was difficult, frustrating, challenging, yet immensely gratifying. We never lost site of the goal. All of this was occurring while I was working full time. We prevailed and successfully launched the process. As of May 2023, 37 states have signed onto the legislation. In 2022, 10,832 applications were processed and 17,973 licenses were issued. The proof is in the outcome. It works.
My role in the regulatory and educational arena continues. I am currently Treasurer of the Accreditation Council of Continuing Medical Education. I am a board member of the National Board of Medical Examiners. I chair the Committee For Individualized Review of the United States Medical Licensing Exam. These organizations have in common the advancement and assessment of medical education to improve health outcomes. I have always found this work fulfilling and the people who do it smart, caring and tenacious.
Lastly, I also serve on the board of the History Theatre, protecting the health, welfare and safety of patrons from substandard entertainment. It has been educational, enlightening and fun.
After retiring from surgical practice I channeled my pent-up desire to create and innovate into a novel, Pigment.
The other outlets for the energy include learning jazz piano, gardening and running marathons (knees don’t fail me now).
I have a fulfilling life. I am filled with gratitude for the opportunities to treat patients and make the world a better place. What remains of my life is icing on the cake. No! I’m not dying anytime soon. At least I’m not planning on it. I still pine to reengineer how healthcare is delivered. I may have to leave that to someone else. It is happening, just at a snail’s pace.
None of this would be possible of course without the loving support of my beautiful wife and children, Duch, Austin, Avi and Zach. Together we are JAAZD.
I wish I could say the same for our pets, who I’m convinced are trying to harm me. They have a penchant for walking around my feet as I sleepily descend the stairs in the morning for that first cup of coffee.
This site is for family and friends who still wonder why the hell I stayed in Minnesota and never returned to Los Angeles.