During its Nov. 11 business meeting, the AMA Advisory Committee on Gay, Lesbian, Bisexual and Transgender Issues co-hosted a joint education session and caucus with the AMA Minority Affairs Consortium to discuss how to confront the shared challenge of health care disparities. Dionne Hart, MD, and Terrance Hines, MD, joined Saul Levin, MD, the AMA's vice president of science and public health, in leading the discussion.

The AMA International Medical Graduates Section held its 14th annual interim assembly meeting Nov. 11, beginning with a meeting co-sponsored by the Louisiana State Medical Society. Richard Culbertson, MD, and David Hotchkiss, MD, of Tulane University School of Medicine, presented the keynote address, "Physician migration determinants: ethical and political issues and the physician health care workforce."

The section co-sponsored an education session with the AMA Women Physicians Congress on Nov. 12 titled, "Strategies to eliminate physician pay disparities." Susan E. Gerber, an assistant professor in Northwestern University's Feinberg School of Medicine's department of obstetrics and gynecology, led the session.

Later that day, the section hosted a roundtable discussion for international medical graduates who have not matched to a residency program.

This year's Busharat Ahmad, MD, Leadership Development Program on Nov. 13 featured a presentation by Daniel K. Winstead, MD, of Tulane University Medical School, titled, "Managing organizational challenges as a physician leader."

The 35th Interim Meeting of the AMA Section on Medical Schools (SMS) took place Nov. 4 in Denver in conjunction with the Association of American Medical Colleges Annual Meeting.

The AMA-SMS meeting included a well-attended education session on the need to expand graduate medical education (GME) to meet the nation's growing need for physicians. A spectrum of panelists discussed innovative strategies to expand and distribute GME funds at the state and regional level.

In addition, Richard Krugman, MD, dean of the University of Colorado School of Medicine, gave a presentation highlighting innovative curricular programs at his school.

More than 800 medical students discussed about 50 items of business and participated in nearly 20 education programs Nov. 11–12 during this year's AMA Medical Student Section (MSS) Interim Assembly Meeting. Education programs covered a range of topics including disaster preparedness, leadership development, writing a research paper, public health and health system reform.

New Orleans health commissioner Karen DeSalvo, MD, gave the keynote address Nov. 11, speaking about rebuilding New Orleans' health system in the years after Hurricane Katrina.

Also that day, about 50 medical students hosted a health fair for members of the community at the New Orleans Mission as part of an AMA-MSS National Service Project event. Dozens of community members, many homeless or otherwise without health care, met with students for basic screenings and received guidance on making healthy lifestyle choices.

The section also held its ninth annual research symposium in conjunction with the AMA Resident and Fellow Section. More than 180 students participated in the event. The AMA-MSS awarded poster winners in the following eight categories:

• Biochemistry/cell biology—Garth Brandal, Medical College of Wisconsin
• Cancer biology—Kelsey Pendleton, University of Pittsburgh School of Medicine
• Clinical/epidemiological/health care—Angela Johnson and Juan Montoya, University of Toledo College of Medicine
• Immunology/infectious disease/inflammation—Devin West, Saint Louis University School of Medicine
• Neurobiology/neuroscience—Kathleen Kassouf, The Ohio State University
• Organ systems—Jennifer Mytar, Touro University College of Osteopathic Medicine, California
• Radiology/imaging—Jensen Hart, University of Texas at Austin
• Surgery/biomedical engineering—Haritha Reddy, University of Michigan

The overall winners of the poster symposium were Angela Johnson and Juan Montoya of the University of Toledo College of Medicine. Allison Dubner and Huy Nguyen tied for first place in the podium competition.

The assembly elected LeAnne Roberts of New Jersey Medical School as AMA-MSS chair-elect and Malini Daniel of Stanford University School of Medicine as AMA trustee. Their terms will begin in June after the 2012 Annual Meeting of the AMA House of Delegates.

AMA Minority Affairs Consortium (MAC) members spoke with students at two New Orleans high schools Nov. 11 as part of the AMA Doctors Back to School™ program. A dozen physicians and medical students encouraged about 300 students at O'Perry Walker College and Career Preparatory High School and at Warren Easton High School to pursue a career in medicine, many of whom expressed an interest in the profession.

Later that day, the AMA-MAC Governing Council discussed various items of business that affect minority patients and physicians. Resolution topics included reproductive health outcomes and development in environmental justice policy, and granting section status to the AMA-MAC, which would rename the consortium the AMA Minority Affairs Section.

In addition, the AMA-MAC collaborated with the AMA Advisory Committee for Gay, Lesbian, Bisexual and Transgender issues on a discussion and video titled, "Confronting a shared challenge: health care disparities," as well as an open forum on AMA House of Delegates reports and resolutions.

Members of the AMA Organized Medical Staff Section (OMSS) discussed 14 items of business during the section's 58th assembly meeting, which took place Nov. 10–12.

In particular, the assembly asked the AMA House of Delegates to oppose the proposed revision of the Medicare Hospital Conditions of Participation that would limit the autonomy, self-governance and quality oversight of the organized medical staff.

Additionally, the assembly called on the AMA to provide information and advice, but not legal opinions or representation, as appropriate to employed physicians, physicians in independent practice and independent physician contractors in matters pertaining to their relationships with hospitals, health systems and other similar entities.

The section hosted a special program titled, "Implementing the physician leadership imperative for quality and value." As part of the program, Donald Palmisano, MD, a past AMA president, presented "Doing the right thing for our patients: leading as a professional." Later, Shawn Griffin, MD, presented "Engaging members of the medical staff to measure and improve quality."

The section also hosted the following education programs:

• "An update on health reform initiatives," by Frank Opelka, MD
• "Your relationship with an accountable care organization," by attorney Paul DeMuro
• "Future of the medical staff organization," bySara Sanchez

The assembly elected Arthur Snow Jr., MD, and David Welsh, MD, as vice chair and member-at-large, respectively, of the AMA-OMSS Governing Council.

More than 375 residents and fellows attended this year's AMA Resident and Fellow Section (RFS) Interim Assembly Meeting and Research Symposium. The assembly considered items of business related to moonlighting, graduate medical education financing, health policy education in medical schools and residencies, and the shortage of necessary prescription drugs. A resolution immediately forwarded to the AMA House of Delegates for consideration asks the AMA to work with all relevant parties to create a method of billing and reimbursement for phone consultations.

The AMA-RFS elected 15 sectional delegates and 15 alternate delegates to the AMA House of Delegates. It also elected Matthew Schmitz, MD, a diagnostic and interventional radiology fellow from Massachusetts General Hospital, as chair-elect of the section's governing council.

The AMA Senior Physicians Group (SPG) Governing Council reviewed resolutions and reports relevant to senior physicians and discussed long-term objectives for the group during its Nov. 13 meeting. The governing council is focused on strategies to engage more senior physicians in the AMA's activities and policies as well as awareness of senior physician issues. 

At the state liaisons meeting that day, the AMA-SPG hosted a program titled, "What Can and Should We Do As Senior Physician Leaders." Attendees learned how states have united their retired and semi-retired physicians for increased awareness of issues confronting senior physicians today. Discussion focused on the most pertinent issues and problems that face seniors today as they move into retirement age.

The AMA Women Physicians Congress (WPC) co-hosted an informative educational session with the AMA International Medical Graduates Section on Nov. 12 titled "Strategies to Eliminate Physician Pay Disparities." Susan E. Gerber, MD, assistant professor of obstetrics and gynecology at Northwestern University, discussed physician pay disparities and strategies for eliminating them. Dr. Gerber is one of the authors of the Health Affairs article, "The $16,819 pay gap for newly trained physicians: The unexplained trend of men earning more than women."

The AMA-WPC also hosted its caucus and reception on Nov. 12. During the session, the AMA-WPC honored physician mentors through its annual physician recognition program. Learn more about the program and view a list of mentors recognized.

Young physicians from across the country met with colleagues to discuss priority issues and help shape AMA policy on Nov. 11 during this year's AMA Young Physicians Section (YPS) Interim Assembly Meeting.

The AMA-YPS Assembly adopted three resolutions. One asks the AMA to strive to place early career physicians on American Board of Medical Specialties (ABMS) boards that oversee maintenance of certification (MOC). The second resolution asks the AMA to recommend to the ABMS that all physician members of specialty boards governing the MOC process be required to participate in the MOC process. The final resolution asks for specific AMA advocacy regarding the U.S. farm bill.

After careful review of the House of Delegates handbook, the AMA-YPS Assembly identified items of particular relevance to the section and developed testimony for reference committee hearings and for the House floor.

"Our patients need heroes, so heroes we must be," AMA President Peter W. Carmel, MD, said during Saturday's opening session.

Recognizing physicians as "the heroes of American medicine," AMA President Peter W. Carmel, MD, reminded them Saturday that their patients need heroes now more than ever.

In an address that earned a standing ovation at the opening session of the AMA House of Delegates, Dr. Carmel honored the physicians of New Orleans who selflessly and heroically cared for patients in the midst of danger and nearly impossible conditions during Hurricane Katrina and its aftermath.

Dr. Carmel also focused on another crisis that threatens millions of Americans and calls for physician heroes throughout the country. As a 27.4 percent cut to Medicare physician payments scheduled for Jan. 1 draws close, seniors and military families need "individuals willing to stand up, speak out and fight for their needs," Dr. Carmel said.

"Already one in four seniors seeking a new primary care physician under Medicare has difficulty finding one," Dr. Carmel said. "Just imagine the chaos that would ensue if doctors across the nation were forced to stop seeing Medicare recipients. It is simply unthinkable, unconscionable, that the government should choose to leave our nation's most deserving citizens out in the cold."

Invoking the power of the AMA, Dr. Carmel asked delegates to join the association by individually calling on Congress to fix the broken Medicare physician payment formula. "Our patients need heroes," he said. "So heroes we must be."

Delegates also honored physician heroes in the military and other federal services with a video paying homage to their selfless contributions in medicine and public health. These physicians respond in unforeseen and extraordinary situations, which, as is stated in the video, "requires unprecedented resourcefulness and creativity."

Later, James L. Madara, MD, gave his first address to the House as the AMA's new executive vice president and CEO. The AMA is "doing all we can to ensure the sacred core of our profession—the relationship between physicians and patients—is protected," Dr. Madara said.

Dr. Madara underscored that "the policies we shape here—at our AMA—touch our citizens in very real ways each and every day."

"The best and most powerful way to serve the health needs of our patients is to ensure that the environments in which our physicians practice are thriving, sustainable and attractive to future generations," he said.

Video of both addresses will be posted here later tonight.

Shawn Griffin, MD, discusses the strides his independent practice association is making by using a physician-led data-reporting system.

When administrators and physicians partner to report and analyze data in their hospitals, independent practice associations (IPA) and other health systems, they can make strides in quality improvement and simultaneously reduce health care costs.

Attendees of a Saturday educational session hosted by the AMA Organized Medical Staff Section (OMSS) heard about the significant improvements one Houston-area IPA is making in the areas of mortality, hospital readmissions, comprehensive care and total charges.

Shawn Griffin, MD, explained that his IPA has successfully improved quality because its data-reporting system is based on "physician partnerships" with an intention to "build relationships" rather than top-down directives from hospital administrators. Physicians actively shape the system by electing their peers to the board, and specialists determine what the most appropriate quality measures are for their specialties.

The process also actively engages physicians by providing timely reporting data that is benchmarked against that of their peers' and allows them to drill down to case-specific information. "Physicians should benefit from the work they're doing," Dr. Griffin said. "We started at 2,000 physicians and moved up to 2,500 because physicians see the value in it."

The IPA's quality reporting initiative saved $10 million in its first year—10 percent of its total contract. This translated into a $5,500 bonus for physicians who qualified for a full share.

One delegate observed that "evidence-based medicine is in its infancy." She cautioned, "Many of your measures are compliance measures. Will this really improve quality?"

Dr. Griffin acknowledged that the system needs improvement but physicians "need to start the conversations," he said.

Jay A. Gregory, MD, chair of the AMA-OMSS Governing Council and delegate for the Oklahoma State Medical Association, urged attendees to work toward producing a better system and placed a vote of confidence in the benefits of quality reporting.

"Good doctors using good data will make good decisions every time," Dr. Gregory said.

Heather Scoffone, a fourth-year student at the Cleveland Clinic Lerner College of Medicine, checks a patient's blood pressure during Friday's event.

About 50 medical students from the AMA Medical Student Section (MSS) spent part of Friday at the New Orleans Mission aiding dozens of local citizens who lack access to health care.

Part of the AMA-MSS National Service Project promoting healthy lifestyles, volunteers talked with the homeless and local community members about men's and women's health issues and provided blood pressure and other screenings, said Aaron George at-large officer for the MSS Governing Council.

"Our goal with the National Service Project is to reach out to patients to promote healthier lifestyles," George said.

The AMA Healthier Life Steps™ Program is the National Service Project theme for 2009-2011. Medical students have hosted various activities, each focusing on four key health behaviors—poor diet, physical inactivity, tobacco use and excessive or risky use of alcohol—that are strongly linked to heart disease, diabetes and cancer.

At the New Orleans Mission, students also learned a key skill for physicians—listening to the patient, said Alexandra Norcott, a student at Marshall University Edwards School of Medicine. "So the service project is not just about helping patients," she said. "It's a great learning experience for students, too."

Kevin McKinney, MD (left), from Houston, Texas; Kelly Middleton, a medical student at the University of Pittsburgh School of Medicine; and Dionne Hart, MD, from Rochester, Minn., speak to students at Warren Easton High School on Friday.

About 300 students at two New Orleans high schools learned what it means to be a physician during of a pair of AMA Doctors Back to School™ events on Friday.

A dozen physicians and medical students shared their passion for the profession with students at Warren Easton High School and O'Perry Walker College and Career Preparatory High School. The visitors explained why they chose a career in medicine and encouraged the students to consider pursuing one as well.

The AMA Minority Affairs Consortium coordinated the visits.

The AMA Doctors Back to School™ program sends physicians and medical students into their communities to show children and young adults, especially those from underrepresented racial and ethnic groups, that medicine is an attainable career option for everyone. The program's main goal is to increase the number of minority physicians and ultimately work toward eliminating racial and ethnic health disparities.

Learn more about the Doctors Back to School™ program and find details about planning an event at a school in your community.

AMA members who want to establish better relationships with a member of Congress or his or her staff can advance AMA advocacy efforts on Capitol Hill by participating in the AMA's Very Influential Physician (VIP) program.

Designed to leverage physicians' existing personal relationships with elected officials, this program enables AMA VIPs to educate and engage members of Congress on the issues that are important to organized medicine.

Attend a session from 3 to 4:30 p.m. Sunday in Salons 4 and 7 to learn more about this program and how you can get involved.

Guest speaker Bradford Fitch, president and CEO of the Congressional Management Foundation, will discuss the latest research and best practices in grassroots advocacy. Delegates who participate in the session will learn how to develop and leverage relationships with members of Congress.

Wireless Internet access is available at both the Hilton New Orleans Riverside and the Sheraton New Orleans throughout the meeting.

The Grand Ballroom at the Hilton—where the House of Delegates convenes—and rooms holding reference committee hearings Sunday each have unique wireless login information. Details on accessing the wireless network in each room, as well as the public networks at both hotels, are available at the delegate and alternate delegate registration desk and in the not-for-official-business bag.

Throughout the meeting, Web video streaming capabilities at the Hilton will be limited to AMA-related content in an effort to ensure that attendees can download meeting-related materials without any service interruptions. Computers with no access limitations are available at the cyber café, located outside the Grand Ballroom.

There will be no access restrictions at the Sheraton. And there will be no restrictions at either hotel on streaming daily highlight videos produced by The Doctor's Channel each day.

Delegates are encouraged to view the House handbook, reference committee reports and orders of business electronically. All meeting-related materials are available under Additional Resources column on the right-hand side of this page.

Follow American Medical News' coverage of the opening session, and the rest of the meeting, at www.amednews.com/house. Coverage starts Saturday night with a story and slideshow, and continues throughout the meeting.

As the Joint Select Committee on Deficit Reduction prepares to issue its legislative proposal Nov. 23, delegates should call Congress today and tell lawmakers to repeal Medicare's flawed sustainable growth rate (SGR) formula now.

Physicians are once again facing significant Medicare payment cuts, with an unprecedented 27.4 percent reduction scheduled for Jan. 1. If Congress does not intervene, many physicians will be forced to limit the number of seniors and military families they treat because Medicare and TRICARE payments already lag 20 percent behind the cost of care.

During Saturday's open forum, AMA Board Chair Robert M. Wah, MD, described how the AMA has urged the supercommittee and other members of Congress to repeal the SGR as part of the deficit reduction proposal.

Delegates have an opportunity to bolster these efforts by sending an urgent email to Congress through the AMA's Physicians' Grassroots Network or calling the AMA's toll-free hotline at (800) 833-6354.

"The latest word from Capitol Hill is that congressmen are starting to complain about their phones ringing off the hooks," AMA President Peter W. Carmel, MD, said Saturday in his opening address. "So let's keep the pressure on. Remember, every voice counts."

Video of Dr. Carmel's address is posted under the "Speeches" tab on this page.

Barbara Spivak, MD, details the benefits of mutual support between physicians and local hospitals during Sunday’s session.

With the nation's health care system in a state of change, physicians have an opportunity—and necessity—to be leaders in shaping its future.

That was the theme of a Sunday education session co-hosted by the Forum for Medical Affairs and the AMA Advisory Committee on Group Practice Physicians. The session's three presenters discussed national trends and their experiences with new models for delivering care that focus on quality, value, accountable care and integration.

Francis J. Crosson, MD, chair of the AMA Advisory Committee on Group Practice Physicians, provided an overview of accountable care organizations and encouraged attendees to be leaders in the formation of new health care models. "If we want medicine to move forward in the way we want, the time for physician leadership is now," he said.

Barbara Spivak, MD, a member of the AMA National Committee on Delivery System Reform, described how her independent physician association (IPA) in Massachusetts has allowed physicians and the community hospital to move forward together. This structure of mutual support has enabled physicians to better coordinate their patients' care through enhanced technology and education. It also has allowed the hospital to thrive despite large competitors in nearby Boston.

Susan Turney, MD, president and CEO of the Medical Group Management Association, spoke about ways that data collection and analysis can help physicians improve patient care. "Data is empowerment and will help drive our decisions," she said.

An open discussion followed the presentations, and several physicians expressed hope for improvements in patient care and offered ideas for additional considerations. One emphasized the importance of involving the patient community as new health care models are created. "We have to define what's going to be required by the patient," he said.

Another delegate cautioned that physicians should be careful in applying principles from pilot programs involving commercially insured patients to models for Medicare patients because the two populations are so different.

Acknowledging both the challenges and opportunities facing physicians today, Dr. Turney summarized the situation. "Clearly, we can't keep doing business as usual," she said. "I hope to say in 10 years that physicians led this charge."

Resident Daryl McCartney, MD (left), presents his research to Mahendr Kochar, MD, during Friday's symposium.

About 500 residents, fellows and medical students shared original research on topics ranging from clinical to health policy Friday during the ninth annual Research Symposium, organized by the AMA Medical Student Section (MSS) and the AMA Resident and Fellow Section (RFS).

A total of 220 residents and fellows and about 180 medical students participated in the symposium, which consisted of poster and oral competitions. Student projects fell into eight different clinical categories, while categories for residents and fellows were basic science, clinical medicine, health policy and medical education, or a clinical vignette.

Nisha Gupta, MD, a resident at Rochester, N.Y., General Hospital, is a new AMA member and one of the winners of the resident and fellow competition. "[The symposium was a] great opportunity to meet different people and also to hone my research and writing skills," said Dr. Gupta.

Among the students who took part was Robert Dugger, who finished his third year of medical school and is spending this year on policy studies at the State University of New York at Stony Brook. Dugger, whose research found that student debt is the No. 1 priority issue for medical students, said the symposium offers a unique opportunity for participants.

"The symposium has created a platform that allows for expression of student perspectives," he said.

Winners announced

The overall winner of the resident and fellow poster competition was Yash Patel, MD. The AMA-RFS announced the following awards:

Poster competition, clinical vignette:

• First place—Nishit Patel, MD
• Second place—Nisha Gupta, MD
• Third place—Demetrios Paidoussis, MD
• Honorable mention—Shiv Kumar Agrawal, MD
• Honorable mention—Ricardo Correa, MD

Poster competition, clinical medicine:

• First place—Lokesh Shahani, MD
• Second place—Yun Xia, MD
• Third place—Saurabh Thakar, MD
• Honorable mention—Shaifali Sandal, MD
• Honorable mention—David Fleischman, MD

The overall winner of resident and fellow podium competition was Deepika Shah, MD. Honorable mention went to Rebecca Rawl, MD.

Meantime, the AMA-MSS awarded poster winners in the following eight categories:

• Biochemistry/cell biology—Garth Brandal, Medical College of Wisconsin
• Cancer biology—Kelsey Pendleton, University of Pittsburgh School of Medicine
• Clinical/epidemiological/health care—Angela Johnson and Juan Montoya, University of Toledo College of Medicine
• Immunology/infectious disease/inflammation—Devin West, Saint Louis University School of Medicine
• Neurobiology/neuroscience—Kathleen Kassouf, Ohio State University
• Organ systems—Jennifer Mytar, Touro University College of Osteopathic Medicine, California
• Radiology/imaging—Jensen Hart, University of Texas at Austin
• Surgery/biomedical engineering—Haritha Reddy, University of Michigan

The overall winners of the student poster symposium were Angela Johnson and Juan Montoya of the University of Toledo College of Medicine. Allison Dubner and Huy Nguyen tied for first place in the student podium competition.

Watch video coverage of the Research Symposium in Saturday's "Minutes in Minutes" recap by The Doctor's Channel.

Newly trained female physicians are paid significantly less money than their male counterparts, Susan E. Gerber, MD, said during Saturday's session.

Although women now make up nearly half of all U.S. medical school graduates, newly trained female physicians receive significantly lower salaries than their male counterparts. An education session Saturday explored this trend and looked at strategies to eliminate such disparities in pay.

Co-hosted by the AMA International Medical Graduates Section and the AMA Women Physicians Congress, the session was presented by Susan E. Gerber, MD, a co-author of the recent Health Affairs article, "The $16,819 Pay Gap for Newly Trained Physicians: The Unexplained Trend of Men Earning More Than Women."

Dr. Gerber, assistant professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, presented her recent study, which found that female physicians of all races are paid on average only 77.4 percent of the salary of their white male counterparts.

"Disparity [in salary] persists even when adjusting for education, experience, occupation [and] union membership," Dr. Gerber noted. "By 2008 there was an unexplained gap of $16,819."

Dr. Gerber discussed various strategies to eliminate pay disparities, including transparency in criteria for promotions, mentorship and training in employment contract negotiation.

With all five reference committee hearings taking place at the same time on Sunday, it was impossible to follow the discussion in all of them. You can catch up with the testimony in each hearing, though, by reading American Medical News' coverage of the reference committees at www.amednews.com/house.

Also, view American Medical News' slideshow of Saturday's opening session. Photos will be added throughout the meeting.

Michael Kitchell, MD, an alternate delegate for Iowa, makes a comment during Monday's open forum.

The Council on Ethical and Judicial Affairs (CEJA) looked at physicians' roles and responsibilities in a team-based care setting during its open forum Monday.

CEJA member Dennis Agliano, MD, gave a brief overview and definition of the collaborative care model and why teamwork is essential for patient care. Dr. Agliano noted that team-based care leads to:

• Better patient outcomes.
• Lower health care costs.
• Increased patient safety and satisfaction.

Delegates shared their own experiences with team-based care, with many noting they had been involved with team-based care for many years.

There was a spirited discussion on who should lead the team. While one physician urged that a physician should be the head of the team, another noted that if a physician is the leader, he or she could be held liable for adverse outcomes.

Roger Kimura, MD, a delegate from Hawaii, said, "Collaboration works when all team members have the same goal."

CEJA members and delegates also discussed efforts to update the AMA's Code of Medical Ethics, and how physicians interpret and apply opinions in the Code in their daily practice.

Sharon Douglas, MD, the CEJA chair, explained how CEJA is updating and modernizing the Code in the hope of making content easier to find, and easier to put the Code to use in clinical practice.

Some delegates suggested CEJA should broaden its publicity of the Code so more physicians and all members of the care team are aware of it and abide by it.

R. Gil Kerlikowske, director of the White House Office of National Drug Control Policy, makes a point about the nation's drug control strategy during Monday's session.

Drug overdose is the most common cause of accidental death in the nation, surpassing even the number of deaths caused by car accidents, and the majority of those deaths are from prescription drugs.

"[This] should be a wake-up call," R. Gil Kerlikowske, director of the White House Office of National Drug Control Policy, said during an education session Monday. "We couldn't have better partners than the AMA and physicians."

In addition to Kerlikowske, who outlined the 2011 National Drug Control Strategy and the public health epidemic of prescription drug abuse, attendees heard about the Food and Drug Administration's (FDA) program for controlling certain opioids and how physicians can manage pain and help prevent prescription misuse.

J. David Haddox, MD, vice president of health policy at Purdue Pharma L.P., described the FDA's Risk Evaluation and Mitigation Strategy program, which seeks to prevent patient harm and death as a result of taking long-acting opioids. The program regulates drug manufacturers to ensure that the benefits of a drug outweigh its risks. More than 4 million patients currently have prescriptions for these substances.

Lynn R. Webster, MD, treasurer of the American Academy of Pain Medicine, discussed the need for a cultural change in how physicians prescribe opioids. Dr. Webster suggested that physicians assess their patients' risk factors for prescription misuse and abuse, closely monitor these patients and clearly communicate the dangers of using the prescriptions other than as directed.

Dr. Webster urged physicians to pay particularly close attention to patients with severe chronic pain. "I can't emphasize this enough," he said. "Aberrant drug behavior is directly related to duration and intensity of pain."

When the presentations concluded, a long line immediately formed at the comment microphone. Delegates raised concerns and questions about inaccurate drug histories from patients, the need for more specific data about deaths related to drug overdose, physician training and requirements, and increasing apprehension among primary care physicians about prescribing opioids.

One delegate, a psychiatrist from Minnesota, expressed concerns about how physicians are portrayed in the media, especially with the recent coverage of the trial of Conrad Murray, MD, the personal physician of pop icon Michael Jackson who was convicted of involuntary manslaughter in Jackson's death. "The room is packed because most physicians want to do the right thing," she said.

AMA Board of Trustees member Ardis Hoven, MD, who was moderating the session, likewise commented, "The AMA appreciates that physicians need this information while they are face-to-face with patients in the exam room."

Howard J. Osofsky, MD (left), and John H. Armstrong, MD, listen to a question from the audience during Sunday's caucus.

The recent hurricane and oil spill disasters have left their print on the citizens of New Orleans and taught two important concepts: the importance of facilitating resilience-building programs and the need to measure baseline data about mental health before disasters strike.

During Sunday's disaster medicine caucus, disaster medicine expert Howard J. Osofsky, MD, who has served as the director for mental health services for the region since Hurricane Katrina ripped through in 2005, discussed the mental health impact of these two disasters on children and families.

Dr. Osofsky stated that the Gulf oil spill has caused "tremendous uncertainty about the future." He explained that technological disasters, unlike natural disasters, create "uncertainty about whether one can rebuild" following the disaster. As a result of these two disasters, some children have been displaced as many as nine times, he said.

Families have been impacted by increased depression, alcohol misuse, family conflict, post-traumatic stress disorder and other serious consequences. In the 2009–2010 academic year, nearly 30 percent of students still met the criteria for recommended mental health services, with 12 percent of adolescents requesting counseling and 30 percent of parents requesting counseling for younger children.

But the New Orleans community has been able to cope with the disasters. "We are actively engaged in resilience-building programs … that have been incredibly effective," Dr. Osofsky said.  

A number of studies have taken place following such disasters as those in New Orleans. Dr. Osofsky explained that while these findings are beneficial, they also are limited because of a lack in baseline data to measure them against. "If at all possible, you need to have baseline data prior to a disaster," he said.

Following the presentation, John H. Armstrong, MD, who concluded his term as chair of the caucus on Sunday, remarked, "We just had a clinic in the mental health consequences from disasters in 30 minutes."

Watch coverage of the caucus in Sunday's "Minutes in Minutes" video by The Doctor's Channel.

AMA Board of Trustees member Patrice A. Harris, MD, and marketing professional Naomi Gitlin were among presenters at Sunday's session.

In order to address the U.S. obesity rate, which continues to increase at alarming rates, physicians need to engage in creative activities to facilitate healthy lifestyles among their patients and communities.

AMA Board of Trustees member Patrice A. Harris, MD, moderated an education session Sunday on physicians as community advocates. Speaking from her experience as the director of health services for Fulton County, which includes Atlanta, she emphasized the need for physicians to lead changes in their communities that would enable healthier lifestyles. "Simply telling our patients to live and eat healthier will not work," she said.

The focal point of the session was an active discussion among attendees, who shared their successes in achieving meaningful changes in their communities.

One delegate from Mississippi explained that he got involved in his chamber of commerce and was able to drive a grassroots effort that transformed an old railroad track into a bicycle trail that runs through five towns. "You can't just be involved in physician organizations," he said. "[You] must engage with the broader community."

A delegate from California called attention to the fact that community advocacy doesn't always require money or lobbying elected officials. "[Advocacy] is about mobilizing people in the community," he said.

Jonathan Klein, MD, associate executive of the American Academy of Pediatrics, stated that physicians will make strides in countering the obesity epidemic when they engage in both community advocacy and direct patient engagement. "Advocacy works best when we work toward improving care of individuals and the community," he said.

Last week, 50 medical students took part in the AMA Medical Student Section's National Service Project event, which engaged the community in a health fair at the New Orleans Mission. Dozens of community members, many homeless or otherwise without health care, met with students for basic screenings and received guidance on making healthy lifestyle choices.

Addressing the side of direct patient care, another education session Sunday presented the National Physical Activity Plan, which promotes physical activity as a means of health. Robert E. Sallis, MD, a past president of the American College of Sports Medicine, discussed this and other practical strategies to address physical activity with patients.

Physicians can also get involved in the AMA's Weigh What Matters initiative, which provides information and resources to help physicians start the conversation with their patients about family obesity and living healthier lives. The program offers such tools as a physician's guide, a patient weight self-assessment, materials for the office and a patient action plan.

Additionally, medical associations and coalitions can apply for a three-hour AMA physician community leadership module. If your organization would like to be considered, email Janet Williams of the AMA.

AMA President-elect Jeremy Lazarus, MD, updates delegates at Sunday's session on legal efforts to prevent the public release of individual physicians' Medicare payments.

A decades-long legal effort to prevent the public release of Medicare payments to individual physicians was reviewed Sunday during the open forum of the Litigation Center of the American Medical Association and State Medical Societies.

Both the AMA and the Florida Medical Association have been fighting for more than 30 years to protect physician privacy, said Jeremy Lazarus, MD, president-elect of the AMA.

Dr. Lazarus reviewed four court cases, with the first dating back to 1977. In three cases, the right of individual physicians to keep their personal income from Medicare payments private was upheld.

In the most recent case, still being litigated, Dow Jones & Company, publisher of The Wall Street Journal, is trying to overturn a 1979 injunction by a Florida court preventing the release of Medicare payments to individual physicians. In September a district court granted a motion to reopen the case. The AMA will seek to have the original injunction extended to cover all physicians—not just AMA members.

This is a perfect example of the kinds of legal actions that the Litigation Center takes on. The Litigation Center gets involved in cases to support individual physicians, cases of interest to a state medical society, and cases of great interest to medicine, usually at the appellate level.

Watch coverage of the session in Sunday's "Minutes in Minutes" video by The Doctor's Channel.

AMA App Challenge winners Cynthia L. Beamer, MD (middle), and medical student Michael Ray Bykhovsky (right) joined AMA Executive Vice President and CEO James L. Madara, MD, at a reception Monday.

After receiving hundreds of medical app ideas during the AMA App Challenge, the AMA announced Friday the names of a medical student and physician whose ideas were selected as the next great medical apps. The two winners were honored at a reception Monday evening.  

Earlier this year, the AMA invited physicians, residents and medical students to submit their unique app ideas for a chance to have the AMA bring them to life. AMA members then voted for their two favorite ideas from 10 finalists. Cynthia L. Beamer, MD, a pediatric emergency physician in Texas, won the category for physicians. The winner in the category for residents, fellows and medical students was Michael Ray Bykhovsky, a third-year medical student in Georgia.

"The 2011 AMA App Challenge was hugely successful," AMA Board Chair-elect Steven J. Stack, MD, said in a news release. "Apps are among the many ways physicians and future physicians learn, stay connected and juggle busy schedules, and we congratulate Dr. Beamer and Mr. Bykhovsky for their innovative and winning ideas."

Dr. Beamer's idea, the "Rounder" app, would provide a point to capture data on hospital patients, allowing physicians to easily track their patients' progress. During her time as a hospitalist, Dr. Beamer found that overseeing residents and taking care of patients left little time to supervise hand-offs.

Dr. Beamer hopes that the app will both streamline the process and make it more methodical.  She believes the new app could replace handwritten notes, which can be illegible and even lead to privacy violations. The app would be a "much safer and better way to trade data," she said.

Bykhovsky's "JAMA Clinical Challenge" app would present clinical vignettes and images along with medical case information. "Typical study tools … cut straight to the chase," he said. "[But this app] would provide an in-depth explanation."

Both winners noted that many physicians have ideas for medical apps but usually don't have the technological expertise required to develop it. They emphasized that the value of the AMA App Challenge is in giving medical students and physicians an opportunity to see their ideas come to life and benefit the medical community.

"I hope this is the start of more [app] challenges so doctors can get their ideas out," Dr. Beamer said.

Read American Medical News' coverage of Monday's action in the House of Delegates, including voting results on major policy matters. Also, view American Medical News' slideshow of the Interim Meeting and events leading up to it.

Here's a recap of the actions taken by the AMA House of Delegates at its Interim Meeting Nov. 12-15 in New Orleans. Physicians from every state and specialty gathered to set policy on issues of most importance to the nation's doctors and their patients.

National drug shortages
In an effort to combat the nation's drug shortages, the AMA House voted to support legislation, such as H.R. 2245 and S. 296, that would require manufacturers to notify the Food and Drug Administration (FDA) of any discontinuance, interruption or adjustment in the manufacture of a drug that may result in a shortage. Delegates called shortages a "national public health emergency."

The new policy also calls on the AMA to advocate that the FDA and/or Congress require drug manufacturers to establish a plan for continuity of supply of vital and life-sustaining medications and vaccines to avoid production shortages whenever possible. Also see amednews.com coverage.

Members of the Missouri delegation discuss pending resolutions.

Prescription drug abuse
With the continued worsening of harms associated with prescription drug abuse, the AMA House encouraged the use of standardized tools to screen for substance misuse and urged physicians to query their state's controlled substance database to help ensure proper prescribing of drugs for their patients.

Campaign to pass private contracting bill
AMA delegates reaffirmed support for the Medicare Patient Empowerment Act (H.R. 1700), which would ease restrictions on private contracting with Medicare patients. Delegates called for initiating and sustaining a well-funded grassroots campaign to secure public support for passage of the bill in Congress. The House also amended the AMA's strategic plan to emphasize efforts to remove current restrictions in Medicare law to allow patients and physicians to enter into private contracts without penalty to either party.

New scope-of-practice policies
Delegates adopted several scope-of-practice policies to ensure patient safety at medical spas and during invasive procedures and anesthesia services. See amednews.com coverage.

Stop implementation of ICD-10 code set
The AMA House of Delegates voted to "vigorously work to stop the implementation of ICD-10 and to reduce its unnecessary and significant burdens on the practice of medicine." ICD-10 has about 69,000 codes and will replace the 14,000 ICD-9 diagnosis codes currently in use. A 2008 study found that a small three-physician practice would need to spend $83,290 to implement ICD-10, and a 10-physician practice would have to spend $285,195.

Andrew Gurman, MD, speaker of the AMA House of Delegates, and Susan Bailey, MD, vice speaker, preside over the meeting.

Guidelines for health insurance exchanges
Delegates also adopted new policies on the health insurance exchanges created by the Affordable Care Act. New policies include AMA support for using the open marketplace model for exchanges to increase competition and maximize patient choice, and the involvement of state medical associations in the legislative and regulatory processes concerning state health insurance exchanges. The new policy also asks the AMA to advocate for the inclusion of actively practicing physicians and patients in health insurance exchange governing structures and for developing systems that allow for real-time patient eligibility information.

"Our patients need heroes…"

In his speech welcoming delegates to New Orleans, AMA President Peter W. Carmel, MD, called on physicians to "stand up, speak out and fight for patients' needs." He urged physicians to protect patient access to care by calling on their legislators to repeal the flawed sustainable growth rate formula.

Watch Dr. Carmel's speech

Watch speech by AMA CEO Dr. Madara

App Challenge winners
A Texas physician and a medical student from Georgia won the 2011 AMA App Challenge with their ideas for the next great medical app. Read more

Physicians should lead health care transformation
With the nation's health care system in a state of change, physicians have an opportunity—and necessity—to be leaders in shaping its future. That was the message at a Nov. 13 education session. Learn more

American Medical News coverage
Read full coverage of all news from the Annual Meeting at amednews.com.