Irving Prengler (Figure 1) is vice president of medical staff affairs for Baylor University Medical Center (BUMC) and medical director for care coordination for Baylor Health Care System (BHCS). He was born at Baylor Hospital on April 25, 1954, and grew up in Ferris, Texas, and after age 7 in Dallas, Texas. He graduated from The University of Texas in Austin in 1976 and from The University of Texas Southwestern Medical School in 1980. He trained in internal medicine at BUMC from 1980 to 1983. Thereafter, he went into the private practice of internal medicine and was an attending physician at BUMC. In 1993, after 10 years in private practice, he became the medical director of Texas Primary Care and served in that position until 2005, when he accepted his current positions. He has been a major force in developing the hospitalist program at BUMC and served as its chief medical officer from 1999 until 2005. Irving Prengler has taken an active role in BUMC activities since he started his internship here in 1980. He is a good man in every way, and it was a pleasure talking to him about his personal and professional life.
Figure 1.
Irving D. Prengler, MD, during the interview.
William Clifford Roberts, MD (hereafter, Roberts): Dr. Prengler, I appreciate your willingness to talk to me and therefore to the readers of BUMC Proceedings. We are at my house on June 15, 2006. To start, could you talk about your early life, your family, your mother, father, and siblings? What are some of your earlier memories?
Irving David Prengler, MD, MBA (hereafter, Prengler): Dr. Roberts, thank you for inviting me here. I was born in 1954 at Baylor Hospital, in the Florence Nightingale building, which is no longer here. We lived in Ferris, Texas, located between Ennis and Dallas. My parents were Holocaust survivors and moved from Poland directly to Ferris, Texas, where they were merchants (Figure 2). They learned how to speak English there. My sister, Ann, is 7 years older. She was born in Germany about a year after the war and then my parents moved here with my sister. We moved from Ferris to Dallas when I was in the second grade. I went to Hillcrest High School in Dallas, then to the University of Texas at Austin for college, and then to the University of Texas Southwestern Medical School.
Figure 2.
Beloved parents, Minnie and Israel Prengler. Photo: Olschwanger.
Roberts: How did your parents survive the Holocaust?
Prengler: They did not like talking about it until late in life. My family lived together underground beneath a chicken coop in Poland. A very benevolent Catholic family hid them.
Roberts: That was your mother and father?
Prengler: Yes, it was my mom and dad and my dad's family (Figure 3). My father was 1 of 13 siblings. Three died of natural causes before the war. Ten remained when the war started, but only 5 remained at the end of the war. All 5 surviving brothers, including my dad, later moved to the USA along with his mother.
Figure 3.
His father's brothers and their wives at daughter Mindy's bat mitzvah, 2001. Photo: Sharon Kuhr.
Roberts: Five were taken by the Germans?
Prengler: Yes, with their families. My dad lost his father, and my mother lost her father. Both my grandmothers survived.
Roberts: They all were lost in the Holocaust.
Prengler: Yes. Most were put in concentration camps. My dad saw his dad shot by the Germans. My father survived by jumping off a train on his way to a concentration camp. It was either be killed from jumping off the train or be killed in the concentration camp. He jumped off into a forest with machine-gun fire spraying about him. He made it. He was a very young man at that point and was just fighting for survival. I am so fortunate to have grown up in the peace and quiet of Dallas when both my mother and father grew up in such misery.
Roberts: After he jumped off the train, what did he do then? Did he later hook up with the Catholic family?
Prengler: Yes. They had already known the Catholic family. The family was already in hiding but he left and got caught. He finally found his family again. My father had many stories, but we didn't talk about it a great deal and it's hard for me to tell the story in chronological order.
Roberts: Do you know what year he jumped off the train?
Prengler: Around 1943 or 1944.
Roberts: Which city in Poland was he from?
Prengler: Lukow. My mother grew up in Suwalk, Poland.
Roberts: How did your mother survive?
Prengler: After both were kicked out of their respective towns, my future mother and father met up. My mother hid with her mother and sister. My mother and father did not marry until after the war. Both my mother's and father's families hid together and therefore went through much of the same turmoil.
Roberts: Who was the Catholic family who saved them?
Prengler: Their last name is Konko. Many times after the war they came from Poland and visited with us. Their son, Jack, was brought over when I was in the first grade, around 1961. He was 17 or 18 years old at the time, and he stayed with us in Ferris for a while. Then he lived on his own. In the early 1960s, it wasn't easy to become a US citizen from Poland because Poland was a communist country. One of my paternal uncles adopted Jack on paper, and one member of the House or Senate in Washington, DC, introduced a bill that was passed and signed by President Kennedy. Attached to a larger bill was an amendment allowing Jack to become a citizen of the USA because of what his family had done for my family. When Jack was in his late 40s or early 50s, he developed chest pain while visiting my dad's brother. My uncle called me, and I told him to take Jack to the emergency room and I would see him there. (I was practicing internal medicine at BUMC at that time.) Jack had an acute coronary syndrome; he underwent coronary angioplasty and finally coronary bypass. He survived with the help of our BUMC physicians, Drs. Greg Matter, Michael Donsky, John Capehart, and Charles Gottlich, who were very benevolent in taking care of him. Thus, I played a part in helping to save his life as his family had saved my family.
Roberts: What was your mother's name?
Prengler: Minnie Trop.
Roberts: When was she born?
Prengler: She was born on December 25, 1927, and died in 1986.
Roberts: What was your father's name?
Prengler: Israel Prengler. He was born in 1924 and died in 1997; he was 30 when I was born.
Roberts: How many siblings did your mother have?
Prengler: She had a sister, who survived, my aunt Myra, who lives in Brooklyn, New York, with her husband.
Roberts: How did your parents pick Ferris, Texas, to call home?
Prengler: It goes back to my grandparents. My father's mother had 3 sisters and a brother, and before the war they moved to the USA. They ended up in towns in Texas: Athens, Ferris, Dallas, and Grand Prairie. My guess is that they came in via the Galveston port. They were all in the dry goods business. Because he had family in Ferris, my dad and mom came to Ferris. Every Sunday we would all meet in Dallas. Some of my fondest memories are of my grandmother making thick barley soup, so thick that a wooden spoon in the middle of the kettle would stand up. She made roasted potatoes that were cooked overnight, and the kids would scrape the container it was cooked in because it was so tasty. It was just great getting the whole extended family together every Sunday.
Roberts: Was this around lunch time?
Prengler: We would arrive late in the morning and spend the whole day together. Everybody would leave at night to go back to their homes.
Roberts: How many people would that be?
Prengler: Fifteen to 20 people at any one time. My paternal grandmother lived on Royal Lane, and her house was our meeting place until later when everyone had moved to Dallas. There were some very lively discussions at these family gatherings.
Roberts: So you had a major extended family while you were growing up. How many kids did your uncles have? I gather that there were a lot of first cousins?
Prengler: Yes. I'd guess there were 10 to 15 Prengler kids—first cousins. Many of us were in the same schools in Dallas. Our teachers would say, “Okay, I had your cousin. Beware, another Prengler child.” Our extended family was very close. My uncles and my father helped me through medical school.
Roberts: How far is Ferris from Dallas?
Prengler: About 10 miles.
Roberts: When your mother and father initially moved to Ferris, what did they do for a living?
Prengler: They had to learn how to speak English. A family member in Ferris had a belt factory called Marilyn Belts, and my father worked as a laborer there. He saved enough money, learned to speak English, and then opened his own business, a very small dry goods store. He and my mother earned enough to send my sister and me through college and beyond.
Roberts: Was the store in Ferris or Dallas?
Prengler: It was in Ferris. After I was in college, he bought a Ben Franklin store, a variety store. Even after we had moved to Dallas, my father worked 7 days a week at his store in Ferris. He would drive from our house in North Dallas to his store in Ferris every day.
Roberts: Your parents moved to Dallas for the better schools for you and your sister?
Prengler: Correct. My sister was already in junior high when we moved, so she went to school in Ferris a lot longer than I did. My dad had a very strong work ethic and insisted that his 2 children also have a strong work ethic. Both my sister and I worked in our store. I started working there when I was only 5 years old. I worked at the store many a weekend and always over the Christmas holidays. Although we had moved to Dallas, we essentially still lived in Ferris because of the store.
Roberts: Where did you locate in Dallas when you first came?
Prengler: Around Williamstown Road, which is a little north of Forest and Preston and adjacent to the Cooper Aerobic Center. At that time Preston Road was just 2 lanes, and there were only 3 streets north of where we lived. There was no LBJ Freeway, no Dallas Tollway, and no Northwest Highway. When my sister got married, she and her husband, Larry, moved to Plano, which at the time was a very small town, and it took awhile to get there because Preston was only 2 lanes. You would have thought she had moved across the country.
Roberts: What was your mother like?
Prengler: My mother was the central focus of our family. She was our stability. She was kind and loving. My sister is a lot like her. We were a volatile family. When my wife and I first got married and she ate with us, she was very surprised the first time and said, “Irving, I cannot believe that you talk in that tone to your parents.” It wasn't a tone; it was simply the volume that we all used. It was animated and lively. My wife is very calm and came from a very calm family. My mother stabilized the emotions. She was the best cook in the world and the most loving person in the world. I miss her dearly.
Roberts: Was your father home for dinner?
Prengler: Yes, he would get home at 7:00 and, unlike my family or most modern families, we waited out of respect for him and we ate supper as a family. We sat together and talked about our day. We would let Dad sort of simmer down from work and would avoid major questions until he was ready. We had the Sabbath dinner on Friday together. Those dinners are very fond memories for me, even though we had to wait until 7:00 to eat.
Roberts: When your father came home, did he have a beer or a glass of wine or a spirit?
Prengler: Yes. It was traditional in his family to have one shot of vodka when he arrived home. He felt it gave him a good appetite. It was just one shot. His dad did it, his great-grandfather did it. That was the custom.
Roberts: What about your mother?
Prengler: I can't remember ever seeing her drink alcohol. She may have had an occasional cocktail at a social.
Roberts: What about on Sunday when extended family got together? Was there wine or beer around?
Prengler: Possibly an occasional beer, but everything revolved around food, great food.
Roberts: Did your father smoke?
Prengler: He smoked cigarettes for 25 years. He quit 20 or 30 years before his death. He started smoking early in life; I remember his smoking Camels without the filters. His fingers had yellow nicotine stains on them. When the surgeon general came out with the warnings on cigarette packs, he quit. He quit cold turkey and never picked up another pack, but previously he had smoked heavily.
Roberts: Most men smoked back in that time. Did your mother smoke?
Prengler: No.
Roberts: When you sat around the dinner table at night, did your father dominate the conversation? Do you remember some of those conversations?
Prengler: It depended on how well the day had gone. We were very in tune to my father's moods. If it was a tough day at work, it was obvious—not in a critical way, but we knew our dad. We knew to wait until after dinner if there was some bad news to tell. Bad news for me would be bringing home a B rather than an A on my report card. That grade was unacceptable to him, although it happened.
Roberts: I presume that both your mother and your father pressed you and your sister to do well in school.
Prengler: That's half true. My parents had a double standard in that regard. They gave my sister and me every opportunity. They lived for us. They only had education up to the sixth grade. They were in awe that they could give their children the opportunity to have an education. They wanted us to go to college. My parents never pressed me to become a doctor but they expected me to become a professional. In contrast, they wanted my sister to have an education, but at the same time they wanted her to be a mother and raise a family. They did not press her on her grades. They were a lot stricter on my sister from a social standpoint, and they were a lot stricter on me for grades. From a social standpoint they had the “boys will be boys” attitude. We knew what we could and couldn't get away with.
Roberts: When you brought an all-A's report card home, what would your parents say to you?
Prengler: They would commend me, but it was an expectation. When I went to first grade in Ferris, the grades were E's and S's. I was an S student—satisfactory but not excellent. At that point my parents didn't have any great expectations or know that I could do well. I started second grade in Dallas and had a wonderful teacher. It was a traumatic experience moving from Ferris to Dallas. Ferris with its 2000 people was a wonderful place to grow up in. Everybody knew you. Moving to a big city and a new school with my parents still working in Ferris was difficult. We initially lived with my grandmother in Dallas. It was a bit stressful; I was extremely nervous and missed a lot of school because of somatic symptoms. The second-grade teacher, Mrs. Dorothy Philpott, whom I also had in fourth grade, took me under her wing. She saw on the achievement test that I excelled and the S's I had gotten in the first grade did not correlate with my abilities. She told my parents that she thought I was smart. It all started from there. The grades at that time were 1's and 2's. I started making straight A's, or straight 1's. Thereafter, whenever I got a B it always created a lot of tension in our family.
By fourth grade, I was a different kid than in the second grade. Dallas was now home, I had become acclimated to the George B. Dealey Grammar School, which is still on Royal Lane. By fourth grade, I talked a lot in class; I hadn't done that when I was in second grade.
Roberts: Did your family speak English or Polish at home?
Prengler: They spoke Yiddish. My sister and I finally picked it up. I joke with my sister that her first language was Yiddish. I have always told her that if she ever reverts back with dementia then she would go back to her first language, Yiddish. She speaks Yiddish fairly well. I don't speak it well. I understand it well but for some reason, maybe my southern accent, no one understands anything I say in Yiddish.
Roberts: What language was spoken around the dinner table at night?
Prengler: That was usually English, but with a little bit of Yiddish thrown in. When my parents spoke to my sister and me, they would speak in English, but oftentimes when they spoke to one another, they would speak Yiddish. My mom and dad spoke 5 different languages: Polish, English, Russian, Yiddish, and German.
Roberts: Both of your parents were quite smart?
Prengler: Yes, they were. I think my dad would have made an excellent lawyer. He could read an insurance policy and pick out the most minor details in it. He could look at a document and could come up with things that lawyers or advisors would not come up with. He had a very keen mind. My mother was smart, but she was smart in a social sense. She got along with everybody. Everybody loved to talk to her. When my cousins couldn't tell things to their parents, they would often talk to my mother as an advisor. Both parents were very smart but in different ways.
Roberts: What was your father like?
Prengler: My father was very hard driven; he had a strong work ethic and was very strict with us growing up. Of all my father's brothers, he was the most affected by his experience in the war. His brothers, my uncles, told me many times that my father was a hero during the war. Many times he did things to save his family. I think those endeavors took their toll on his health. Both my mom and dad were very ill throughout their lives, and their illnesses were one reason I became a physician. My dad wasn't a flexible person. My mother was. If I needed something I went to Mom; she talked to Dad and was able to get some flexibility. My dad was fair and very loyal. He would give his life for a family member, but at the same time he could be fairly domineering—my way or the highway.
Roberts: Did your mother and father get along well? Was it a good marriage?
Prengler: Yes. They were married almost 50 years. They had totally different personalities, but their loyalty to one another was a good example to both my sister and me. They loved each other. We had a loving family. I have fond memories of growing up.
Roberts: What was your home like after you moved into your own home?
Prengler: It was a lively home. My sister and I didn't get close until I become old enough not to be a pest to her. When I was in grade school, she was already in college. As I got further in school, my mother worked less at the store so she was home when I got home. The house had a wonderful aroma from her cooking. Our dinners would begin with a salad and then move on to beef or chicken and potatoes, the main vegetable in our house. There would also be another vegetable, soup, and a dessert. It was quite a meal. That's why I'm addicted to food at this point. After arriving home from school, I would go play outside in the neighborhood. I had a tree house in a field, which is now the North Dallas Tollway.
Roberts: Were there books around the house? Did your mother and father read much?
Prengler: My dad read more, not particularly books but newspapers. He read a Jewish newspaper. My mom was an avid reader. She loved reading romance novels, the Harlequin romances for example. My mother had a book going at all times. She always encouraged me to read. She would take me to the library often.
Roberts: Your mother worked in the store with your dad?
Prengler: Yes. They worked together.
Roberts: When your father would drive to the store in the morning, your mother went with him?
Prengler: Initially, yes, but later she worked only on Saturdays.
Roberts: You would work on weekends also?
Prengler: Many times. Later on I would ask my dad to give me a weekend off. I had full rein of the house on those Saturdays when I did not work at the store.
Roberts: You said your father worked 7 days a week. The store was open on Sundays too?
Prengler: In Ferris as in Dallas at that time, there was a Blue Law that was supposed to prevent stores from opening on certain times on Sundays. He opened up the store on Sunday mornings. At that time, although the Blue Laws were in existence, no one seemed to mind that he was open on Sunday mornings.
Roberts: You went to synagogue every week?
Prengler: No, not every week. We'd celebrate Sabbath at home with our Sabbath dinner. My family kept kosher at home. Both my sister and I went to religious school 2 or 3 times a week after school. We'd go to synagogue on the high holidays: Rosh Hashanah, Yom Kippur. We'd have a Seder for Passover.
Roberts: Was the Jewish community minute or sizeable in Ferris?
Prengler: The Jewish community in Ferris was the Prengler family. We were the only Jewish people in the town. One of my best friends was the son of the minister from the Church of Christ, located across the street from where we lived in Ferris. We were best friends in first grade. The son of the minister of the Methodist church also was a friend. Even when we lived in Ferris we kept kosher.
Roberts: Did your family ever take a vacation?
Prengler: Rarely. I'm sure my parents regretted that. They worked so hard to give my sister and me whatever we needed that we didn't take many family vacations. My uncles often took me on their vacations. Between work and my mother's and father's illnesses, we didn't get away for vacations.
Roberts: What were your father's and mother's illnesses?
Prengler: My father had severe Crohn's disease and short-bowel syndrome; my mother had multiple myeloma. Both were BUMC patients. Both as a kid and as an adult, I spent many a night at BUMC with my acutely ill father or mother. My dad intermittently was on total parenteral nutrition, which at that time was given only in the hospital. The day I graduated from medical school, my father was in the hospital. He told his doctors that he was coming to the graduation, total parenteral nutrition or not, and 105 degrees or not. (The ceremony was outside.) Mila Zapanta, the supervisor on 15 Roberts, figured out a way to keep the central line in so he could attend. He made it through the ceremony, and they took him right back to the hospital afterwards. My parents' early experiences in the war and their frequent illnesses prevented them from really enjoying their time here on earth.
Roberts: How old was your father when the first symptoms of Crohn's disease appeared?
Prengler: He was in his 30s, but initially they did not know what he had. Physicians weren't that familiar with Crohn's disease back then. Perry Gross was our family physician. He has been my physician since I was 5 years old. Initially, my father had a fistula, and at that time it was not known that that was a part of Crohn's disease. My father even went to Dr. Crohn, a surgeon, in New York, for a second opinion. He was always on very high doses of prednisone and had cushingoid facies.
Roberts: How old was your father when he died?
Prengler: He was 72. My mom died at 58 or 59. My father had numerous surgeries. Perry Gross took care of him, and Zeck Lieberman operated on him numerous times. Charlie Walker, a BUMC gastroenterologist, also often saw him with his partners, Dan Polter and Kent Hamilton.
Roberts: Your mother was awfully young to have multiple myeloma. How long did she have this illness?
Prengler: They discovered it about 10 years before she died. Dr. Merrick Reese diagnosed multiple myeloma. She already had bony lesions when the diagnosis was made. She had chemotherapy numerous times. For 8 of those 10 years, she remained active. Her last 2 years were very tough and painful.
Roberts: You were in your early 30s when your mother died?
Prengler: Yes.
Roberts: How old were your mom and dad when they got married?
Prengler: My mom was 17 or 18 and my dad was 20 or 21.
Roberts: In junior high school and high school, were there other teachers who had a major impact on you?
Prengler: A few. Mrs. Philpott is always the one that stands out. I had a math teacher in junior high, Mrs. Files, who pushed me hard and saw potential in me. (The female students did not like Mrs. Files because if they wore a dress above the knee, she would have a ruler out to measure whether the dress was too short.) She was very strict, but she took a liking to me and that was nice.
Roberts: In high school and junior high school, did you participate in extracurricular activities? Were you an athlete?
Prengler: I loved to play football, basketball, and baseball in the neighborhood, but I was not a gifted athlete. As a kid, I was an avid Dallas Cowboys fan. I would meet the team at the airport after almost every game. Once I skipped school and ended up being on TV at a parade when they won one of the championships. Sports were a large part of my life growing up, but I was not on the school's teams.
Roberts: Do you go to games now?
Prengler: I've changed my allegiance. I am an avid Dallas Mavericks fan (Figure 4). My wife is as much of a fan as I am, probably even more so. We have “dream seats” right behind the Dallas Mavericks bench. We share season tickets with another couple. We get to half the home games.
Figure 4.
The Prenglers in their Dallas Mavericks gear.
Roberts: How did you select your college?
Prengler: It was very easy for me. My dad said, “Irving, you're going to the University of Texas.” I couldn't have been any happier. That's the only college I applied to. I wanted to be a doctor from an early age. Even though I grew up in retail, my dad always told me, “You're not going to be a merchant. You're going to be a professional.” I chose to be a physician after watching my role model, Dr. Perry Gross, who has always been the ultimate physician. He would come to our house. I always thought that I wanted to do that. I wanted to take care of people. I wanted to take care of families. I did not want to do anything dealing with business.
Roberts: Were any of your extended family in medicine?
Prengler: No. I'm the only physician in our extended family.
Roberts: How did the University of Texas work out?
Prengler: It was a dream. It was the most wonderful 4 years of my life. I blossomed at the University of Texas.
Roberts: What do you mean by that?
Prengler: First of all, my future wife and I became close in college. We had known each other since grade school. Although we went to the high school senior prom together, we didn't start dating regularly until college. I wasn't the most social animal in high school. In high school I was considered the studious type, not the social type. At the University of Texas, I was a member of a fraternity. I blossomed socially in college. I made good grades but also was an active fraternity member. I was treasurer and then president of the fraternity. I made lifelong friends in college. Even though there were 40,000 students in the college, the fraternity allowed development of many close friendships.
Roberts: What years were you at the University of Texas?
Prengler: From 1972 to 1976.
Roberts: What fraternity were you in?
Prengler: Zeta Beta Tau.
Roberts: Did you live in the fraternity house?
Prengler: Yes. I could live in the fraternity house with free room and board because I was an officer. That made it easier on my dad at least for those 2 semesters that I was president.
Roberts: Did school come easy for you, or did you have to work very hard?
Prengler: I had to work very hard. After I pledged the fraternity the first year, some activities lasted until midnight. I would come home at midnight and study until the early morning classes. When I study even now, I have to read something over and over again. I had to work hard for my grades.
Roberts: Was it that way in junior high and high school?
Prengler: Yes. I always did very well, but I needed to study very hard.
Roberts: Were you a natural science student?
Prengler: I loved biology. Studying the human body was my favorite, even in grade school. In high school, I took a physiology course and loved it. Chemistry was harder for me, although I always made good grades in it. Biology was a natural for me.
Roberts: You mentioned that you went on vacations with your uncles sometimes. Did you go out of Texas?
Prengler: Rarely. We went to the World's Fair in New York once, but most of the time we went to Padre Island or Galveston.
Roberts: When it came time to pick a medical school, how did it work out that you came to Southwestern here in Dallas?
Prengler: I had good grades and received early interviews. I knew I wanted to stay in Texas. At that time, my parents were ill, and I knew I wanted to be close. I interviewed on a Friday in Galveston and the next day on Saturday at Southwestern. Galveston had fraternities and a beach. It was like a medical school with college life. They wanted me. I came back and said to my fiancée, “Lauri, Galveston is the place; I love it.” I told my parents, and they weren't quite as excited as I was. Lauri said, “Irving, we had 4 years of fraternity life. We're getting married.” Southwestern is more of a commuter school. It did not have the collegiate atmosphere that Galveston had. I was very impressed with the faculty at Southwestern and decided that it would be my first choice, and it worked out quite well.
Roberts: You and Lauri got married just before you started medical school?
Prengler: Right. We had been dating since we were 18. We got married at age 22, the summer before medical school.
Roberts: What were her characteristics that attracted you to her?
Prengler: I always thought she was beautiful. She had a lovely smile and laugh. She always made me feel good when we talked. She is a very feeling and kind person. I still feel the same about her, and we will be married 30 years in August 2006.
Early on, the dean at medical school asked the class, “Who's married?” I raised my hand and maybe 50 other students raised their hands. He said, “Just wanted to let you know that probably at least 75% of you will be divorced by your senior year.” I think it was more like 90%. At that point, I thought, “What did I do?” Yet, the marriage stabilized me. As hard as medical school was, it was nice to come home to Lauri. I had my family, my extended family, and my wife's family here in Dallas. For me it worked out beautifully. Lauri and I got married very young and had a family early. There is a Hebrew word bashert, meaning she's my other half. I think she would say the same. It has been a wonderful marriage.
Roberts: Where did you live during medical school?
Prengler: We lived in various apartments for the first 3 years. In my senior year with the help of my uncles, my grandmother, and my dad, we bought a townhouse. I was a nursing assistant at BUMC even during medical school. At that time they allowed the medical students to pass out prescription medicines to the patients and give intramuscular injections. It was before the BUMC weekend plans went into effect, so there was a nursing shortage and medical school students helped. It was a great experience; I had empathy for what nurses go through because I was the person calling the attending physician for medications, etc. The medical student nurses worked all the overtime they wanted. I could work 3:00 to 11:00 pm or 11:00 pm to 7:00 am through medical school and had odd jobs throughout. Through that work and the help of my uncles, we were able to afford the townhouse.
Roberts: Where was your townhouse?
Prengler: It was in the Forest and Skillman area.
Roberts: When you entered medical school, were there any surprises for you? Medical school is a very select group, and competition is stiffer. How did all that hit you?
Prengler: It was a huge surprise. I entered medical school a little bit cocky after having an excellent grade-point average at the University of Texas.
Roberts: What was your grade point?
Prengler: It was a 3.7 or 3.8. In medical school, my classmates came from all over Texas and spoke with a marked southern twang. I remember thinking, having grown up in a big city and having gone to a big college, that I would have the big advantage. I found myself in a class of students who seemed to have an “extra frontal lobe” because learning came quite easy for so many of them. My early judgment had been wrong: the competition was much greater than I'd ever dreamed of, and it correctly put me in my place. I learned quickly what becoming a professional was all about.
Roberts: Were any of the courses a surprise to you?
Prengler: No. Because I had always wanted to take care of patients, the first 2 years were a little frustrating without the hands-on experience. There were times in medical school when the amount of information we were expected to learn in such a short period looked almost impossible to accomplish. But we all ended up doing it. The only other surprise at Southwestern was the “tough love.” The teaching was outstanding, but it wasn't very touchy-feely in many of the classes. We were told, “You're going to be a doctor, and you need to know this information.” Admitting before a class of 200 that you didn't know the answer to the question and being told, “You can't not know” was instructive, to say the least. We had one of the best teachers of pathology in the world, Dr. Bruce Fallis. (I think he's now practicing pathology in Plano.) He looked like General Patton; in fact, he played General Patton in one of the senior films.
Roberts: Who else had an impact on you at Southwestern?
Prengler: Certainly Dr. Donald Seldin was very influential. He and his internal medicine faculty made me want to become an internist, and they helped prepare me to be one.
Roberts: I gather that choosing internal medicine just seemed natural to you.
Prengler: Right. I wanted to deal with people and their families and have long-term relationships, much like Dr. Gross had with my family. Taking care of whole families, dealing with the good and the bad through life—that was what I had in mind. In our rotations, students got to perform many procedures, and I realized that I was not a proceduralist. I love physiology, the disease process, prevention, and the interaction between people—a physician and the patient and his or her extended family. Internal medicine was a natural for me.
Roberts: You were a busy guy in medical school, studying hard and working at BUMC on many off-hours.
Prengler: Yes. I had a family already; my son who is 28 now was born in my second year of medical school.
Roberts: What did Lauri do when you moved to Dallas?
Prengler: Initially, she worked at a bank in East Dallas and that helped to support us. Again, my dad and uncles helped. When our son, Jeffrey, came, Lauri became a homemaker and took care of our family.
Roberts: Not only your mother and father but your entire extended family must have been incredibly proud of you to have gotten into medical school.
Prengler: Yes, they were, and they all played a large part in who I am today. I am also very proud of them and thankful to them for helping.
Roberts: Did your father's brothers have an opportunity to go to college?
Prengler: No, except for his youngest brother, Aaron, who went to Southern Methodist University and the University of Texas after World War II. He got drafted and went to Korea. He survived the Holocaust because he had blond hair and blue eyes and could pass for not being Jewish. He would often be sent out of the ghetto to buy food.
When my family went to the court to get their citizenship, my father's mother, Rebecca, who had never learned to speak English very well, had a problem passing the test to get her citizenship. A bailiff in the court, who treated my family very poorly, asked my grandmother questions. She was nervous about the test, and the bailiff was very rude to her. When introducing my grandmother to the judge, who was a very compassionate fellow, the bailiff said, “Look, she can't even speak English; she can't be a citizen here.” The judge asked him to move aside and started talking to my grandmother, who was able to communicate with him in broken English, and what she didn't know would be interpreted through one of my uncles. The judge could see she was a very learned woman. He asked about her sons, and she mentioned that her youngest son was an American soldier in Korea at the time. The judge looked at her and said, “With your son being a veteran and with what you have gone through in life, you are automatically a citizen of the United States—regardless of what this test shows.” The bailiff didn't like the verdict too much.
Roberts: How did you choose your internship?
Prengler: During the 4 years in medical school, my parents were often in the hospital, and as a consequence I knew that I wanted to stay very close to them. Also, my wife's family lived in Dallas. (They had moved from St. Louis when she was in grade school.) We were very comfortable living in Dallas. I had taken some senior elective rotations at BUMC during medical school, including part of the internal medicine rotation. I had already met Drs. Reese, Walker, Polter, Gross, and Lieberman, all of whom had taken care of my family. Thus, BUMC was my top choice. I was lucky enough to be selected in the match. We had 7 interns for internal medicine in my year.
Roberts: How did BUMC work out for you from a training standpoint? Who at BUMC had a major impact on you?
Prengler: Many people influenced me. After I spent much time in medical school at Parkland Hospital and at the Veterans Administration Hospital, BUMC was a culture shock. The collegiality was phenomenal. As an intern, it was wonderful to be able to talk to Marvin Stone or John Fordtran in the hallway to ask them a question and to be treated as a colleague. The whole teaching program was based on that collegiality; it wasn't “the more you suffer the more you learn.” At medical school the students were taught that BUMC was just a community hospital and that trainees there weren't going to see as much “pathology.” That was far from the truth. As everyone who practices at BUMC knows, a wide and varied assortment of patients come through its doors. There was so much to be learned at BUMC, and the collegiality with the attending physicians and among the residents themselves was wonderful, a very nice family. While competition was present among residents, it was relatively minor. Although he had just finished his fellowship, Bill Sutker was head of medical education and my boss. My internship class was John Fordtran's first after he became chairman of the Department of Internal Medicine at BUMC.
Roberts: You started your internship in July 1980?
Prengler: Yes. I was a resident at BUMC from 1980 to 1983 (Figure 5). John Fordtran was a wonderful teacher at that time and still is. Charlie Walker, a gastroenterologist, was an excellent teacher. Kent Hamilton, Dan Polter, Marty White, Charles Gottlich, and Mike Emmett took major roles in teaching residents even though they were in private practice. Teaching was a major part of their professional lives and an important part of the residents' lives.
Figure 5.
During his third year of residency at BUMC in 1983. Front row: Irving Prengler, Tim Ellington. Second row: Rick Alexander, Dan Boone, John Brooks, Don Pacini. Third row: Kevin Wheelan.
Roberts: Who were some of your fellow interns who stayed at BUMC?
Prengler: Kevin Wheelan and John Brooks. The other 5 went elsewhere.
Roberts: You were very pleased with your internship?
Prengler: Very much so. When I finished the 3 years of training, I felt very comfortable going into private practice and taking care of inpatients and outpatients.
Roberts: You decided to be a general internist and not do training in a subspecialty. What was the thinking there?
Prengler: I wanted to be able to take care of families long-term, and I loved both the outpatient and the inpatient practices. I liked the idea of taking care of many types of problems and in following someone long-term rather than short-term, as in subspecialties.
Roberts: You went into private practice in August 1983. How did it work out? How did you pick whom you would go into practice with?
Prengler: As a senior resident I was moonlighting at the old Gaston Episcopal Hospital. David Bornstein, who was a beloved internist at BUMC and Sue Bornstein's dad, said to me one day, “Look, Irving, there is an internist, Elias Strauss, who is retiring and he is looking for someone to take over his practice.” Before that I had spoken to Perry Gross about my joining his practice. I talked to Dr. Strauss and liked the idea of being a solo practitioner. Dr. Strauss thoroughly checked me out to see if I was the right fit for his practice. He had 150 to 200 patients, a very nice practice to start with, but of course I had to build it much larger to survive.
Roberts: How did it work out?
Prengler: It was what I wanted to do, but at the same time medicine was changing. Medicare was making changes every 6 months: diagnosis-related groups and managed care came out, all within the 10-year period that I had my own practice. I had a large, busy, and successful practice. I took care of many people I had grown up with, parents of good friends. Dr. Herman Ulevitch, a beloved internist at BUMC, sent me many patients when he retired. Dr. Arthur Gott-lich, Dr. Charles Gottlich's dad, also an ultimate physician, did much primary care although he had trained in obstetrics-gynecology, and I also took over much of his practice at his request. Nevertheless, private practice wasn't what I thought it would be. I loved the inpatient arena more than the outpatient one. Managed care and Medicare came between the patient and me.
I finally decided that private practice was not a good fit for me. I realized after talking to my wife that I wasn't happy, and I decided to do something else. I didn't know exactly what I was going to do. This was around 1993. In addition to my private practice, Susan Brown and I were medical directors and the internists for a head injury hospital and a long-term acute care hospital in Dallas, and I thought briefly about expanding that opportunity. I also liked the possibility of spending more time with my family and not being a workaholic.
About this time the internists at BUMC were being overwhelmed by emergency room calls and we all signed a petition, which we gave to Dr. Fordtran, saying that we no longer wanted to take emergency room call because it disrupted our practices. Simultaneously, the hospital was talking to Dr. Leonard Riggs from EmCare to see if they could form some type of practice to take care of the unassigned patients admitted through the emergency room so that the BUMC internists would no longer have to take call. Drs. Dighton Packard and Leonard Riggs had studied how many unassigned patients went through the emergency room for internal medicine. A group was formed, which included some graduating Parkland residents, to take care of the unassigned internal medicine patients admitted to the hospital. I thought it would be a disaster to have these young physicians start and not know the BUMC system. Dr. Riggs and I agreed that I should be a part of the new in-hospital group. Thus, I helped EmCare start Texas Primary Care (TPC). We were hospitalists long before the term was coined. The appealing thing for me was I could dedicate myself to inpatients rather than running back and forth between the inpatient and outpatient settings.
Roberts: You were the director of that group from the beginning?
Prengler: Yes. The first few years were difficult. We thought that we would admit 3 to 5 new patients a day, but that was a gross underestimation. We thought we'd have an in-hospital service of about 20 patients. I had that many in-hospital patients by myself when in private practice plus the outpatient practice. It was extremely busy from the very start. We really had no idea how busy the emergency room was. Although when TPC came, cardiologists took care of the patients with acute myocardial infarction, our group took care of all the other admissions from the emergency room. As a consequence, the first few years were tough. We ended up having about 50 patients on our in- hospital list from the beginning. Within a year or two, we had 100 patients. Now, TPC probably has 150 patients in the hospital on any one day.
Roberts: How many people were with you?
Prengler: Ali Bagheri and myself from the beginning. Susan Kohl came the second year. The others were part-time or transient. We had residents do a year with us before entering a fellowship; others would work 2 or 3 months, and others 2 or 3 days a week. Our hospitalist group initially confused the hospital and the consultants. I'm certain my former colleagues said, “What in the world were you thinking when you gave up your private practice to do this?” But I always believed that there was a place for inpatient medicine, and clearly there was. TPC needed physicians who wanted to be hospitalists full-time. Now we probably have one of the most mature hospitalist practices in the country. Brad Lembcke now runs TPC. They still allow me to work on the weekends. When we started TPC at BUMC, there were only about 100 hospitalists in the entire USA. Now hospitalists are one of the fastest growing groups in medicine; an estimated 12,000 to 15,000 hospitalists are in the major US hospitals. All of our sister BHCS hospitals as well as most community hospitals in the area have hospitalists.
Roberts: When you switched from private practice to TPC, you immediately went on salary?
Prengler: TPC is owned by EmCare, an emergency room physician management company. EmCare started our hospitalist group. EmCare and BUMC trusted me enough, because of my longevity at BUMC, to try to turn the hospital practice into a good form of practice from a medical standpoint but also to turn it into a viable business.
Roberts: You had decided to stop your private practice before you knew what you were going to replace it with? TPC came along almost right away.
Prengler: Looking back, it was a huge gamble. I knew it was the right thing for me to do. I can't tell you why I knew that, but history has proven it to be true. If you now look at both hospitalist groups at BUMC, they comprise very well respected internal medicine physicians. They are extremely active in our teaching program and our hospital. For the last 4 or 5 years, a member of TPC has been voted “best attending” by the residents. I have taken a great deal of pride in that accomplishment. Dr. Lembcke has taken over the reins, and the group remains in excellent hands. Our hospitalist groups will continue to grow. The hospitalist specialty is just in its infancy now, and it was just a zygote when I started.
Roberts: How many hospitalists are at BUMC now?
Prengler: Probably between 20 and 25.
Roberts: When you were in private practice after 3 or 4 years when your practice had about filled up, what were your working hours? What was your day like?
Prengler: I would get to the hospital about 7:00 am and make inpatient rounds.
Roberts: How many patients would you generally have in the hospital?
Prengler: The criteria for admission to the hospital were a lot less strict then. I had a very busy inpatient practice. I'd do consults for subspecialists. The first few years I'd take emergency room call. I saw outpatients in my office from 9:00 am until 5:00 pm. I worked through lunch. I thought that if I worked through lunch I'd get home on time, which was a fallacy. At 5:00 I would go back to the hospital and see any patients who were very ill or in the intensive care unit. I would return to the office for dictation and get home between 7:00 and 8:00 pm. I shared call with a great call group: Bob Rosen, Bob Fine, Robert Thompson, and later Susan Brown. I rotated on call over the weekends with that group and covered my own calls during the weekdays. So at least on the weekends I'd get off. It took me about 4 or 5 years, however, not to see my own patients on the weekends. After a while, my astute call group said, “Irving, these patients will live without you.” My patients couldn't have been in better hands.
Roberts: You worked “half day”—12 hours? You rarely sat down?
Prengler: Correct. Every day was a 12-hour day.
Roberts: Where was your office?
Prengler: Always in the BUMC towers. Initially, I had only 800 square feet. Each move was to a larger office.
Roberts: You were always by yourself?
Prengler: Yes, except for my last year, when Susan Brown and I shared space. At the time many internists were in solo practices. A large group then was only 4 physicians, and there were no multispeciality groups.
Roberts: How often during those 10 years in solo practice would you be called back to the hospital?
Prengler: Very often, probably twice a week. The emergency room would call about a “nice person to add to your practice” and ask if I could come in and admit the patient. And I also had some very sick patients in the hospital and they had various emergencies. My son reminds me that when I asked him why he didn't consider medicine, he just said, “Dad, very respectfully, I remember your having to go back to the emergency room, hearing the phone ring every 2 seconds, and seeing you working on the weekends.” That wasn't the lifestyle he wanted.
Roberts: Did you take vacations during those 10 years you were in private practice?
Prengler: We did. Again, the call group would cover me. If I took a week off, they would alternate among themselves a day at a time.
Roberts: You must have been beside yourself when you were off a day.
Prengler: I've been so hard driven since I was a kid. I've always worked. I worked in high school in warehouses; I worked in my dad's store. After my bar mitzvah (Figure 6), I worked for a caterer and helped her wash dishes for several years. Work is something I've always done, but, at the same time, I have learned that everybody needs to take some time off. I'm trying real hard to do that.
Figure 6.
At his bar mitzvah. On the right are Perry Gross, MD, and his wife, Harriett.
Roberts: You were director of the TPC group for 12 years?
Prengler: Yes, from 1993 to late 2005, nearly 13 years.
Roberts: Then you switched gears again. So what's happened?
Prengler: BUMC decided to have a vice president of medical staff affairs. They interviewed for the position for about 1 year. I thought they had some very good candidates but none had been selected. The thought to interview for the position did not occur to me. In addition to my TPC role, for the previous 6 years, I was medical director for the Center for Quality and Care Coordination. We did health care improvement and utilization review. Don Kennerly and I were co-medical directors at the time. Those 6 years gave me an insight into how the hospital functioned from a financial standpoint. It was a wonderful experience. I was able to continue to practice and to start doing quality improvement and quality assessment also at the Baylor Jack and Jane Hamilton Heart and Vascular Hospital. That too was a great experience.
I was extremely happy and content in doing that and working with TPC but, at the same time, I felt a need to grow or to tackle something new. One day I talked with Donna Bowers, whom I worked with in the administration for care coordination. She served as my administrative mentor. I asked her, “Is this a crazy idea? I really would like to grow.” When I joined TPC, EmCare was a publicly traded company. In the early years of TPC we lost much money, and I decided I needed some formal business training. Although it took awhile, I did get an MBA, which gave me formal training in economics and accounting. I thought it very beneficial to have an MBA as well as an MD after my name. Although in life I said I would never go into business, look what happened. You can plant an acorn and you can wish for a pecan tree but you're going to get an oak tree. I guess my acorn was that I came from a family of merchants and even though it's not something I ever wanted to do, I'm ending up combining my love of medicine with my interest in business.
Roberts: When did you get your MBA?
Prengler: I went to the University of Dallas. They had a very nice program where one could concentrate in health care. I went to school at night and on weekends.
Roberts: How long did it take?
Prengler: It took me 3 years to get through.
Roberts: What do you do in your present position as vice president of medical staff affairs at BUMC?
Prengler: It's a wonderful position with marked potential. I serve as the liaison between the medical staff and the administration. It is my job to be objective and state the position of the medical staff to our administration and vice versa. Most commonly, both are on the same page, but occasionally, the viewpoints of each group are at variance and I try to find common ground with collegiality. I wouldn't have taken this position if I didn't believe that the BUMC administration had an excellent relationship with its medical staff, especially compared with some other hospitals in Dallas.
Roberts: Do all of the big hospitals in this area have your position?
Prengler: No, but across the USA many hospitals have the position and it is called the vice president for medical affairs or chief medical officer. It's a necessary position in very large hospitals. I help support the medical staff office along with Donna Bowers, Martha Buhman, and Stuart Owen.
Roberts: What are physician relations?
Prengler: These are the duties of the medical staff office. The medical staff office is almost a human resources department for physicians and handles credentialing, education, health, and behavior. Until I got involved I didn't appreciate how much work they do to serve our medical staff. I'm also in charge of physician contracting and am the administrative head of medical education, the A. Webb Roberts Center for Continuing Education, the outpatient clinic, and the BUMC Proceedings. These aren't large administrative roles, but they get me involved in managing some things my business background allows me to do comfortably. Running a hospital is a very complex business, and it has fascinated me. I learn something new daily. I love the atmosphere and the direction our administration is going, their feelings toward patients and toward our medical staff. I've been in this position for only a year, but it's been a very nice experience. I'm extremely happy.
Roberts: What's your day like? What time do you come in now?
Prengler: I thought it would be easier when I took on this role. To devote all my time to this primary role, I've given up 4 previous jobs. I still do clinical work on the weekends. For 3 or 4 weekend days a month, I'll work for TPC because I still want to keep my skills up. Presently, my day starts usually with an early meeting at 6:00, 6:30, or 7:00 am. Throughout the day I have other meetings with the administration and the medical staff. Oftentimes, there are also evening meetings. Although I'm used to hard work and a very fast pace, I'm going at the speed of light now. It's grown astronomically within the 12 months that I've been doing this new job.
Roberts: So the actual amount of time you spend working is about the same as when you were in private practice?
Prengler: Yes.
Roberts: Do you think eventually that all physicians will be working for hospitals or that socialized medicine is inevitable?
Prengler: The one-man practice that I had when starting is almost impossible now because of all the regulations. A large organization, whether it be a physician-managed group or a hospital-managed group, can provide the necessary resources to keep up with the many regulations.
Roberts: Let's talk about your family a bit. How many children do you have?
Prengler: I have 4 children. They are the pride of my life, my hobby. Jeffrey is 28; he was born on November 11, 1977. He went to the University of Texas, got his master's in public accounting, became a certified public accountant, worked in accounting for 2 years, and then decided to go to law school. He just recently graduated from the University of Houston Law School. He has passed his bar examination and now works with Deloitte doing international tax law. He's very happy, married to Neera (Figure 7), and they live in Houston.
Figure 7.
With Mindy, Jeff, Neera, Lauri, Rebecca, and Rachel at Neera and Jeffrey's wedding in 2005.
Rebecca will be 22 in July, and she was born on July 20, 1984. She just graduated from Emory University in Atlanta (Figure 8). We had 3 graduations in 2006. The law school graduation was in Houston; 4 days later we had one in Atlanta; and 2 weeks later we had a high school graduation in Dallas. Rebecca spent the summer after her junior year at St. Jude's Hospital in Memphis, Tennessee, and, as a consequence, got interested in going to medical school. She still has to take some prerequisites, so she's going to the University of Texas in Dallas taking some premed courses. Hopefully in about a year she'll go to medical school. I'm ecstatic about that!
Figure 8.
Rebecca's graduation from Emory University in 2006.
Mindy is 17 years old (Figure 9), and she was born on July 14, 1988. She just graduated from Richardson High School. She will go to Texas A&M starting in September 2006.
Figure 9.
Mindy's bat mitzvah. Front: Irving, Lauri, Rachel. Back: Jeff, Mindy, Rebecca. Photo: Sharon Kuhr.
Rachel is 10 years old (Figure 10), and she was born on March 1, 1996. (Lauri was 41 when she became pregnant with Rachel.) She is an added blessing in our lives. I said at the time that this was the first child I could afford. Our children are the highlights of our lives.
Figure 10.
With Rachel and Mindy at the annual State Fair visit, 2005.
Roberts: Where do you live?
Prengler: We live in far North Dallas around Campbell and Hillcrest. Our kids went to the Richardson elementary and high schools and got a wonderful public education.
Roberts: You must have a little more time for vacations now than you used to?
Prengler: I'm getting better at that. We love Hawaii. It's a place where I can leave my Blackberry at home and truly relax. Lauri and I do enjoy going to Las Vegas once or twice a year. At my 40th and 50th birthdays, I was totally surprised and “kidnapped” to Las Vegas, and we had a blast. I go for the rest, believe it or not. I love the beautiful hotels. I like to sleep late. I love to order room service. I love to sleep in a suite at the Bellagio with a whirlpool and steam bath. My wife loves to pull the slot machine handles. I do gamble but not much. We used to go to a lot of shows. We don't anymore.
Roberts: How much sleep do you need to feel good the next day?
Prengler: I probably sleep about 6 or 7 hours a night. I can wake up in the middle of the night with an idea. (It's just funny when ideas come to you.) If you put me in front of the TV set on the couch after a meal, I'm out.
Roberts: Do you have time for any nonmedical hobbies?
Prengler: Because I spend so much time at the hospital, I try to devote my time to my family when I'm home. I don't exercise like I should. I do like to read, and I do find time to do that.
Roberts: What do you like to read?
Prengler: I love to read “how-to” management books and inspirational books. I'm a nonfiction reader. I love listening to other people's ideas and saying, “Could that work in my life?” I've always got one of those types of books going.
Roberts: Are you a religious person?
Prengler: In my heart, I think I'm very religious. I'm very liberal in that regard and very open. Judaism is a huge part of my life. It's my culture. It's my identity. I am conservative. I'm not very strict, but at the same time, it's a huge part of our lives.
Roberts: Do you go to synagogue regularly?
Prengler: I don't go every week, but I go for the major holidays. I don't go as much as I would like. Our services are about 3 hours long, and I have a hard time sitting.
Roberts: Irving, is there anything that you would like to talk about that we haven't touched upon?
Prengler: No. This has been wonderful rehashing the past. The future is extremely exciting and I feel very fortunate to be at BUMC at this time. I am so happy. Thank you.
Roberts: On behalf of BUMC Proceedings, thank you for being so open and transparent. I am sure that our readers will enjoy getting to know you better.