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Voice

James L. Madara, MD
Executive Vice President and CEO
American Medical Association

American Medical Association
Annual Meeting
Hyatt Regency Chicago
June 7, 2014

Mister Speaker, Madam President, members of the Board, delegates, guests: It's been three years since I was introduced to this House by then Chair, now outgoing President, Ardis Hoven. I'm grateful that your search committee recommended me for this position. It's a great privilege to serve our mission of "promoting the art and science of medicine and the betterment of public health."

Working with a talented management team, supported by outstanding staff, under the oversight of our committed Board – and based on the policies of this House – together we have created a strategic vision that aligns squarely with a vital, core tenet that has served as the AMA's "True North" for 167 years: That core tenet is the physician-patient relationship.

Think about it. The vital work done here and across the AMA has had a common and indisputable feature – enabling, enhancing and protecting this sacred physician-patient relationship.

We celebrated this relationship again last night during our special "Inspirations in Medicine" event. I hope many of you had a chance to attend. And this relationship continues to be a focal point as we advance our strategic plan. 

Today, I will target most of our time toward discussing how we can best achieve success in advancing this important agenda. I want to talk about one of the most important assets we have: Our collective voice.

But first a quick update on the progress we are making in our strategic plan.

Our work toward improving health outcomes, focusing on the areas of pre-diabetes and poorly controlled hypertension is well underway.

Our collaboration with the YMCA to prevent type 2 diabetes is progressing. Currently we are working with physician practices in the state of Delaware, and the cities of Indianapolis, and Minneapolis/St. Paul to connect patients with prediabetes to a proven Diabetes Prevention Program.

We are also engaging public and private insurers to collaborate on strategies for expanded coverage of the CDC's National Diabetes Prevention Program.

Meanwhile, our collaboration with Johns Hopkins to help prevent cardiovascular disease by improving hypertension control continues to move forward. We are working with physicians and care teams at 10 diverse clinical sites in Illinois and Maryland, to develop and test a framework for achieving optimal hypertension control. We will take what we learn from these pilot clinical sites, including how to work with community partners, and spread effective models to more practice settings and communities.

Our work to accelerate change in medical education continues to gain momentum as well.  Our 11 grant recipient schools are working together to implement innovative curricula to better prepare the next generation of physicians.

These curricula focus on key areas and disciplines that are important cornerstones for the future of care delivery and include, for example:  chronic health management, population health, team-based care and the improvement of health technologies.

Just two months ago, the 11 consortium schools assembled at the University of Michigan to share their progress and to map out joint innovations going forward. Michigan's Dean, Jim Woolliscroft, was a wonderful host and expressed how honored Michigan is to be working with the AMA.

I'll provide a more detailed progress report on both our improving health outcomes and medical education initiatives at the upcoming Interim Meeting.

But , as I indicated . . . today I want to concentrate on a different topic – one that connects directly with our work to enhance physician satisfaction and practice sustainability; and that is increasing and leveraging the full potential of our physician voice.

Let me start with a personal story that speaks to the power of that voice.

My story, and an underlying reason I became interested in medicine, began on the school playground in my small hometown in the Appalachians of central Pennsylvania. I was playing basketball with some of the other sixth graders and saw an opening for what I imagined would be a spectacular layup.

I ran full speed, tripped, and ended up flinging myself head-first into the iron pole holding the backboard. Yeah I know what many of you are thinking: not surprising, sounds like something Jim might do.   

That night, around 3 a.m., I developed a terrible headache. My mother came and was dismayed to see the exophthalmos of my left eye. I was admitted to the local hospital, then quickly transferred to Pennsylvania Hospital in Philadelphia. Diagnosis: cavernous sinus thrombosis.

I remained hospitalized in Philadelphia for about two months – the first few weeks isolated, and the remainder in an open children's ward.

What is still a fresh recollection from that time is my physician – his name was Dr. Edmund Spaeth, Jr. Each morning Dr. Spaeth visited me with an entourage of young physicians. Even now I vividly recall, as he examined my retina, the deep spicy smell of his aftershave comingled with the odor of coffee on his breath.

Dr. Spaeth took the time to chat. He asked how I was doing. He answered my questions. He even suggested I develop a jump shot and stay away from the layups (he meant this as a joke, but as an 11 year old I took this as serious, serious advice). Dr. Spaeth put me at ease. In his hands, I knew I'd be fine.

Now a story like mine isn't unique. Americans across the country have experienced their own special, memorable, life-changing moments with a physician. And you all know what I'm talking about – because you play a starring role in such moments.

As physicians, we're privileged to touch our patients' lives in profound and lasting ways. We earn their trust and respect.

A 2013 Gallup poll shows that physicians are among the most trusted professionals. The public's trust in physicians is 50% greater than judges, 3 1/2 times greater than lawyers.

Physicians garner more trust from our citizens than hospitals, big pharma, or insurers.

And when it comes to Congress? Well I don't like running up the score on folks, but our trust rating is 8 times greater than our lawmakers on Capitol Hill. (Congress by the way just narrowly loses to car salesmen.)

A working paper by Alan Gerber at Yale in the Journal of Health Politics, Policy and Law, reveals that Americans view physicians as  "harder working, more trustworthy, and more caring than other professions."  

 The same study found that the public has more trust in healthcare proposals supported by physicians than those supported by either Democrats, Republicans or even bipartisan commissions.

The trust and visibility physicians have with the public, combined with the respect and influence the AMA has earned over 167 years – affords us a unique opportunity for impact. Patients trust us. They respect us. They want us to lead the way toward a better health care future.  

Yet, at times our voice seems to lack the power and influence that one would logically expect given these facts.

So how can we leverage this widespread status of respect more consistently and fully…..and realize it in our voice?

I think it comes down to two key things.

First, we must understand and respond to the needs of physicians who today are immersed in often chaotic environments. Doing so will help unify our physician community.

Second, we must harness our collective voice – by striving for more consistency and thus more effectiveness.

So how do we do these things?  Let me take them in order.

First, understanding and responding to physician needs.

Our environment is changing, thus physician needs are as well.  We have to understand what those needs are today, and what they will be tomorrow.  This is a driving force behind the AMA's physician satisfaction and practice sustainability work.

Simply put: the more we know about physicians – the better we can serve them. And our plan is to know the needs of physicians more precisely than anybody. Period.

Our initial collaborative work with Rand has identified common drivers of physician satisfaction and dissatisfaction and we have begun developing practice-related resources to help physicians reduce the non-clinical demands on their time. As Dr. Chris Sinsky puts it to me: physicians want to be doctors, not typists.

Initial issues we're addressing include: systematic prescription renewal, pre-visit planning, expanded rooming and discharge and collaborative documentation. We are developing user-friendly resources to address such issues and will be piloting them later this fall.

Meanwhile, EHRs are one of the biggest sources of frustration. In their current form they largely hinder, rather than help, the physician-patient relationship. So the AMA is engaging vendors and regulators to help make EHRs more user-friendly and better aligned with physician practice.

Speaking of our work with Rand, it bears mentioning that since our initial report last fall – the term "physician satisfaction" and its link to improving health care delivery is gaining traction. The concept has been mentioned in more than 300 media reports related to our work. Many outside our profession are finally starting to take note that physician satisfaction is critical to healthcare.

Elsewhere, we are making business intelligence and physician insights a priority across the organization. Our newly created Physician Engagement unit is working to develop deeper insights around key physician segments to better understand their needs by variables such as demographics and mode of practice.

In addition, we're working to make our AMA Masterfile more robust and apply it in ways to benefit physicians. Many physicians say they're frustrated by how physician directory Web sites mischaracterize their information. The AMA is looking to develop a "best-in-class" product that will allow physicians to accurately portray their practices – providing a better resource for patients and other physicians.

Another way the AMA is gaining a better understanding of physicians is through intensive market research. We've developed deeper health analytics to better understand trends and factors affecting physician practices in the current environment . . . from the impact of the ACA to changing practice demographics.

We are also examining the impact on physicians of emerging new payment models, such as accountable care organizations, medical homes and bundled payments.  A second national study, again in collaboration with RAND, will examine the impact of these new care models on physician practices.

While these models may hold promise for increasing quality and efficiency; to what extent have physicians begun adopting them?  What has been their experience? What can be done to improve these experiences?  And are there some models that are just unworkable from a physician perspective and need be resisted or radically restructured?

We also want to pinpoint physician frustrations within the current environment and the mitigating steps we can take to address them. We will use these insights to develop tools and to guide our advocacy efforts to ensure that practice satisfaction and sustainability are important markers in evaluating proposed changes in healthcare.

All these efforts are aimed at increasing our knowledge of physicians and giving us the insights we need to serve them better.

But gaining a better understanding of physicians' needs and forging innovative solutions to address them is just the first part of what we must do to be successful.

The second piece is working to ensure our respected positioning is more fully realized by employing the power of our voice.

A strong, unified voice is one of the greatest assets we have.   Our status and reputation among the public is revered and respected. However, I ask you: do we leverage this attribute fully?

The potential power of our collective voice was underscored during this year's National Advocacy Conference.

Those of you who attended will recall that we heard from Robert Gibbs, the former press secretary for President Obama, and Dana Perino, the press secretary under President Bush. Both offered their advice on how physicians could strengthen our voice.  And while Gibbs and Perino's political perspectives are polar opposites, their advice to us was the exactly the same.

Here's how Dana summed it up . . .

CLIP: "Based on some things that I've heard and you've probably heard this feedback from members as well is that you're a very powerful group if you're speaking collectively with one voice about an issue that you can drive home. You might have a specialty area or you might have something that a congressman particularly likes and I think one of the things that's happened with all big groups that have members from all over the country coming that have lots of different types of practices and specialties and abilities and capabilities and talents is that sometimes it can get a little bit splintered."

The advice of these communication experts bears repeating: We're a powerful group when we speak collectively with one voice.  However, we're greatly weakened when our voice is splintered.  In DC, they call that splintering: stepping on your own message.  And frankly, at times our voice seems less unified than hospitals, payers and other groups.

This hurts us in both the short and the long run. It allows other interests to divide and conquer us. It's frustrating . . . I'm frustrated . . .  I know you're frustrated . . .   If my hero Dr. Spaeth was still with us – he'd be frustrated.

The good news is that this condition is curable.

Diversity of opinion is both important and beneficial.  The debates that characterize this House lead to better, more informed policies. 

In fact, I must confess that my first exposure to this body three years ago surprised me. After that meeting I thought to myself, "that just might have been the purist form of the open democratic process I have ever witnessed."

But once consensus IS achieved. It's critical, if we want to take advantage of the natural position of power we intrinsically have, that we take that next step. An even tougher step – of supporting these policies and with a single, unified voice to assure they gain traction with our colleagues, our lawmakers and the American public.

I don't think I'm naïve in saying this.  If we can simply shift, even marginally, toward more uniformly supporting the majority view, our voice will be so much stronger.

I'm confident that we can further bolster the power of our collective voice.

Working together, we are advancing a strategic plan that invites and inspires physician unity.  A plan that serves us well with the public because it reflects the power of our mission statement.

A plan that guides our advocacy efforts and focuses them on the things that matter most to America's patients, medical students and physicians.

Our respected voice is a tremendous asset – one that has been hard-earned.

Hard-earned not only in the 167 years of work by this House, but also in quieter conversations each of you share with your patients daily – like those Dr. Spaeth shared with an 11-year-old boy years ago in a Philadelphia hospital.

The potential power of our AMA voice is immense. Let's exercise that voice fully -- by casting a clear and unified voice for all to hear.

Thank you.

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James L. Madara, MD, EVP and CEO