Report of the American Medical Association Special Meeting

The 2022 Special Meeting of the American Medical Association (AMA) House of Delegates (HOD) was at the Hawai’i Convention Center, Honolulu. As the second HOD meeting, and the first Special (formerly “Interim”) Meeting to be held in person for three years, it was especially pleasant to have it in Hawaii. Tropical paradise aside, it is good to be back to meeting in person. Interpersonal interaction is really the point of AMA meetings. Keen observers will note that the AMA has renamed the meeting. It is now the Special Meeting, not the Interim Meeting.

The HOD sessions were better attended than previous virtual meetings, drawing 96% of delegates. The Special (Interim) Meeting focuses on advocacy, particularly on current and pending legislation, other urgent issues, and ethics. Some of the resolutions offered were not considered at the meeting. The Resolutions Committee has been responsible for screening. This process was started with the virtual meetings, and will no doubt become a permanent part of the process. Quite frankly, too many resolutions are submitted to permit adequate consideration of all of them. There was considerable discussion of this process at the meeting, and on whether to include such a screening process for the Annual Meeting.

Jack Resneck Jr., MD, AMA president, addressed the meeting. Physicians have had tough times for the past three years. Physician burnout has grown from 36% to 68% over the period 2019–2021. Some 20% of us plan to retire within two years. We need relief. It’s not the doctors who are broken, it’s the system. But frustrated doctors just give up, which is burnout, or simply retire. We need to fix our health systems, and take better care of our physicians.

The Physicians Recovery Plan is a series of goals which are designed to promote physician recovery after the stresses of the last two years. Specifically, we must prevent the scheduled 8% Medicare payment cuts. We strongly support the prior authorization reform which is presently working through Congress. Inclusion of a cost–of–living allowance for physician payments is a crucial goal. We will work towards more comprehensive reform of Medicare physician payment. Finally, the AMA will continue to work for health system reform to promote health equity.

James Madara, MD, Executive Vice President, explained the strategic long–term goals of the AMA. He noted that the long–range strategic plan was begun 10 years ago. The plan is dynamic, yearly refining a five–year projection. There will always be unanticipated short–term needs, as well as new initiatives from the HOD. The strategic arcs are removing obstacles that interfere with patient care, confronting chronic disease, eliminating health inequities, and reimagining medical education, and lifelong learning. These are driven by three accelerators: equity, advocacy, and innovation.

We really don’t know what the health care system will look like in 10 or 20 years. But we know that it is essential to educate new physicians, to support practicing physicians, and to improve public health. In medical education, a consortium of medical schools will enhance and transform medical education. There is a new consortium of 11 large health systems to improve resident training. Removing obstacles is exemplified by the Physician Recovery Plan. There are physician–controlled companies working to deliver better care and better clinical research. Confronting chronic disease is exemplified by working toward the control of hypertension in cooperation with physicians and with other organizations.

Moving to the main business of the HOD, well over 100 resolutions and reports were considered. Certain themes emerged. The Physician Recovery Plan is strongly being supported. Several resolutions dealt with various aspects of Medicare reimbursement. Health equity was a major theme. There were two open forums on the subject, several reports and resolutions. As expected, speakers generally deplored inequities in the health care system. There are millions of people still uninsured in the U.S. The AMA will continue to work for universal health care. There was debate over whether this will be best done using a single payer system or improvements to our present mixed system. At present, the AMA favors a mixed system.

There was much agitation over abortion. The Dobbs Supreme Court decision, which returned abortion regulation to the states, has produced a lot of fallout as states continue to go in multiple directions. Board of Trustees (BOT) Report #2 stated that abortion is a human right and should not be limited by legislation. Abortion is a medical procedure and should be performed by or supervised by a licensed physician. The Council on Ethical and Judicial Affairs (CEJA) Report #1 restated that physicians may ethically perform abortions and that the decision to terminate must be made within the patient–physician relationship. Resolution #8 asked AMA and state societies to support physicians actively defying state law. Resolution #223 changed AMA policy to hold that physicians should not be liable for civil or criminal penalties for abortion a result of medically necessary care or in other circumstances.

Alternate Delegate Kayce Morton, DO, in the AMA House of Delegates.

Climate change continues to concern many physicians. The Council on Science and Public Health (CSPH) Report #2 calls climate change a “public health crisis,” supporting a commitment for the AMA to cut carbon emissions by 50% by 2030 and to be carbon neutral in 2050. It rescinded AMA policy supporting the use of nuclear power to achieve carbon neutrality, although it did not commit the AMA to oppose nuclear power. The question of just how to achieve carbon neutrality without nuclear power was not brought up in discussion.

The HOD continues to deplore gun violence. BOT Report #3 summarized current efforts. It called for a task force on gun violence with yearly reports. Several resolutions addressed such issues as illegally possessed guns, gun safety, safe storage, “smart” guns, suicide prevention, and increased federal funding for firearms research (#907, #908, #909, #922, #923). There is increasing attention being paid to preventing suicide. About 25,000 of the 45,000 firearm deaths in 2020 were suicides.

There continues to be interest in how best to address issues important to employed physicians, who have now become the majority in the AMA. BOT #2 suggested expanding the role of Organized Medical Staff Section (OMSS) and using it to incorporate these concerns into the AMA. This important concern was referred back to the BOT for further study and recommendations.

Resolutions #204 (from Missouri) and #210 (from the Young Physicians Section) called for the AMA to support a change to year–around standard time. Legislation in Congress (“Sunshine Act”) favors keeping year–round daylight savings time (Sunshine Act). It passed the Senate in 2022 but stalled in the House. While it is the time change which produces the most harm, sleep specialists pointed out that standard time is better adapted to the human diurnal cycle. Supporting year–around standard time is now AMA policy.

Another Missouri resolution, #205, called for eliminating so–called “waiver of due process” clauses in physician contracts, because they greatly limit the rights of employed physicians. Resolution #203 advocated reducing the administrative burden of hiring International Medical Graduates.

Vaccinations were addressed. Resolution #913 emphasized that there are many HPV–related cancers, not just cervical cancer. The resolution advocated HPV vaccinations but not mandatory vaccination. However, resolution #906 supported mandatory COVID vaccination at all levels of education if the vaccine is fully approved by the FDA.

Obesity management has changed greatly, with better drugs, more reliable surgical options, and extension into the teen–age years or younger. Resolutions #917 and #937 advocated in favor of comprehensive obesity care for children, including bariatric surgery and reimbursement under federal programs for children.

Resolution #911 called for establishing systems of Emergency Cardiac Care (ECC) Centers in each state. There is strong evidence that such care can improve survival for myocardial infarction and cardiac arrests. This may be a good idea, but it was referred for further studies. While this system seems to work well in one or two states, it isn’t clear that it would work everywhere.

Medical education is always a concern. The Council on Medical Education (CME) Report #2 addressed inequities in both undergraduate and graduate medical education. Specific concerns were the over–emphasis of medical honor society membership in the Electronic Residency Application Service (ERAS) and the increasing use of online assessments. Resolution #312 asked for demographic reporting and data collection. Resolutions #302, #303, #308, and #309 dealt with medical and parental leave policies for students, residents, and physicians. Resolution #317 dealt with access to abortion training for programs in states prohibiting the practice.

As usual, the HOD dealt with a mixture of physician–specific issues, such as Medicare, and societal issues, such as the public health impact of climate change. There was a lot of very specific action on specific issues. There was also a lot of virtue signaling on issues like climate change and gun violence. We may view this in a couple of ways. On the one hand, the AMA should stay “in its lane,” advocating for policies that affect physicians. On the other, the AMA has a legitimate interest in public health, and a large number of societal issues have great effects on public health. In summary, the AMA sees itself as having an additional role beyond simple physician advocacy, which remains important to all of us.

Several Missouri physicians continue to serve in leadership roles. Edmond Cabbabe, MD, serves as chair of the Council for Long Range Planning and Development. Elie Azrak, MD, serves on the board of AMPAC, the AMA Political Action Committee. Jerry Kennett, MD, is on the AMA Foundation board. Kelly Schmidt, MD, is the Chair of the Resident and Fellows Section. David Fleming, MD, serves on the Council on Ethical and Judicial Affairs. Sue Ann Greco is a past president of the AMA Alliance. Charles Van Way III, MD, is on the steering committee of OSMAP, the Organization of State Medical Association Presidents.

Your AMA delegation would very much like to hear from AMA members throughout Missouri about all of the issues discussed at the meeting. The business of the meeting is available on the AMA website. Highlights and all of the reports and details are at https://www.ama-assn.org/house-delegates/interim-meeting The Annual Meeting of the HOD is scheduled for Chicago, June 12–16, 2023. We expect that it will take place as planned, in person. Meanwhile, the AMA continues to advocate for physicians and their patients at the national level.

The Missouri Delegation to the AMA, L–R standing: Drs. Ravi Johar, Charlie Van Way, and Ed Cabbabe; L–R sitting: Drs. Peggy Barjenbruch, Joe Corrado, Elie Azrak, and George Hubbell.