Medicine needs a leader with a strong vision – someone adept at focusing in on details while keeping an eye on the bigger picture.
Austin colon and rectal surgeon David C. Fleeger, MD, an avid photographer who artfully documents his travels and missionary work abroad, certainly has those skills.
Medicine also needs a leader who brings a unique perspective to the profession – someone, like Dr. Fleeger, who has been on both sides of the patient-physician relationship.
When Dr. Fleeger was about 9 years old, he ran through a plate-glass door – “before safety glass was around,” he notes – and cut tendons and nerves in his foot. He also was treated for nephrotic syndrome from ages 4 to 12, which gave him early and frequent exposure to the health care system and set him on the path to becoming a doctor.
“My childhood illness would be ultimately what … made me feel that [practicing medicine is] how I could give back,” he said.
So it should come as no surprise that Dr. Fleeger will become the Texas Medical Association’s 154th president this month at TexMed 2019.
“It’s certainly a great honor,” Dr. Fleeger told Texas Medicine. “It’s also a great responsibility in that the president serves as the spokesperson for our association, and we are in a profession that’s in a time of transition and more challenges than there have been historically.”
Dr. Fleeger starts his tenure after more than a quarter-century of involvement in organized medicine. (See “Bio Box,” page 27.)
But his ascension to the presidency brings with it a background markedly different from his predecessor, Doug Curran, MD, a self-proclaimed “old country doc” who runs a family medicine practice in the rural East Texas town of Athens. (See “Dr. Curran's Great Legacy: Civility,” page 30.)
Instead, Dr. Fleeger grew up an Army brat, “raised on concrete” as an urbanite, and he lives and works in a large metro area.
But Dr. Fleeger says he and Dr. Curran have certain commonalities that make for a successful president.
“The perspective that I will have is similar in many ways to Doug’s, in that I am an actively practicing physician … and run a practice of eight surgeons that face all of the same challenges that our members face,” Dr. Fleeger said. “So I have the same frustrations, whether it be in the hospitals, which I’m in every day, or outpatient surgery centers, or in the clinics.”
At the top of his agenda for his term as president: protecting the patient-physician relationship and making sure physicians are equipped to roll with the sea changes that are rocking medicine today.
“I have a very grounded understanding of the challenges that face our members that will allow me, I hope, to help to try to find solutions to those challenges,” Dr. Fleeger said.
Rolling with change
As president, Dr. Fleeger intends to preserve “the values of our profession.” That includes maintaining control against the interference medicine routinely encounters from corporate invaders and other nonphysicians who have skin in the health care game, but not the medical expertise to dictate care.
“There are many outside entities that would like to relegate us to the role of technicians – that they can plug us into a particular spot to do a particular job the way they want it done,” he said. “It’s up to us to make sure that we maintain our professional values, the center of which is the protection of the patient-physician relationship.”
At the same time, he says, TMA has to recognize and adapt to changing times and their implications for medicine – for example, the increasing percentage of female medical school entrants. In 2018, according to Association of American Medical Colleges data, 51.6 percent of new medical school enrollees in the U.S. were female, the second straight year that women made up the majority of new medical students. (In Texas, women comprise a record 52.3 percent of the 2018 entering classes.)
“That tells us that in just a few short years, half of all of our peers will be female. And it’s important, both as a profession and as an association, to make sure that they are leaders in our organization,” Dr. Fleeger said.
He also recognizes a shift away from independent practice and toward physician employment.
TMA’s newly released 2018 Survey of Texas Physicians shows that the percentage of Lone Star State doctors employed by a hospital or health system has tripled since 2012, with 12 percent of 2018 respondents falling in that category. Also, the 27 percent of physicians who said they were in solo practice in 2018 was significantly less than the 44 percent who reported they were solo in 2012. (See, “Taking Medicine's Temperature,” page 15.)
Dr. Fleeger says even as TMA fights to preserve independent practice, it can’t leave behind physicians who have chosen the employment path.
“Historically, the TMA has been about the private-practice physician, solo, small group. And much of our organization has been developed to support those physicians. That’s important; we need to continue to do that,” he said. “But at the same time, we need to realize that more and more of our young physicians are entering employment, and I think we need to make some changes that will allow us to provide value to them as members.”
In his interview with Texas Medicine, Dr. Fleeger’s deliberate, thoughtful composure provides a clue as to why his philanthropy has made him a household name in villages abroad, and why he’s come home with stunning, artfully created photographs that capture the essence of each place he’s been. He and his wife Jamie, a physician assistant, make a volunteer mission trip to Guatemala each year to offer primary care services in remote villages.
“We put everything in the back of a truck and … set up a pharmacy, an optometry clinic, dentists and doctors, and just sit there and see a long line of people until they’re all done,” he said. “It’s a lot of fun.”
Dr. Fleeger’s annual trips back to Guatemala have made him well-known in the villages. The mission also has taken him to Panama for primary care work.
“It’s called Christian Medical Missions, but it’s [an] organization that we basically feel that what we do as far as taking care of patients is sort of the way that we demonstrate our Christianity,” he said. “We take care of people, and we take care of them because we’re Christians. Many of them aren’t, but that doesn’t change how we do it or what we do.”
For the past five years or so, Dr. Fleeger has posted at least one picture a day on his Facebook page from his many travels, including Myanmar, Bhutan, Cambodia, France, Colombia, and New Zealand. He’s particularly a fan of portrait photography, and the familiarity he’s developed with his Guatemalan patients makes them comfortable with posing for his portraits.
Whether it’s the smiling or solemn face of a local, memorable statues or buildings, or a cloud looming over the hills and water below it, Dr. Fleeger’s photos expose the insight and care that make both a good physician and a good photographer.
“You realize that people are very similar no matter where you go,” Dr. Fleeger said. “There’s been some personal lessons that I’ve learned in the sense that I’ve been to some very, very poor communities where people live [on] dirt floors and [under] thatched roofs, and have their whole lives and will their whole lives, and yet they’re very happy. You don’t have to have a lot of things to be happy. More important are family and friends and community. Those are things that in the long run probably mean more.”
As for his own family, Dr. Fleeger and Jamie have been married for 34 years. Their daughter, Lauren Seesel, lives in Chicago with her husband, Jim. Dr. Fleeger’s parents live in Houston.
Dr. Fleeger’s globe-trotting began at a young age. His father is a U.S. Military Academy West Point graduate who followed in the footsteps of his own father. Growing up with two sisters in a family where “duty, honor, country” were words to live by, Dr. Fleeger bounced all over the world before settling in Houston for his high school years.
His mother worked at several physician offices, which, along with his childhood illness and injury, gave him a fair amount of exposure to medicine.
So Dr. Fleeger forged the path that he said jokingly made him the “black sheep” of his family, choosing a medical career over a military one. After graduating from Baylor University in 1981, he received his medical degree from the Texas A&M College of Medicine and completed his residency at the Mayo Clinic in Rochester, Minn.
Dr. Fleeger jokes that travel and photography are his prime spare-time interests “other than TMA, which is a hobby in and of itself.” For the next year, that hobby will become a solemn duty, as nearly 53,000 physicians and medical students look to him for leadership.
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