Here's one concrete way he wants to do that: "I would like to develop mechanisms to encourage physician members to preferentially refer patients to other physician members, and mechanisms to encourage patients to preferentially select physicians who are physician members." The plan, he elaborates, is to mimic the physician directories published by large independent practice associations for the very same purpose--letting them know who, among their available referral options, are also members of the organization. "I want to push for a directory of OCMA physicians specifically at each large hospital in the county, such as Hoag or St. Joseph's [hospitals]," he says. "Doctors' referring patterns tend to be through one hospital. So I'd pick one of those institutions and have a directory printed up with all OCMA members listed by specialty, and then distribute the directories to the physicians and patients in that institution's local community."

Accompanying that directory would be a letter encouraging doctors to use it as their referral source book--and encouraging patients to see those doctors. The California Dental Association has had success doing something very similar, Dr. Strebig points out, even running advertisements asking, "Is your dentist a member of the CDA?" He adds: "There are things we can do to make the organization more visible and more public. If we have even higher visibility in the media, then perhaps we can increase our stature among patients in the community, as well. Then you can send out the message asking patients to ask if doctors are members of the OCMA."

His is not a recent enthusiasm for organized medicine; indeed, Dr. Strebig joined OCMA in 1994, as soon as he moved to the area. "I became active in organized medicine my first year out of residency training," he says. "My early involvement was with the Young Physician Section of the California Medical Association. I was chair of the YPS in 1997 and 1998." It's no surprise, then, that he offers this encouragement to his fellow physicians: "Never give up trying to recruit non-member colleagues to join us in organized medicine to help carry out our mission to fight for doctors, patients and the medical profession."

Guillermo Valenzuela, MD, MBA
San Bernardino County Medical Society

Advocacy is a critical mission for physician organizations; nobody's denying that. But Guillermo Valenzuela, MD, MBA, the just-installed president of the San Bernardino County Medical Society, wants to make it his mission to also help doctors remember why they became doctors in the first place. "We have to fight the fights, but we also deserve to go home with the feeling that today we did something good," he says. "Pointing to everything that's wrong with what we do is not going to change anything. We should spend more time emphasizing what we do well, which is taking good care of our patients."

Of course, that includes protecting them from insurance companies and sometimes the government--in the form of Medicare and Medi-Cal cuts--he adds. "But instead of thinking about nothing but pay-for-performance programs and insurance company reimbursement," he emphasizes, "let's remember the joy of being a doctor--and try to have fun again doing what we do."

One of his focuses during his term as president, he says, will be programs to spark in young children that love of being a doctor, with the hope that it will encourage them, as well, to take better care of themselves along the way. His involvement with young people saw its genesis a few years ago in a news report that housing a prisoner costs more than a year at Harvard University. Stunned, he says, he decided he'd be the one to do something about it. He chose a nearby high school with a particularly low graduation rate and offered $500 and a cap and gown to every 9th grade student who completed all 12 years.

As his involvement in the program grew, he realized that intervention in the students' mid-teens was helping, but faced a likely insurmountable obstacle to real effectiveness: the previous 14 or 15 years of the kids' lives, when they didn't have a program available to boost their chances of graduation. So Dr. Valenzuela wants to capture students' imaginations about medicine when they're even younger.

"I picked four elementary schools with 700 students total and sponsored an essay competition--'What I Want to Be When I Grow Up'--in which the winning student in each grade gets a laptop," he reports. "If we educate children, they'll be more interested in learning, and maybe we'll help discover some bright students who will pursue medicine later on." The society, he adds, already supports elementary school programs, so his emphasis will be a natural fit. "I'll try to get involved as much as I can with early grades programs," he says.

It's his inclination to get involved that led Dr. Valenzuela to SBCMS about a decade ago. "I feel that it's my duty to participate in the things that I care about," he says, "and I care about the changes taking place in medicine." The more he got involved in the organization, the more involved he wanted to get, moving up through the ranks.

Here's part of the reason: "I've learned over the years to be very tolerant when people have an opinion that's different from mine," he says. "When I was younger, I saw things more in black and white terms, with very little gray. But as I've participated in the [medical] society, I've found there are more points of view than my own--and that some of them are even better than mine. I've learned to truly listen to people and to try to understand what they're trying to say." A natural consensus-builder, he says he's known for seeking a lot of advice and for trying, when possible, to reach consensus on contentious issues.

That means that if you're looking for fireworks from San Bernardino in the next year, you're likely to be disappointed. Dr. Valenzuela doesn't plan to issue any dramatic new directions in policy, to rattle any establishment cages nor to break ranks with other physicians on any critical matters. The society under his leadership will support California Medical Association positions as far as political advocacy, he says, and will focus much of its outreach efforts on San Bernardino County's youngest residents.

The MBA after his name, he adds, makes the economic issues bedeviling the healthcare system clearer to him--but that often only adds to his frustration. Understanding how the economy works is often as terrifying as it is empowering. "At least I understand the economic forces that are moving healthcare. That makes me often wonder, however, if some of the economic issues are really--or should really be--social issues."

Indeed, he says, "I'm becoming more and more convinced that, short of socialized medicine, at some point society is going to have to decide that healthcare is a social responsibility. It's useful to have an MBA, but it's also necessary to take a step back and wonder how fixing the economic side of healthcare is really going to solve the bigger problem by actually improving outcomes. In the face of that uncertainty, the right thing to do is to get involved."