Is it a crime to love your medical associations too much? Then lock up Robert Pugach, MD, and throw away the key. The Los Alamitos urologist, who's also medical director at Pacific Coast Urology Medical Center, calls organized medicine "the key to the future of medicine"--and he's always put his money where his mouth is when it comes to physician advocacy.

A Los Angeles County Medical Association member since 1988, Dr. Pugach has served on its Executive Council and its Strategic Planning and Membership Committees over the years. He has also been at various times president, vice president, secretary and treasurer of LACMA's District 3 in Long Beach.

At the state level, Dr. Pugach served his fellow physicians for four years as chair of the California Medical Association Organized Medical Staff Section and as vice-chair for two years before that. Currently, he is on the CMA's Council on Legislation and its Hospital/Organized Medical Staff Section Executive Board. At the national level, Dr. Pugach fills the role of secretary on the American Medical Association OMSS Governing Council and was chair of its Western States Caucus. Further, he is a member of the American College of Physician Executives.

If his track record of organized medicine loyalty isn't proof enough, here's how Dr. Pugach describes the situation: "Physicians have always been the best advocates for our patients. In the era of insurance company domination, doctors stand out as the last, best defense against economic abuses against patients. Without the strength of organized medicine, patient advocacy would disappear. Organized medicine allows doctors to practice with autonomy so that we can provide the best possible care for our patients. Imagine a world where insurance companies dictate how we care for our patients! Without organized medicine, we would be beholden to insurers. Every practicing physician should realize this and take part in organized medicine."

Considering his extensive association participation, Dr. Pugach has always followed a broad career path, and that extends to advancing his specialty as well. For almost a decade, he has worked as a clinical development and product-marketing consultant for medical device manufacturers, most recently with Minneapolis-based Urologix Inc. on a noninvasive treatment for benign prostatic hyperplasia called microwave thermotherapy. Dr. Pugach introduced the technique to Southern California in 1998 and since then has treated more patients with it than any other urologist in the country.

"Microwave technology has gone through many developmental stages," he says. "I have been privileged to work with several other urologists in the United States who have considerable experience with the technology as well, because we helped the manufacturer of the premier system develop what's called the CoolWave system, a remarkable advance in microwave thermotherapy that allows customized treatments for most patients with BPH."

Dr. Pugach considers his switch several years ago to a practice based largely on the technology as the high point of his career. "I realized that new, minimally invasive techniques could be used for urology patients, often achieving better outcomes than traditional invasive or radical therapies," he says. "I was concerned at first that my focus might cause me to lose patients, but the opposite has been true. Many more patients have sought my care because of the new methods I use. My practice has grown dramatically." Indeed, he sees patients from all over the United States, as well as international locales including Japan, India, Canada, Mexico and Pakistan.

This summer, Dr. Pugach was invited by the Chinese government to make a weeklong trip there to teach the microwave thermotherapy technique to urologists in Beijing and Shanghai. He was accompanied by Gladys Rentie, RN, Pacific Coast Urology Medical Center's nursing coordinator. "Because of the sheer size of the population, the number of Chinese men affected by BPH is staggering," Dr. Pugach explains. "What I learned on that wonderful trip was once you change in a locker room and put on a scrub suit, doctors are all the same. We are there to help our patients and to improve their quality of life. No matter where we practice, we all have the same altruistic goals."

Those goals were formed early on. Dr. Pugach was a high school volunteer at the local hospital in Englewood, N.J., where he grew up. "I set up a preceptor program for other young volunteers so we could round with the attending physicians at the hospital," he recalls. "Urology caught my interest because of a wonderful chief of urology named Alexander F. Bonacarti Jr., MD. His patients were so grateful for the care he provided."

In the future, Dr. Pugach would like to see noninvasive treatments become the gold standard everywhere. "As technology progresses, forward-thinking urologists will be able to treat more urologic diseases with less-invasive therapies," he says. One such therapy uses high-intensity focused ultrasound for prostate cancer instead of any form of radical surgery. "In 10 years, I think there will be many new alternative therapies that have the potential to further improve our patients' quality of life," he adds. "I hope to continue my focus as an innovator and teacher in this exciting area of urology."