Board Exams

An every ten year ritual, starting about four years ago with open book self-tests and this horrid thing called a Practice Improvement Module that started out as a legitimate assessment of how well or poorly I communicate with referring physicians but morphed into a series of complex work flow diagrams when my two secretaries and I were the only ones there to do work.  And now the exam.  The patients in my practice modules and on the last two exams don't resemble what I actually see most days.  I do not think I've ever seen a Fragile X Syndrome or a McCune-Albright "coast of Maine" cafe-au-lait spot.  I've been studying from practice exams written by various professors whose biases can be detected from the questions but at least I can extract the principles that I am expected to know from the questions.  Did well with the diabetic questions, stunningly poorly with the adrenal questions and somewhere in-between with the reproductive questions.

This is big business.  I paid about $1000 to enroll in the program, $120 for the review book published by the Endocrine Society, and the outlay for the review course will set Mercy Hospital back most of my contracted Continuing Education allotment.  The pass rate for Endocrinology is reported at 77%, the lowest of any specialty.

To be fair the American Board of Internal Medicine which sponsors this, it has moved ahead of the fraternity hazing of ten years ago.  There is legitimate educational content to the practice sessions, the people I've dealt with by phone have been responsive and professional, the Old Boys have been retired and replaced by a CEO from the American College of Physicians who at least has a sense that an annoying process needs to have some off-setting benefit.  Still the exam looms a month away as I continue to struggle with the review book and head off to the intensive review course in Cleveland in a few days.

Investing in Bingo

Many synagogues, including mine, have their financial challenges.  There is actually a literature on this, though my sense of the officers is that they really haven't explored this much, opting instead for a quest for fundraising which in a good year may add 5% to revenues though it usually comes with a significant financial risk to get that 5%.   Memberships make the place financially solvent, either in the form of dues or contributions beyond dues.  There is a limit, though, to how much of our own member funds we can wring out, so there is always an interest in getting income from other sources.  Synagogues and churches have rented space in their buildings.  Some have elegant catering facilities that generate a profit.  Some have public events.  Our officers opted for Bingo.  Without  getting into the propriety of this, which the Rabbi approved so it must be OK, its only direct purpose was to generate revenue with perhaps an unintended by important benefit of generating a rather strong group of volunteers dedicated to the project.  It was expected to lose money the first six months, which it did, to the tune of $8 K which required re-examination.

As AKSE projects go, this one seemed to be handled reasonably well.  People did their homework in advance, knew what to expect, analyzed trends, and expanded participation beyond the President's usual A-list people.  Will it ever make money?  What about serious money?  What about the value of having a project that members are committed to for its own sake?  Any indirect benefit to member retention?  My interpretation on these questions is mixed.  It can probably make some modest profit, about what a successful fundraiser would make.  

When all is said and done, there is still a budgetary deficit forecast this year and no serious intervention to erase that, let alone repay what is owed other than Bingo.  Until something else arises, break even with a measure of community development as a beneficial unintended offshoot needs to continue a while longer.

Vengeance and Grudges

"Regarding your request to deliver Dawson's fish to AKSE. The answer is no. You were permitted to do this as a convenience for AKSE members while you were employed at AKSE. Now that you are no longer employed at AKSE, I cannot allow you to continue this practice."

Thus came Rabbi Joel's update on the delivery of certified Kosher fish to AKSE, though I think the actual certification may be his rather than the Vaad's.  I've never bought fish from Dawson's.  Next week we read the section on kashrut which includes the pasuk on what constitutes a Kosher fish:


אֶת-זֶה, תֹּאכְלוּ, מִכֹּל, אֲשֶׁר בַּמָּיִם:  כֹּל אֲשֶׁר-לוֹ סְנַפִּיר וְקַשְׂקֶשֶׂת, תֹּאכֵלוּ.

I'm quite content to eat whatever has fins and scales, irrespective of its origins and whatever else the equipment that gutted the innards and removed the required s'napir v'kaskeset may have sliced.  There are some who are more meticulous, striving for a loftier perch of frumkeit,sometimes even hypercorrect which I usually regard as a variant of wrong.  While I never purchased anything from Dawson's, I also never deleted the weekly message as Mr. Kessler transitioned from Cantor Joel chess maven to Rabbi Joel pursuer of the visibly Orthodox trappings.  Fish prices are best at Trader Joe's.  People from AKSE purchase these aquatic critters prepared in the most meticulous way.  It's addition added something to a small cadre of members who set aside some of their druthers to stay with AKSE, compromising on things they might really liked to have had from a mechitza to a closed shabbos parking lot to a Rabbi who attended RIETS or Chovevi but would not show us interest amid our customary practices.  Issues of genevah or even Elmer Gantry parallels aside, if Rabbi Joel's departure creates a schism it will be the purchasers of Dawson fish who decide that a Shteible atmosphere, or in current parlance "post-denominational", might be their darchei noam.  They may very well conclude that they can purchase a lot of personally gratifying Judaism on their own for $2625 less a certain amount of more nominal contribution to operating expenses that do not include salaries or much in the way of postage.

I am hard pressed to think of what good can come of banning the fish deliveries.  These people in quest of frum are the often underserved members that one would most want under AKSE's roof as much as possible and with minimum recruitment contact with the former Cantor.  Discouraging that seems unwise.  Even the manner in which it was quoted has some theological problems for AKSE as a Torah driven organization.

לֹא-תִקֹּם וְלֹא-תִטֹּר אֶת-בְּנֵי עַמֶּךָ
(Lev. 19:18)

Taking reprisals has the same prohibition as eating crustanceans.  True, lo tikom would me a mishpat which has some means of understanding while s'napir v'kaskeset is a chuk which seems more arbitrary.  Not permitting somebody who developed a program to advance Kashrut in the community to include AKSE in its continuance diminishes AKSE.  And maybe that is what makes v'lo titor a mishpat.  Its negative consequences to the people acting petty exceeds its restraint of the intended target.

Evening of Learning

Tisha B'Av 2011/5771.  It was an ordeal to get home in time for the fast, having gotten some patients who needed the healing hands before I could head home.  Rather than cut it tight, I stopped off at a buffet with a reasonable amount of vegetarian not far from Mercy Philadelphia Hospital which would assure me some nutrition in advance of the fast.  I ate quickly, arriving home in time to get to either AKSE, Chabad or Beth Shalom, where my wife was chanting Eicha Chapter 2, barely in time to go to any of them.  I decided to stay home and observe Tisha B'Av evening with the insights of the cyberspace Rabbis instead of rushing to hear Eicha.  Since we are not permitted to greet people that evening, nobody would feel slighted by my staying home

Yeshiva University has an extraordinary program of recording lectures from all sorts of venues, then making them available for download at http://www.yutorah.org/.  They had an entire Tisha B'Av program so I started with an presentation of about a half hour's length by Rabbi Kenneth Brander on Lessons of the Destruction of the Second Temple which was destroyed due to Sinat Chinam and never rebuilt.  Then an intro to Eicha by Rabbi Einhorn who does the synagogue development program for the Orthodox Union.  Then one more less memorable and I fell asleep.  The following night the fast had not yet concluded so I listed to another iPod presentation. 

None of these are interactive, which should be the prototype of rabbinical education, yet there was an elegance to each of the presentations that rarely comes my way live.  We are fortunate to live in a time where the ideas of learned people are so readily accessible and if you want the learning and don't particularly desire the university degree or other credential, they are available at nominal cost.

Genevah

New stationery for AKSE with the name of the newly hired cantor on the letterhead.  The first mailing was to tell the truth about the now former cantor's departure.  Rumors have a way of getting around.  No, he was not fired but submitted his resignation with six month's notice and fulfilled his professional expectations to the final day.  He will need a minyan and has to assemble it from somewhere or find one already functioning if he does not wish to attend the one at AKSE.  Nobody will chase him away if he shows up.  I hope nobody will expect him to provide his skills for free if he does come.

Apparently there are rumors that AKSE terminated the Cantor and rumors that he is in the process of siphoning AKSE's talented members.  I must be on the B-list since I've not been invited to join him and heard nothing to the effect of an involuntary departure, though word of these things has reached me indirectly over a considerable distance.  To squash this the President sent out a broad mailing to the congregation, copied to the presidents and Rabbis of all the area synagogues and the Federation.  I think the content of the letter is accurate, whether worth the mailing costs to the congregation might be more questionable.

The On-Line Smicha program apparently goes in stages by topics.  I surmise from all this that the module containing the principles of Genevah or stealing has not yet been tackled.  Leaving a false impression like being terminated when reality is an unsolicited decision to quit would fall into the category  of Genevat Da-at or literally stealing information.  Depriving a congregation of its needed membership dues and its talent by soliciting the departure of others would also be a form of Genevah if specific individuals were targeted, though probably would be more akin to legitimate competition for desired services if not individually solicited.  There is a synagogue etiquette not to lure members of another congregation to your congregation which has maintained collegiality in our region.  This came up at a Board Meeting about three years ago when the new Rabbi arrived and the Membership Committee felt it appropriate to invite back members who had left with individual invitations to return, particularly those with Rabbi generated attrition.  Most had latched onto other congregation, one even becoming its President, so the project was not undertaken to avoid the impression of Genevah.

Will AKSE have some of its dues, attendance and participation skimmed off by all this?  I think there will be a small amount of one time attrition, though less than would ordinarily occur by other deterrents such as high dues, often boring sanctuary experience, and the actuarial outcomes of an aging membership base. 

Six Projects

Semiannual planning amid a time of overwork, where one transfers from one urgency to another without regard to importance.  There are patients that need to be seen right now, others in the hospital that need to be seen today, expected to show up at AKSE on Saturday morning, there are deadlines related to my medical license and to closure of my office which still goes on one year after the last patient exited the exam room.  Most of the important things do not have deadlines but are easily deferred to less important things that do.  Each June and December I try to decide which things deserve my attention and creation of some appointment time with myself to do them.  Usually I agonize over this, often spending more effort with the planning than the doing.  It started out that way again but to my surprise, the projects fell readily into place over coffee at the Brew Ha-Ha about two weeks ago.

1. I will pass Endocrine Recertification Boards
2. I will create an estate plan with the attorney
3. My bedroom will be decluttered and redesigned as my personal sanctuary
4. The scale will read under 150 pounds
5. My blog will become an interactive one
6. I will finish the book I bought on how to derive maximum benefit from my iPod

All projects are doable and have identifiable end points where a box can be checked as done or not done.  In the two weeks since its creation, the progress has been less than I hoped but this week I carved out specific time to do some of these things.  Unfortunately I am still often tired when I return home at the end of the day.  The bedroom and estate planning can be done on Sundays, the other stuff probably best to carve out 20 minute blocks during the week.  The trick to accomplishing these will likely be to have finite intermediate points and somebody prodding me along the way.

Overdue Vacation

It's been diificult to stay focused and motivated.  The management has decided that there is too much idle time in the office due to no-shows and responded by overscheduling which leaves me scrambling to take care of the hospital and in a little ongoing conflict with them.  I had some welcome down time yesterday, easy morning at the satellite clinic, no-shows at the office in the afternoon, enabling me to get to consults and hospital rounds earlier than usual.  Last week at the satellite I divided the no-show time between semiannual planning and catching up on medical records.  Yesterday I devoted a welcome hour to commenting on some postings by my electronic friends at AEI and reading about health economics and reviewing some Delaware medmal cases that were posted on line.

There was a fancy dinner at a hotel for employed physicians.  On one of the rare occasions that I could have gotten there at 6PM, I sent my regrets, preferring instead to just get home, work on my upcoming Torah reading and maybe do a few chores.

My last recreational vacation took place in summer 2008.  Since my partner left in February I have not had a beeper free day.  The patients just keep coming at me.  Any escape from that is welcome, even if only for an hour on company time.  I've tried carving out ME days on Saturday and weekends where I just stay home, including the coming one.  But I think the activity has gotten to me, I'm irritible, make decisions a little too impulsively, drop followup balls and really need to get away from this for maybe a whole week.  Scheduled for November.  Need to work on what my highest level of amusement is so that I might seek it.