Presentation of the Julius M. Friedenwald Medal to Martin Brotman, MD
2008; Elsevier BV; Volume: 134; Issue: 7 Linguagem: Inglês
10.1053/j.gastro.2008.05.023
ISSN1528-0012
Autores Tópico(s)Primary Care and Health Outcomes
ResumoThe Julius M. Friedenwald Medal is the most prestigious award bestowed by the American Gastroenterological Association (AGA) Institute. Named for a distinguished Baltimore gastroenterologist who served as the 8th president of the AGA, the medal is given in recognition of lifetime service, achievement, and contributions to the AGA and the specialty of gastroenterology.The 2008 Friedenwald Medal is presented to Martin Brotman, MD, AGAF, President and Chief Executive Officer of San Francisco's California Pacific Medical Center (CPMC). This is just one of the many achievements that have defined the life of this respected leader, educator, businessman, and, most especially, dedicated physician and family man.Canadian Boyhood and EducationMartin's father wanted so deeply for his only son to become a doctor that he kept the boy away from the clothing factory that was his own life's work so Martin might take less interest in the business. The strategy worked. Through 10th grade, Martin focused half his time on Hebrew studies, half on the standard school curriculum, and still graduated early. At 15, he was accepted into the pre-med program at the University of Manitoba. At 22, he graduated first in his Manitoba Medical College class, with gold medals for that accomplishment and for the best performance across all 4 years. He won a record 9 of 14 awards available to graduates.No parents could have been more proud. Israel (“Izzy”) Brotman belonged to the Jewish Diaspora, emigrating from his native Russia to Winnipeg, Canada, with little formal education and no job. Izzy worked as a janitor until a friend loaned him $200 to start the Canadian Garment Manufacturing Company, makers of sturdy clothes for men. The business flourished.Martin's mother, Helen, had come to Winnipeg from Poland. She too had a clear vision of what she wanted for her son—what she herself already had: a close-knit family and a love for their shared Jewish traditions. Helen lived to be 90, long enough to see all these dreams and many more come true. Izzy died young, but not before seeing Martin enrolled at the Manitoba Medical College.From his father, Martin learned perseverance, unwavering honesty, and integrity; from his mother, compassion and spiritual strength. In medical school, he also took life lessons from his “most respected teacher” Joseph Doupe, chair of the Department of Physiology, who helped him hone his critical thinking skills. Another life lesson came from Dwight Parkinson, Chief of Neurosurgery at Winnipeg General Hospital, who told him “for the rest of your life people will pay you to know, not to think.”Postgraduate Work at the Mayo ClinicMartin was just 24 when he went to the Mayo Clinic in Rochester, Minnesota, for postgraduate studies in medicine and gastroenterology. There he did his research under William Summerskill and was mentored by Hugh Butt, Jim Cain, Charles Code, William Sauer, Richard Reitemeier, Alan Hoffmann, Leslie Schoenfeld, and Sid Philips. Another major influence during this period was the University of Chicago's Joseph Kirsner. While in Rochester, Martin also earned a Master's degree in Medicine and Physiology from the University of Minnesota, published his first Mayo paper (“Protein biosynthesis and the genetic code,” with Doug McGill) and discovered his clinical interest in inflammatory bowel disease (IBD).Childhood Sweethearts in San FranciscoMartin did not go from Winnipeg to Mayo, or from there to national acclaim, alone. At his side, at every step, has been his wife and sweetheart since the age of 14, Farron. The Brotmans married in 1960, during Martin's second year of medical school. They graduated together, he with a doctorate of medicine, she with a masters in social work. On their honeymoon, they spent 2 days in San Francisco—long enough to fall in love with the city. When Bill Summerskill learned of their enthusiasm for the Bay Area, he arranged a visiting professorship for Martin with Bill's old friend, the late Rudi Schmid, at that time the new chief of Gastroenterology at the University of California San Francisco (UCSF). That year, 1967, marked the beginning of cherished connections—between Martin and Rudi (and his associates Marv Sleisenger and Bob Ockner), and between the Brotmans and their new hometown.Here the Brotmans raised 2 daughters, Ilana and Brenley, and a son, Stuart, all now happily married, with successful careers and, among them, 6 thriving grandchildren. Farron completed her advanced degree in psychoanalytical psychotherapy and opened a private practice that still keeps her busy.Clinical Practice With a Previous Friedenwald HonoreeIn 1966 came a life-changing phone call. Dwight L. Wilbur, MD—distinguished trustee of the Mayo Clinic, former president of the AGA and the American College of Physicians, and 1966 winner of the Friedenwald Medal—was looking for a young physician to take over his large gastroenterology practice in San Francisco in the most respected multispecialty medicine group in the city; Dwight would be leaving practice for 2 years to serve as President-elect and President of the American Medical Association. Dwight asked his colleagues at Mayo for a recommendation from among their many GI Fellows. They urged him to talk with Martin. The 2 connected, and Martin said yes. At that time, Pacific Internal Medicine Associates (the “Wilbur Group”) had 4 members; today, it is 11 strong, with Martin as senior partner.Clinical practice brought the greatest satisfaction of Martin's career. Above everything that would come later, and a great deal came later, his patients would always come first. By his own admission, Martin has missed countless family dinners because someone needed care that could not wait. For more than 30 years, until recently, he made more than 12 trips a year to consult in far-off Eureka and Ukiah, California, to relieve GI patients there of the high cost and stress of travel to San Francisco. On every visit he would see patients, provide “curbside” consultation, deliver a lecture, train his GI fellows who would accompany him, teach endoscopy to local surgeons, and generally raise the level of care in these communities. Only when the community recruited younger GI consultants ready to take over did he finally retire from this arduous travel schedule.Today, Martin still sees patients weekly at his medical office and performs endoscopy one morning a week. For many patients with IBD or other chronic GI and liver diseases, he provides primary as well as specialty care. In fact, he always budgeted his time so that 30% of his practice was in primary care internal medicine. How does he stack up as a clinician? Ask his peers; they have chosen him in large numbers as their own doctor. For decades, he was considered the gastroenterologist's gastroenterologist in San Francisco.An Academic at HeartMartin was Board Certified in internal medicine in 1970 and recertified in 1978, and in gastroenterology in 1972. He continued to teach at UCSF, quickly earning a clinical professorship in the Department of Medicine, a post he has held since 1982. Every November for more than 20 years, Martin was the attending physician on the medicine service at UCSF under Department of Medicine Chair Holly Smith, while also actively participating in teaching gastroenterology at UCSFAs noted, Martin has remained committed to education and research throughout his career. He has won “Best Teacher” award at several San Francisco hospitals. He continues as a respected teacher of our GI Fellows and his CPC presentations both at CPMC and UCSF are legendary. For his dedication to the AGA's research agenda, the American Digestive Health Foundation named the ADHF Martin Brotman Advanced Training and Transition Awards in 2000. At CPMC, he was instrumental in building a new research facility and fostered major expansion of research and education activities. He has published on a wide variety of topics, including new device development, physiologic disorders in digestive disease, percutaneous gastrostomy, irritable bowel syndrome, and managed care. He also chaired the National Consensus Conference on E coli 0157:H7 infections and the AGA Taskforce on Quality of Clinical Care.The Call to LeadershipMartin's favorite movie is Patton. Although the general's stern bearing, gravel voice, and dark eye bear no kinship to Martin's easy warmth and inclusive style, the 2 men do share a can-do determination, an articulate charm at the podium, unfailing loyalty to their subordinates, and high ideals that make for ambitious goals. Leadership comes naturally to Martin, and he has had ample opportunity to practice it, first at small hospitals and then, in the early 1970s, at San Francisco's Pacific Medical Center (soon renamed Pacific Presbyterian Medical Center), a teaching hospital with a distinguished pedigree.This campus has roots in the West's first medical school, Cooper Lane Medical College. It also served for more than 50 years as the medical school and hospital of Stanford University. In 1959, Stanford sold the property to the Presbyterian Church for $1 and moved its entire infrastructure 40 miles south to Palo Alto. Most physicians on the faculty stayed on in the city, however, establishing a new institution that would open, on day 1, with an internationally esteemed medical staff, a tradition of clinical and scientific innovation, a large and diverse caseload, and the West's oldest medical library.Having started his practice at French Hospital, where Dwight Wilbur was Chief of Medicine, Martin first arrived at Pacific Medical Center in 1970, already a Bay Area leader in gastroenterology. By 1974, he was Division Chief. Over the next 18 years he would establish a GI fellowship and direct its program; build a GI laboratory (which grew to 15,000 procedures annually); and create an Inflammatory Bowel Disease Center where he served as medical director. He not only expanded the staff of GI specialists from 2 to 37, but molded them into a collegial team committed to collaboration, volunteer education, and high-quality care.His physician leadership quickly extended beyond gastroenterology. As early as 1977, he anticipated the increasing interdependence between hospitals and physicians and he undertook development of a physician-owned office building on the hospital campus. This he did, joined in leadership by obstetrician/gynecologist George Lee and ophthalmologist Robert Webster, through a development firm they founded and named Pan-Med Enterprises. Eight years and countless regulatory hurdles later, the Pacific Professional Building opened. Linked to the hospital, it houses free patient education and social services, hospital-operated ancillary services, and a commercial pharmacy, as well as offices for 160 clinicians selected for their balance of specialties and their full commitment to this medical center. Until 1992, Martin presided over Pan-Med Enterprises as its President. He still sits on the Board of Directors. It has been a role model for physician/hospital cooperation, and an exceptional investment for its ≥100 physician-owners.Meanwhile, in 1981, Martin also accepted the directorship of the medical center's deteriorating Division of Education. Over the next 11 years, he led the division to national stature in both professional and community health education. By the late 1980s, Pacific Presbyterian Medical Center (PPMC) was sometimes called a “hospital without walls,” in part because of the reach of its community education programs. It was also out front in the emerging national movements of complementary and patient-centered care, which have strong educational components. For his work in patient education in clinical care, Martin received the Premier Physician Award from the Crohn's and Colitis Foundation of America.To reach health professionals, Martin and his team produced countless on-site courses and dozens of live interactive audio teleconferences, including 2 live nationwide conferences (with Ted Koppel as host) using interactive video technology. Martin built on this media experience to launch his own public radio interview show on medical topics. It had a 10-year run. He also narrated and appeared in The Physician as Fundraiser, a video produced by PPMC Foundation to inspire physician giving and donor cultivation. As with so much else, Martin was becoming a force in hospital philanthropy.By the mid 1980s, every important PPMC committee and task force had Martin either at the helm or on board. Then, in 1991, he supported the merger of PPMC with its neighbor and long-time competitor, Children's Hospital. A fiscal necessity, this was a marriage of equals—2 beloved institutions committed to voluntary governance, nonprofit financing, and quality care. The governing boards, philanthropic foundations, and medical staffs all united under a new name: California Pacific Medical Center (CPMC). Martin became chair of the combined departments of Medicine.Unfortunately, under the impact of managed care, medical centers nationwide and particularly in California kept spiraling downward. By mid-decade, a consulting group was managing California Pacific, losses were at $3 million a month, large amounts of maintenance and capital investment were being deferred, layoffs were large, morale was low, many programs had seen the axe, the Board was dipping into reserves to meet payroll, and rumors hinted at bankruptcy, a possible sale, or even closure. Given Martin's background, no wonder the governing board turned to him for leadership. He was named President and Chief Executive Officer in 1995.Piloting the PhoenixMartin is the first to say that no one man could have lifted California Pacific from the ashes. This took hard work, courage, vision, and sacrifice by an exceptional management team recruited by Martin and his invaluable co-leader Jack Bailey, CPMC's Executive Vice President and Administrator. Still, there is no denying the turnaround that occurred on his watch. The new management team was soon in place, planning and implementing changes that would take the medical center from a $34 million loss in 1994 to a net income of $128 million in 2007. Enterprise wide, annual net revenue rose dramatically, exceeding $1.2 billion by 2007. In 1996, Martin led CPMC into affiliation with Sutter Health, a large northern California system. He instantly became a leader in system-wide planning, development, and management. By 2002, California Pacific had the best financial bottom line of any hospital in the Bay Area and one of the best in the nation. Primary through quaternary care expanded. A unified corporate identity was taking hold. Physician, employee, and patient satisfaction were all on the way up, currently sustained in the top 10% in the nation. Annual contributions to CPMC Foundation went from $6.4 million in 1994 to $28.2 million in 2007. Accolades, never taken for granted, became frequent. The Leapfrog Group, AARP, Health Grades, and other rating groups have placed California Pacific among the nation's top hospitals. Reader surveys repeatedly identify this as the city's best hospital and one of the area's best workplaces.In 1998, Martin piloted California Pacific's acquisition of a third major San Francisco Medical Center: Ralph K. Davies Medical Center, which is now being developed into a Neuroscience Institute and a Regional Rehabilitation Center. In 2005, under Martin's leadership CPMC embarked on a $2.4 billion rebuilding project that will include a new, state-of-the-art acute Medical Surgical and Women's and Children's hospital, 2 new medical office buildings, and renovation of 4 existing campuses.In the past year, California Pacific opened a new Child Care Center, a new Advanced Interventional Endoscopy Center, acquired 2 major office buildings, and will soon open the only Pediatrics Emergency Department in San Francisco and a new Surgery Simulation Training Center.Martin's commitment to education and research has resulted in continuous growth of the Medical Centers training programs. In 2008, California Pacific became a major teaching affiliate of Dartmouth Medical School.In 2005, St Luke's Hospital—a 260-bed acute-care facility and the only nonpublic hospital located in the southern half of San Francisco—reached the end of its financial rope, and California Pacific took on a fourth campus.The silver lining for him is the opportunity to bring the kind of health care he believes in—care that goes beyond the expected—to more families in underserved neighborhoods.Giving Back to the ProfessionWoven throughout this story is still 1 more thread that speaks to Martin's leadership skills, his dedication to medicine, and his willingness to give of himself—namely, his volunteer services to the AGA, other professional associations, and his local physician community. In the 1980s, Martin was invited to join the Subspecialty Board on Gastroenterology of the American Board of Internal Medicine. He served for 6 years, including 2 as chair. He also spent 2 years on the board of the American Board of Internal Medicine. In 1989, he was appointed to the Technical Advisory Group of the Harvard School of Public Health's National Study of Resource-based Relative Value Scales for Physician Services.Across more than 30 years, Martin has served in innumerable key volunteer positions in the AGA. In the 1980s and early 1990s, as Treasurer he strengthened the AGA's financial position sufficiently to develop the foundation for a national office and transformed the journal Gastroenterology into a major revenue source. In 1993, he was the founding Chair of the AGA Foundation and raised more than $29 million for education and research. Later, he played a key role in transitioning AGA philanthropic efforts to The Foundation for Digestive Health and Nutrition. He fostered the development of AGA's 10-year Research Plan, and was an effective Chair of the Research Committee. He became the AGA's 96th president in 2002, serving with great distinction. During his presidency he successfully focused on his highest priorities: addressing the needs of clinicians in private, group, and academic practice; expanding funding for young investigators; strengthening the education experience of trainees; developing new partnerships with the international GI community; creating a clinical track at DDW; and initiating discussion of constituency-based strategic planning and governance. He has continued his commitment to our society, remaining available to serve whenever called upon.In San Francisco, the Pacific Professional Building was only one aspect of Martin's service to local physicians. Simultaneously he helped to create the Pacific Presbyterian Medical Group, an Independent Practice Association (IPA), which has evolved into Brown & Toland Medical Group, San Francisco's largest IPA. He planned and implemented the Physicians Foundation at CPMC to ensure the retention and recruitment of tertiary/quaternary specialists and teaching faculty.Anyone who has practiced in gastroenterology during the past 40 years knows how tough it is to take on even 1 extra, nonclinical assignment. Martin's many professional friends understand better than anyone the sacrifices he has made. For his own part, at every opportunity he expresses how thankful he is to his colleagues for the opportunities he has been given and especially to those of us in our practice office Pacific Internal Medicine Associates who have made it possible for him to serve. We are all grateful for his example.Giving Back to the CommunityToday, as communities struggle to stretch health care dollars to serve an increasingly underinsured and aging population, a man like Martin is a local treasure. He understands the whole story—from the perspectives of hospital administrator, medical staff member, physician educator, compassionate clinician, and concerned citizen and family man—and he cares enough to get involved.Over the years, he has served a large number of community service agencies, including serving as President of his synagogue. From 1998 to 2001 he cochaired the Northern California Hospital Council. For 9 years, served on the Board of Directors of the California Transplant Donor Network, our local Organ Procurement Organization and served as chair for 3 years. To address the needs of San Francisco's most underserved population, he cofounded a City-wide African American Health Disparity Initiative in 2002, and continues to serve as cochair. In 2006, he served on Mayor Gavin Newsom's Task Force on Universal Health Care Access. He continues to raise dollars for local charities, including the CPMC Foundation, where he works with staff to cultivate and solicit major gifts. He is also a familiar face at innumerable community events sponsored by California Pacific. In February 2007 and 2008, for example, at a free clinic sponsored by the medical center at a City program called Project Homeless Connect, Martin delivered one-on-one primary care to homeless San Franciscans throughout the day. Under his leadership, CPMC provides more than $50 million of free care and services to San Franciscans annually. In 2006, Martin received the Ritz E. Hermann Memorial Award from the California Hospital Association for “outstanding contributions to the California health care community.” In 2008, he received the University of the Pacific Arthur A. Dugoni School of Dentistry Medal of Distinction for his exceptional contributions for many years.A Treasured LifeDespite his enormous responsibilities, Martin has remained a devoted and available husband to his always patient and supportive wife Farron (a psychotherapist in San Francisco) and father to his exceptional children, Ilana and her husband Neal, Stuart and his wife Elizabeth, and Brenley and her husband Kevin. He and Farron adore their 6 grandchildren Blake, Olivia, Meredith, Abigail, and the twins, Ashley and Joshua. They are a close-knit, loving family, traveling, boating, skiing, celebrating traditional holidays and family events together frequently. Their home in the Napa Valley is a favorite weekend gathering place. Martin ensures that there is time to nurture his relationship with family and friends all over the world.Deserved RecognitionMartin has proved himself to be an inspirational mentor, a visionary planner, an exceptional builder, a diplomatic and effective leader, a thoughtful and creative change agent, and a role model clinician, colleague, and friend. He has devoted all of these attributes to his service to AGA. He is most deserving of the highest award of our organization in recognition of his service to our profession. The Julius M. Friedenwald Medal is the most prestigious award bestowed by the American Gastroenterological Association (AGA) Institute. Named for a distinguished Baltimore gastroenterologist who served as the 8th president of the AGA, the medal is given in recognition of lifetime service, achievement, and contributions to the AGA and the specialty of gastroenterology. The 2008 Friedenwald Medal is presented to Martin Brotman, MD, AGAF, President and Chief Executive Officer of San Francisco's California Pacific Medical Center (CPMC). This is just one of the many achievements that have defined the life of this respected leader, educator, businessman, and, most especially, dedicated physician and family man. Canadian Boyhood and EducationMartin's father wanted so deeply for his only son to become a doctor that he kept the boy away from the clothing factory that was his own life's work so Martin might take less interest in the business. The strategy worked. Through 10th grade, Martin focused half his time on Hebrew studies, half on the standard school curriculum, and still graduated early. At 15, he was accepted into the pre-med program at the University of Manitoba. At 22, he graduated first in his Manitoba Medical College class, with gold medals for that accomplishment and for the best performance across all 4 years. He won a record 9 of 14 awards available to graduates.No parents could have been more proud. Israel (“Izzy”) Brotman belonged to the Jewish Diaspora, emigrating from his native Russia to Winnipeg, Canada, with little formal education and no job. Izzy worked as a janitor until a friend loaned him $200 to start the Canadian Garment Manufacturing Company, makers of sturdy clothes for men. The business flourished.Martin's mother, Helen, had come to Winnipeg from Poland. She too had a clear vision of what she wanted for her son—what she herself already had: a close-knit family and a love for their shared Jewish traditions. Helen lived to be 90, long enough to see all these dreams and many more come true. Izzy died young, but not before seeing Martin enrolled at the Manitoba Medical College.From his father, Martin learned perseverance, unwavering honesty, and integrity; from his mother, compassion and spiritual strength. In medical school, he also took life lessons from his “most respected teacher” Joseph Doupe, chair of the Department of Physiology, who helped him hone his critical thinking skills. Another life lesson came from Dwight Parkinson, Chief of Neurosurgery at Winnipeg General Hospital, who told him “for the rest of your life people will pay you to know, not to think.” Martin's father wanted so deeply for his only son to become a doctor that he kept the boy away from the clothing factory that was his own life's work so Martin might take less interest in the business. The strategy worked. Through 10th grade, Martin focused half his time on Hebrew studies, half on the standard school curriculum, and still graduated early. At 15, he was accepted into the pre-med program at the University of Manitoba. At 22, he graduated first in his Manitoba Medical College class, with gold medals for that accomplishment and for the best performance across all 4 years. He won a record 9 of 14 awards available to graduates. No parents could have been more proud. Israel (“Izzy”) Brotman belonged to the Jewish Diaspora, emigrating from his native Russia to Winnipeg, Canada, with little formal education and no job. Izzy worked as a janitor until a friend loaned him $200 to start the Canadian Garment Manufacturing Company, makers of sturdy clothes for men. The business flourished. Martin's mother, Helen, had come to Winnipeg from Poland. She too had a clear vision of what she wanted for her son—what she herself already had: a close-knit family and a love for their shared Jewish traditions. Helen lived to be 90, long enough to see all these dreams and many more come true. Izzy died young, but not before seeing Martin enrolled at the Manitoba Medical College. From his father, Martin learned perseverance, unwavering honesty, and integrity; from his mother, compassion and spiritual strength. In medical school, he also took life lessons from his “most respected teacher” Joseph Doupe, chair of the Department of Physiology, who helped him hone his critical thinking skills. Another life lesson came from Dwight Parkinson, Chief of Neurosurgery at Winnipeg General Hospital, who told him “for the rest of your life people will pay you to know, not to think.” Postgraduate Work at the Mayo ClinicMartin was just 24 when he went to the Mayo Clinic in Rochester, Minnesota, for postgraduate studies in medicine and gastroenterology. There he did his research under William Summerskill and was mentored by Hugh Butt, Jim Cain, Charles Code, William Sauer, Richard Reitemeier, Alan Hoffmann, Leslie Schoenfeld, and Sid Philips. Another major influence during this period was the University of Chicago's Joseph Kirsner. While in Rochester, Martin also earned a Master's degree in Medicine and Physiology from the University of Minnesota, published his first Mayo paper (“Protein biosynthesis and the genetic code,” with Doug McGill) and discovered his clinical interest in inflammatory bowel disease (IBD). Martin was just 24 when he went to the Mayo Clinic in Rochester, Minnesota, for postgraduate studies in medicine and gastroenterology. There he did his research under William Summerskill and was mentored by Hugh Butt, Jim Cain, Charles Code, William Sauer, Richard Reitemeier, Alan Hoffmann, Leslie Schoenfeld, and Sid Philips. Another major influence during this period was the University of Chicago's Joseph Kirsner. While in Rochester, Martin also earned a Master's degree in Medicine and Physiology from the University of Minnesota, published his first Mayo paper (“Protein biosynthesis and the genetic code,” with Doug McGill) and discovered his clinical interest in inflammatory bowel disease (IBD). Childhood Sweethearts in San FranciscoMartin did not go from Winnipeg to Mayo, or from there to national acclaim, alone. At his side, at every step, has been his wife and sweetheart since the age of 14, Farron. The Brotmans married in 1960, during Martin's second year of medical school. They graduated together, he with a doctorate of medicine, she with a masters in social work. On their honeymoon, they spent 2 days in San Francisco—long enough to fall in love with the city. When Bill Summerskill learned of their enthusiasm for the Bay Area, he arranged a visiting professorship for Martin with Bill's old friend, the late Rudi Schmid, at that time the new chief of Gastroenterology at the University of California San Francisco (UCSF). That year, 1967, marked the beginning of cherished connections—between Martin and Rudi (and his associates Marv Sleisenger and Bob Ockner), and between the Brotmans and their new hometown.Here the Brotmans raised 2 daughters, Ilana and Brenley, and a son, Stuart, all now happily married, with successful careers and, among them, 6 thriving grandchildren. Farron completed her advanced degree in psychoanalytical psychotherapy and opened a private practice that still keeps her busy. Martin did not go from Winnipeg to Mayo, or from there to national acclaim, alone. At h
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