YK Reflections

Our holiest day came and went.  Kol Nidre was not particularly well attended.  The sanctuary seemed more completely occupied the following day, keeping in mind that the portion devoted to seating has been reduced every few years.  We were asked for money a lot.  Mostly noble causes like keeping the synagogue solvent or supporting the infrastructure of Israel.  The reason for buying Israel Bonds was a lot more obvious than the reason for keeping the synagogue solvent.  One of the salient features that keeps AKSE different from Chabad is that AKSE has to adapt to its constituents while Chabad does not.  Keeping it solvent for the sake of keeping it solvent without keeping it attractive and vibrant as a consequence of keeping it financially viable might be a hard sell.  And there was a pitch for pet projects:  AIPAC,CUFI, multicongregational Israeli trip which seems unduly expensive, parsha class.  None of this really grabs me, though I do plan to study the parsha each week on yutorah.org, something I've not done in a few years.  Maybe Israel has become the new Holocaust, a purpose for existence beaten into a cliche by Hebrew School or Rabbis who want to turn their congregations into Hebrew School.  Of course it has its place, but so does the Parsha and so does the reality that CUFI while friendly to Israel also carries the banner of some very un-Jewish ideology that gets hidden, perhaps even a form of genevas da-as.  But throughout the YK observance, somebody on the bimah was trying to sell us something.  It all registered neutral, which is better than registering negative.

In my capacity as observer, there were some encouraging parts of the experience.  People of great talent occupied those seats, most of them capable of doing a lot more to enhance the congregation than they currently do.  Perhaps they would if anyone solicited their participation but for the most part nobody has.  If there is any legacy to the outgoing President, who has really worked hard on the congregation's behalf, I think it is that he surrounded himself with a small group of insiders that he knew he could work at the expense of creating a grass roots.  The role of committees has contracted, contrary to the advice of the consultant a few years back.  Appointments for key initiatives comes from an ever contracting pool.  The Nominating Committee has been thoroughly corrupted from a means of evaluating and expanding talent to a telephone squad for the President to decide who he wants to surround himself with.  That form of thinking has some very negative consequences for an organization that has thrived on its openness, some of which seem to be playing out.

And finally, the break the fast presentation was superb.  In addition to an outstanding display of food, they took advantage of a diminishing attendance to create a space with tables behind the sanctuary where people could help themselves to food and enjoy each other.  The people really are capable of excellence but sometimes you have to insist that excellence be consistent in all activities.

Opting Out

My third and final ACP renewal notice came in the mail yesterday, still unopened.  While the ACP remains the medical organization for which I hold the greatest fondness, I decided last spring to let the clock run out on the membership without renewal.  The reasons are multiple, reflecting on a mixture of the organization and of me.  I'm in the middle of reading a well considered book called Relational Judaism by Prof. Ron Wolfson who I've met a few times.  He describes the atrophy of once strong Jewish organizations which now struggle, partly through no fault of their own but partly through decisions of how the leadership and policy makers related to constituents.  It is very easy to look at synagogue membership or ACP membership as a consumer purchase.  In one sense, the rather high fee is of secondary importance since my hospital pays for one membership a year.  I could ask them to pay $600 to the ACP instead of half that to the Endocrine Society but my professional attachment has clearly evolved with the specialty.  But as a consumer purchase you have to assess what is received and set a value on it.  It's probably better for medical organizations or Jewish organizations to promote relationships, as Ron suggests in his book, than to sell a product that is often difficult to define.  I've not read an Annals article in a few years, attended a local or national meeting in a few years, bought insurance or studied from the MKSAP in some time, while the products have always been top notch and the people very gracious when I have attended.

No, it is not a purchase but an assessment of personal and organizational values that are always in evolution, sometimes for the better, sometimes not.  I think I became a continuous member circa 1982.  That leaves about 30 years of experience and transition.  There was a time when Masters got their designation by becoming the people who advanced medicine.  Some undoubtedly still do, though increasingly the designation reflects loyalty to the organization more than the gurus of clinical studies who transform out ability to function professionally.  That can only be a reflection of how the leadership of the organization assesses its purpose.

In 2011, I took what I hope will be my final recertification exam, especially if they decide to do drug screening on illicit Namenda which I will probably need to protect memory at age 70 ten years from now.  To be fair to the ABIM, the experience this time around seemed pretty decent, though cumbersome, unlike 1991 and 2001 when it was more of a fraternity hazing.  I think some of that credit goes to ACP alum, Dr. Cassells.  But the reality is that while my scores are comfortably above threshold, there is an endocrine failure rate of about 12% whose professional lives are disrupted while they remain worthy and competent colleagues.  More recently, the ABIM has made the MOC process more burdensome with little benefit to the public.  This seems like an obvious place where the ACP dropped the ball as the advocate of its members and no particular incentive to cap this type of regulatory excess.

Over that same 30 years the role of the internal medicine specialist has become more amorphous under the ACP's organizational watch.  There are places in our State of Delaware where a Board Certified, fully trained ACP Fellow can request expert consultation and have their patient assessed primarily by a nurse practitioner in lieu of the expert they were hoping to capture.  Not only has the ACP never challenged this but now they have taken a position of boosting membership by absorbing professionals of lesser training into the organization.  This, of course, never came up three decades back but sometimes the physician advocacy organization has a lot more credibility if they put expediency on the back burner and take a stand for consistency with the values that I think most physicians have.

And as Ron writes, it's about relationships.  Would I approach a large check as a contribution for noble cause rather than a purchase if the cause was really noble and if I had a fair amount of skin in the game?  Jewish organization and to a lesser extent medical ones design programs hoping that people will come.  I've designed my share for Adas Kodesch in recent years, some highly well attended.  But are they successful?  If attendance is the goal, then sure they are.  If developing an enduring attachment that withstands strained times and invites a measure of forgiveness for policies that do no go your way, then no, programming does not cement relationships.  In my decades as an ACP member and later a fellow, I was only invited to two meaningful projects the entire time.  Both involved my skill, by the way.  One was to create a wallet card with essential patient information that they could bring to office visits, the other was to attend a national meeting in Philadelphia to critique how the organization could be more responsive to its dwindling subspecialist members.   Total time spend on meaningful projects about eight days.  Never been invited to a standing committee all that time.  Never invited to share my expertise or experience at a meeting, never been invited to suggest an expert to share their special ability with the group.  These are the things that generate loyalty which transcends personal experience that will inevitably have its favorable and unfavorable times.  I do not know if ACP has as part of its mission to bring people on the sidelines into the group, hear their stories, fill in some of the voids that are inevitably part of professional life.  There have been a lot of Governors and a lot of projects in thirty years.  My guess is that the Pareto Principle where 80% of the activity is generated by 20% of the people prevails in the ACP as in anyplace else.  The question is whether the leadership ever thought seriously about how to change the proportion to 70/30 or whether they have the same complacency with A-lists that my synagogue does.

I eventually opened the final invoice letter. sending back the invoice unpaid with a note wishing the organization continued success.  The ACP has always had dedicated well meaning people at its helm.  But they may need to pause to reassess what their own constituents desire from affiliation and a fair amount of financial commitment, then provide it.

Early Rosh Hashana

While the Holy Days being on the first of Tishrei from year to year, I tend to think more in terms of my customary secular calendar which tells me which days I am supposed to work and which I can stay home.  Summer begins on Memorial Day, ends on Labor Day, irrespective of astronomical realities.  The Jewish holidays are therefore perceived as variable.  When they come in early September, they sneak up on you relatively unprepared.

In my commitment to myself to function as an observer, I approach the New Year with a measure of detachment.  There are five people I'd like to greet from afar, and probably will by Hoshana Rabba.  And I really do take some account of misdeeds that should not be repeated.  I have greatly enjoyed Rosh Hashana services at the Merion Tribute House, a synagogue offshoot while the fast of Yom Kippur gives me some measure of accomplishment.  Relented from my non-participant status and agreed to do Shabbat Shuva Haftarah which I've not done in a while.

These days have become something of quiet time for me.  Schedules are flexible for the most part, but not absent.  In another era, the early arrival of the Holy Days would have me scrambling to complete greeting cards but they have largely succumbed to easier electronic communication.  Fewer on the receiving end as well so less of a display to tack onto the walls of the sukkah.  While attendance at the Merion Tribute House has been well subscribed, Yom Kippur attendance at my home congregation has atrophied from year to year in proportion to the membership attrition.  It has its predictability and maybe some people are inspired in some way from the experience.  At other places Rosh Hashana displays the real character of the congregation with people trekking to the Rehoboth Beach Outlets for discounted designer finery and machers parading up to the Bimah for their Aliyot.  A place where everyone who's anyone comes to be seen.  For us it is more of a chore to get through, busy season for the clergy and a few volunteers, but it does not stand disproportionately to other events of the year.  Sukkot quickly takes over followed by shabbos each week.  Our Board has a discussion of the Holy Days were received each year but like macrophages, they have no memory and the same experience will get carried over to subsequent years.  So will my relatively ingrained misdeeds.

They Moved On

Two AKSE departures of note, one earlier this spring, one yesterday.  I might have encouraged both to go elsewhere, one for the congregation's benefit the other for his family's.  Yet there is an overlap of needs, one fellow who had a personal agenda and would disrupt the congregation to fulfill it, the other with a young family whose forebears have been with AKSE for generations.  My guess is that he came to AKSE as the congregation of default but eventually one must be a consumer of what is offered there.  Items on the shelf are many.  Conversion prospects for a spouse might have been worth dues to the first fellow.  But to the young family, there is a Jewish education, a Bar Mitzvah or for some a Bat Mitzvah, social interaction with other Jewish kids.  For me I like to engage my mind in Jewish analysis, something I generally seek elsewhere where it is more readily available to me.  Some want to be part of the tribe, whether that means attending Minyan, Shabbat, Sisterhood, Bingo, or Minyanaires.  Most want to advance themselves or their families Jewishly in some way, which I think could be fairly assessed as the core business of the synagogue, though it has never really been pursued as a congregational mission during my time there.  I think balancing the finances has been the mission of Board of Governors.  I do not have a good sense if the Rabbi even has a professional mission, for all his dedication and hard work.

But they are both en route to elsewhere or nowhere.  Both did some things as participants from teaching to governance but I suspect they will not be missed equally.  The family that moved on will make Judaism better wherever they are.  He has an AKSE education.  He understands quality and will bring that expectation to the Reform congregation that he selected instead.  While commitment to ritual may not be as strong, their Rabbi always has important perspectives on Judaism to impart while the congregation has been committed for decades to broad membership participation in the activities, be they worship or social.

In the book Jewish Megatrends, Rabbi David Ellison, head of Hebrew Union College, wrote the essay on denominationalism.  While I thought the expression of the historical background was too cursory, he is right that we are approaching transdenominationalism.  If what you want is social interaction there is a place to find it.  If you want an inspiring Rabbi there is a place to find it. If engaging in communal Tikkun Olam efforts fulfills you Jewishly, there are groups that will get you there.  If you want congregational peers with no Rabbi, there is a place to find that too.  So each of us has a personal agenda to pursue with an assortment of options for accomplishing it.

So where does that leave the traditional congregations or Federations?  Some will undoubtedly accept a smaller cohort that tells each other how wonderful they are, much as business as usual.  Others will have officers and Rabbis of greater vision emerge.  These are the people who can tease out the individual Jewish agendas that people create for themselves, either by asking their potential participants or observing how they already participate, and adapt programming to the person rather than expecting the public to adapt to the programming.

Elephants in the Room

We all have them.  For the most part we don't exactly ignore them, as much as we might like to.  But we do not discuss them in a forthright way either.  We have them in medicine.  We have them in Judaism.  Yet there is a measure of Derech Eretz that keeps the items under wraps.  There is also a very legitimate fear of disruption that would inevitably occur if you fixed what needed to be fixed.  And there is a reticence to avoid victimizing some very nice but ineffectual people in the process from doctors who function above their level of skill to clergy who fail to inspire.  Whatever the benefits of revolution might be, somebody gets figurative beheaded in the process.  So we sidestep the discussions of computerizing medical care or we look to the future of what the Judaic experience might be without ever schecting the sacred cows that need to go to get it there.  We rationalize the decline of Federations and Synagogues over a generation from circumstances beyond the control of the organizations' leadership without acknowledging that the leadership has been engaged in a cloning experiment that begets more of what the desired public walked away from.

Somewhere along the way, my congregation needs to deal with bringing women ahead, the mediocrity of the worship experience, managing shrinking membership that is not going to reverse by bringing a personable Rabbi to the Bimah, unrealistic attachment that people have to what is there now to the neglect of what might be.

In my work world, you cannot keep looking the other way while residents discharge people without appreciating what the recipients of those patients will need to do on their behalf.  Not all loose ends and be tied together with a quick turf to somebody's office.  The office computers are diminishing medical care.  Expectations are put on primary doctors that exceed the skill of many and overwhelm those at the upper tier of knowledge who have to process though increasing volumes of people who are generally well without special provisions to isolate and focus upon the few who need more meticulous decision making.

So do I think formal Judaism and ordinary medical care are going to hell in a handbasket?  Well, not exactly, but I do think there is a day of reckoning where the status quo becomes unsustainable.

Easiest Person? Right Person?

For all the frustrations of my work place, I like going there and doing the things I do there.  At the other pole, as attached as I am to Judaism and eager to engage in print and cyberspace, I do not particularly like attending services or other activities at my synagogue.  Having just completed a wonderful collection of essays assembled in an extraordinary book called Jewish Megatrends, I've had a chance to tease out the difference.  The various contributors to Jewish Megatrends have a few common themes which seem highly adaptable.  The purpose of the book is to adapt elements of formal Judaism and innovative Judaism to young people who are first coming of age but never acquired a connection to the organizations that the main author, Rabbi Sidney Schwarz, refers to as tribal.  This has its analog in medicine, of course, where the AMA and the regional medical societies are struggling to maintain membership.  I allowed my American College of Physicians membership to expire this month, partly due to a financial request far in excess of its value but more directed to decisions the leadership of the organization has taken to move it away from what first attracted me to it.  No, shabbos morning services are increasingly an obligation on my part to be at least a nominal member of the community.  I think if the treasurer finds that the dues check clears the bank, the people in charge take that as a vote that contentment reigns.  While attendance lags, I find it hard to believe that the people who used to be there have made themselves Jewishly idle, any more than the people who no longer pay dues to the AMA  no longer engage enthusiastically in medical care.  I do and they do.  As the authors of the different essays recognize, the difference distills down to finding a measure of meaning in the things we do.  Rabbi Schwarz identifies four elements:  wisdom, righteousness, community and sanctity or their Hebrew chochma, tzedek, kehillah, and kedusha.

When I go to work, I am expected to be knowledgeable, do the right think for patients and residents who depend upon my skill, be a good citizen of the hospital that invited me in, and add to the holiness that befits the Catholic medical centers that trained me and where I now work.  And they do a pretty good job of keeping the people there focused on the organizational mission.  Jewishly I am expected to be knowledgeable, do right by people, contribute to the advancement of Judaism, and be the kind of person whose presence promotes sanctity.  The Judaism of cyberspace has enabled this, the Judaism that I have encountered organizationally does not give these four elements the same value.  Sometimes it can be quite difficult to absorb people into the community and insist that the people present function at the upper level of their skill.

My synagogue's baalebatim decided some time ago to go in the direction of expediency.  We had volunteer Torah readers.  Low hanging fruit required giving the holiday reader his usual section.  There has not been a new reader in some time.  The Haftarah pool has atrophied without replacement.  It is easier for a nominating committee to recycle officers than to groom new ones.  Sometimes it takes a lot of effort to assemble the right team.  And it's pretty easy to renew the Rabbi's contract with only a few changes on dollar amounts or vacation, maybe placate a few pet peeves on either side, but not the more critical performance upgrades that bring the kehillah to a destination that one could honestly call upgraded.  The easiest team and by inference easiest decisions will get you by, maybe even deliver you to the Promised Land of Judaic mediocrity.  But it will be a very restrictive view of what Judaism can be.  Those who might like something a little more engaging can figure out pretty quickly that you can't fight City Hall but you can move someplace else.

So Easy Person?  Enough of them around to fill the slots on a schedule.  Right Person?  There are enough of them around too.  Harder to tap into but these are the people who ultimately promote the logo of Embracing/Engaging/Enriching.

Not Seen in a While

Been scarce.  Hiding under rocks.  Watching shabbos morning services on live stream with a virtual minyan in cyberspace.  Wherever people might be instead, they do not seem to be in the AKSE chapel on shabbos morning.  I never went looking for them and I doubt if the Membership VP did either.  And I don't take attendance either but I have a sense of who used to be there with greater regularity in the past than now, putting myself at the top of the do something else that morning crew.  Probably there is a mental note on this by the baalebatim as it is hard to overlook, maybe even some rationalization as to causes but no real incentive to explore or correct this type of attrition.  I'm there about half the time, another doctor who used to come regularly and a young professor have found other places to be instead the majority of the time.  The retired dentist hardly ever comes anymore.  My radiologist friend seems to come primarily as a bimah participant.  There are others.  I have a sense of why for myself, but for the others I'll leave it to the analysis of sociological trends for not going to shul on shabbos morning.  It just seems a little more precipitous than a simple trend.  More likely it makes a statement about the experience of being there, though a tacit one.

One of the previous guest scholars at the USCJ affiliate, Prof. Woolfson of the American Jewish University wrote an op-ed piece for the Jewish Telegraphic Agency in which he suggested that the decline in attendance and failure to reverse the trend has its foundation in how people already there make an assumption that what they want is transferable to people who would be there if they knew about it.  He writes:

To create such a community, we need to turn our engagement model upside down. Rather than spending all our time planning events and hoping people show up, let’s begin with the people: Welcome them, hear their stories, identify their talents and passions, care about them and for them — and then craft programs that engage them with the Jewish experience

In all this time, which for me is about fifty years of being a consumer of Jewish programming, almost nobody has asked what I might like to have that I no longer have.  I have also been a designer of Jewish programming, often very successful ones at least on the day of presentation.  When I design something, most recently AKSE Academy, the design is my concept of what has appealed to me in other situations, present it and let the consumers' acceptance or rejection prevail.  In many ways we have built a trough, filled it with our finest slop, inviting those who feel hungry for something Jewish to immerse their snouts into it.  Eventually they will have their fill, no longer be hungry, and waddle off someplace else.  And sometimes the contents of that trough leave us with a little indigestion.

So if I really detest Aliyah Sound Bites should I say so or should I silently move on to someplace that has an uninterrupted Torah reading?  Or perhaps somebody should ask me so that I can tell them.  If somebody likes being in the open space of the main sanctuary instead of the more confined chapel and therefore doesn't come, should somebody on the A-list be aware of that?  Not all feedback is actionable, of course, but having sensitivity to solicit it may make all the difference.