A Look Back on an AMA Presidency

No one, literally no one, not even my mother, could have imagined that when a local physician invited me to take his place as the MSMA 9th District Councilor back in 1987 it would ultimately lead to the presidency of the AMA. What a ride it has been and what a year an AMA presidency is. I was on the road almost 200 days during the year addressing issues that will impact our profession and our patients for years to come, speaking to students, residents, physicians, external audiences, the media and Congress, and representing US physicians to the world medical community. Grueling at times, but every minute of it was an amazing experience.

The Issues

I was elected to the AMA Board in June 2009 during the height of the national debate on the Affordable Care Act that was eventually passed and signed into law in March 2010. Although the debate was heated (to say the least), both the AMA House and Board supported policies that would reduce the number of uninsured. The intensity of that issue during my first year was quite an initiation for a freshman member of the AMA Board.

Fast forward to June of 2016 when the AMA House of Delegates gave me the greatest honor of my professional career in selecting me to serve as AMA president. Then what happened? The national debate over healthcare reform was once again front and center in the November 2016 presidential and congressional campaigns. Those elections were immediately followed by efforts to undo the gains made under the Affordable Care Act, thrusting me once again into one of the most passionate and potentially divisive discussions facing our country and the profession of medicine.

As before, the AMA took a principled stand and, as the AMA spokesperson, I traveled the country advocating for maintaining coverage gains and patient protection provisions, protecting the safety net programs of Medicaid and CHIP, and stabilizing the insurance markets. I’m pleased to say that the gains remain mostly intact. However, there is much more to be done to improve affordability and further expand coverage.

During this time, our profession was also making the most significant change in Medicare physician payment in a generation with the AMA led repeal of the SGR and consolidation of the value payment programs into a single Medicare Quality Payment Program including the Medicare Incentive-Based Payment System or MIPS. I gave countless media interviews and live presentations that helped physicians understand how to either be successful in MIPS or how to avoid the penalties for the 2017 and 2018 performance years.

Ongoing efforts to address the opioid epidemic were part of almost every presentation. I am pleased to say that over the past few years, physicians have really stepped up and led the changes that resulted in a 22% decrease in opioid prescriptions, 50,000 physicians certified to prescribe buprenorphine and a leveling off in prescription opioid related deaths. However, with heroin and synthetic opioid related deaths continuing to rise – now up to 135 deaths per day in the US – we must continue to advocate for broader availability and better coverage of non-opioid pain management and substance use disorder treatment.

Some of the most significant near-term wins are coming in regulatory relief, blocking unfavorable insurance payment proposals, blocking insurance mergers and reducing the prior authorization burden. In one physician audience after another, news of these wins brought encouragement and gave hope to physicians – many of whom had begun to lose sight of the joy in medicine.

In the same way, the AMA’s efforts to bring the physicians and innovators together to shape and accelerate development of health care technology that works for physicians and patients and efforts like the AMA’s Integrated Health Model Initiative that will bring more actionable information and decision support to physicians are generating excitement among physicians.

Physician burnout – or conversely, trying to restore the joy in medicine – is a high priority of the AMA and was a major point in my messaging to physicians and external audiences. The above initiatives are designed to address some of the underlying causes in the short and long term. However, as importantly, awareness of the extent of the problem and the urgent need to address it is now highly visible and a wide range of stakeholders are beginning to take steps to address the problem.

The above barely scratches the surface of what the AMA is doing for American medicine – and what I’ve been able to promote during my year as president. I haven’t even touched on the AMA’s major initiatives around accelerating changes in medical education (and soon to include GME), reducing the burden of chronic diseases such as diabetes and hypertension, addressing the opioid epidemic and gun violence, and the contribution to advancing medical knowledge through the JAMA family of publications. I could go on and on.

The Audiences and the Experiences

It was immensely gratifying to speak to physician audiences of all sizes and types across the country – from small county societies to small and large state societies and national specialty societies. At the end of every presentation, physicians would invariably come up to me and say, “I didn’t have any idea the AMA was doing all that.” That made me proud of the AMA and encouraged me to take the message to as many audiences as possible. My favorite audience was medical students. They are eager to learn not only clinical medicine but to learn about our profession, the challenges we face and how they can be involved in addressing those issues. They are also excited when they hear what the AMA is doing to make the practice of medicine better for physicians and patients.

Audiences outside of medicine were very interesting. I made many trips to Washington DC to meet with legislators on both sides of the aisle. The most substantive meetings were with leaders of the committees of jurisdiction and their staffs as they considered payment changes and regulatory relief. I did meet with CMS Administrator Seema Verma and her senior staff. No, I did not ever get summoned to the White House or meet with the President.

I was also impressed with the high regard with which I, as a representative of the AMA, was received by external audiences. I was often treated as a celebrity. One of the more notable experiences occurred at the end of a one-on-one meeting with the world-wide vice president of product development for Samsung. He said “I’d like to get a picture with you. My son is a medical student and he won’t believe I met with the president of the AMA.” I laughed and responded to him, “I need a picture too. My son is a medical student also, and he won’t believe I met with the vice-president of Samsung!”

Epilogue

The breadth, depth and impact of the AMA’s activities on behalf of physicians, patients and the health system in this country are nothing short of amazing. To have had the opportunity to lead the oldest, largest and most respected national physician organization was an experience that defies description. Almost any positive superlative that you can think of would apply to this past year. I was at the same time both humbled and extremely honored and found the entire experience exceptionally personally and professionally satisfying. I owe an immense debt of gratitude to you, my physician colleagues, that have mentored, encouraged, supported and worked along with me during my efforts to guide and lead our professional associations – the MSMA and AMA – to be what we need them to be “to promote the art and science of medicine and the betterment of public health.” Thank you!