In rebuttal: Physicians trained as mohalim are competent and reliable

I would like to take the opportunity to respond to Rabbi Daniel Wasserman’s letter to the editor dated Jan. 9.  But first a little background is in order.

I am a mohel and physician with 28 years of experience. In my career, I have performed more than 9,000 brit milah ceremonies throughout the world. I consider myself an absolute expert and consummate professional at what I do. I hold myself to the highest professional and moral standards. But I am not alone, as many of my medically trained colleagues share the same values and skills.

As such, I believe I am in a unique position to respond to the fine rabbi’s letter.  And in this regard, I found many of the rabbi’s statements to be subjective, factually unfounded and inflammatory.  

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Throughout his letter, the rabbi seems to draw a distinction between a mohel and physician, as though they are mutually exclusive. As he should know, a mohel can be, by definition, anyone who has been specifically trained in the procedure of circumcision and the ritual requirements of brit milah. Historically, this included rabbis, cantors, shochets as well as physicians, and even an occasional lay person. To argue that a physician mohel cannot competently perform a brit milah equal to a rabbinic mohel because it is “not their core, default training” would argue that a rabbi’s training as a rabbi somehow diminishes his ability to perform a brit milah simply because he is trained for many more things.

While I would agree with the rabbi’s comment that “competent mohalim are supreme professionals who are highly trained,” and that “issues arise and difficult situations do occur” as in any field of human endeavor, his assertion that brit milah is “unequivocally safe” is misleading. It is not. I have been the medical expert for more than a few cases of nonphysician mohel “mistakes.”

Therefore, one needs to separate the Jewish ritual of brit milah from the medical procedure of newborn circumcision. The rabbi would have been better off asserting that newborn circumcision is, in fact, statistically quite safe in competent hands. And when I say competent, I am not separating nonphysician, rabbinically trained mohalim from physicians.  Many of my nonphysician mohalim colleagues are quite competent. I am not arguing otherwise. However, the contention that they are somehow more competent than physician mohalim is absolutely unfounded. While the medical profession routinely compiles complication statistics based on a procedure, there are no corresponding statistics regarding complications or tragic disasters that occur by nonphysician mohalim performing brit milah.  

In addition, the complexities of most procedures performed by physicians, especially for sick patients, are far more challenging than the average newborn circumcision. And so the incidence of “problems” experienced by physicians will always be greater. It is a grossly unfair comparison.

I repeat: There is no way of knowing the number of “mistakes” and poor outcomes attributable to circumcisions performed by nonphysician mohalim, so there may be many more than we know.  They simply are never reported.

The rabbi has nothing to support his contention that brit milah by a nonphysician mohel is inherently safer than a newborn circumcision conducted by a physician and may at times be riskier, especially if a nonphysician mohel performs mitzizah with his mouth or there seems to be a serious medical complication. Where is the proof of this?  Where are the statistics?

What is the rabbi’s issue with Jewish mohel physicians performing brit milah?  Why does he think they can’t handle a few photographers and a crowd? Has he attended many ceremonies conducted by my colleagues? Does he contend physicians are less competent as surgical operators than “lay” individuals trained as mohalim under the auspices of a rabbi, or does he contend the training of physicians is less rigorous than a nonphysician mohel?  What about complications?  Is a nonphysician mohel better suited to contend with medical complications than a physician?  I think not.

Though not all physicians are equal, medical schools do not accept just anyone who applies for medical training.  There is a rigorous process that winnows out those who lack the intellectual or scholastic acumen to be a physician.

All things being equal when selecting someone to perform the brit milah, it would be wise to choose the most experienced, talented, best-trained and competent individual with the finest reputation, irrespective of their ancillary training — rabbi, physician, nurse, schochet or lay person — but not dismiss a physician simply for

being a physician.

Far be it from me to suggest that we should abandon the use of nonmedically trained mohels, but in the interest of absolute truth one cannot deny that using nonphysicians is riskier than medically supervised circumcisions.  In my opinion, if you want to be as safe as possible, hire a mohel who is also a doctor. That is the Solomonic choice, indeed.

(Dr. Fred Kogen is a mohel and physician based in California. He is a graduate of the University of Chicago Pritzker School of Medicine, and a certified mohel under the auspices of the Hebrew Union College, Union of American Hebrew Congregations (now known as the Union for Reform Judaism) and the Central Conference of American Rabbis. He also is past secretary of the Berit Mila Board of Reform Judaism and the National Organization of American Mohalim.)