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The AMA's role in U.S. health care

July 30, 2008

National Medical Association Annual Meeting
Georgia World Convention Center
Atlanta, Georgia

James Rohack, MD
President-elect
American Medical Association

I'm proud to represent the AMA and to join Dr. Davis, who's a tough act to follow.

Throughout his career, Ron had waged a personal war against tobacco, alcohol abuse and poor nutrition. The results have been impressive.

But his fight now against his illness is nothing short of inspirational.

I ask you to keep him in your thoughts and prayers.

He represented us as the Dr. Davis of the 21st century during our AMA's >recent public apology to the nation's African-American physicians a discussion found in the most recent issue of the Journal of the American Medical Association.

The reason your organization exists is because of the actions (and inactions) of Dr. Nathan Davis in the 19th century and those who followed him as AMA leaders.

They refused to accept African-American physicians as equals and thus as members of our AMA.

It led to the founding of the National Medical Association in 1895.

It represents decades of lost chances and missed opportunities. This sort of segregation cheats our medical profession and poorly serves our patients, regardless of race, color, creed or condition.

That was the past. To move forward for medicine to thrive we need to be partners as we confront the issues we face as physicians.

The problems of the uninsured, Medicare, disparities, diversity these take the efforts and unique insights of every one of us to solve.

For instance, I've been fortunate to work with NMA officials including Dr. Willarda Edwards, who of course holds high positions with both the NMA and the AMA. Partnerships like this are invaluable.

We'll need those partnerships as we attack issues such as the disgraceful number of people without health coverage in our country.

Disparities and the Uninsured

The Census Bureau tells us that 47 million people lack health insurance.

That's one in seven people. All under the age of 65.

All risking catastrophic disease or accidents

With the same odds as those with coverage but without the means to pay the bills.

Nationally, about 16 percent of our population is uninsured.

Statistically, that's 15.7 percent of the population

But for African-Americans, that rate is almost 20 percent. One in five.

For Hispanics, almost 33 percent one in three.

So, obviously, the uninsured problem is also a problem of disparities.

And the AMA is responding -

Seeking free-market solutions for the uninsured problem -

To provide access to health care to affordable care to the best quality care for all.

That's why the AMA has stepped up its presence on this issue, and last fall launched our Voice for the Uninsured Campaign.

It's a multi-million dollar effort to focus the attention of the media - political candidates and our patients on the problem of the uninsured and the AMA's plan to get them coverage.

As the candidates offer their health care plans the AMA will be at the table, helping to influence the debate and shape the outcome.

Commission to End Health Care Disparities

Another area where partnerships are vital is in the fight against disparities in medical care, which we've addreseed head on with the Commission to End Health Care Disparities.

In partnership with you in the National Medical Association, the commission includes more than 65 medical and public health organizations.

We seek to end disparities through education and awareness, and through our "train the trainer" programs to encourage sensitivity to ethnicity and culture in medical education.

We're focusing on four broad areas:

o First, educating physicians about the extent of the racial and ethnic health care disparities in America and offering some solutions.

o Second, we support collecting racial and ethnic data on patients. This helps improve quality, and make health care better for everyone.

o Third, we study key and emerging issues, and then disseminate our findings through comprehensive reports.

One recent report shows that using so-called "pay for performance" criteria could actually worsen disparities. It's really a lose-lose situation for everybody.

o And last, the Commission promotes workforce diversity - through initiatives such as the "Doctors Back to School Program."

Our country's minority population is now more than 100 million - about a third of the nation.

And for too many young people, their main role models are entertainers and athletes. That's not necessarily wrong, if you have those skills. But they shouldn't be the only role models.

As physicians, we're concerned about diversity in America's physician workforce. Patients tend to seek out physicians most like themselves.

Doctors Back to School

Our "Doctors Back to School" initiative that was started by our AMA Minority Affairs Consortium sends physicians out to visit secondary schools - to recruit future minority physicians.

Dedicated physicians visit grade schools and high schools - and share their passion for medicine with minority kids.

Hopefully, some of them will be inspired to become physicians themselves. Just like you.

But we also need to make sure people from disadvantaged backgrounds can get to medical school in the first place.

The average resident earns just over $43,000 a year and carries a debt burden of more than $130,000.

Many residents pursue their training in urban areas where the cost of living is high. And the high debt burden that many medical graduates face can influence their career choices.

This burden can deter young physicians from entering public health service, practicing in underserved areas, working in medical education or research, or practicing primary care medicine.

That's why the AMA has been fighting hard for programs such as the "20/220" rule.

The "20/220" rule enables many resident physicians to defer loan payments for three years without accruing interest on subsidized loans.

And we support our AMA Foundation's grants of $10,000 scholarships to 10 qualified minority medical students annually, a program started in 2004.

AMA Activities Aimed at Minority Health

The AMA has long had a "zero tolerance" policy toward racially or culturally based disparities in health care.

A top priority is raising physician awareness about racial and ethnic disparities in care.

Toward this end, the Commission has created a video, featuring minority patients who speak directly about their experiences, good and bad, within the health care system.

We also recently released an online video called "Language Barriers in Your Practice" -

We want to help sensitize physicians to the medical and ethical issues involved in caring for patients who speak a language other than English.

You can see the video on the AMA Web site.

Our surveys tell us that three out of four physicians believe they were in a good position to improve the quality of care for minorities.

That's only right, since disease knows no ethnical or racial barrier.

So neither should prevention, treatment or cure.

But, as you know, minorities in this country suffer disproportionately from diabetes, heart disease, HIV/AIDS, cancer, stroke and infant mortality.

And sometimes treatment itself falls short.

For instance, some African-American and Hispanic heart attack victims arriving in an emergency room still aren't getting aspirin as fast as they should.

And they're not getting it prescribed as often as they should when they leave the hospital.

Finally when I look at the statistics on uninsured Americans - I see a disparity in need of correcting, as well.

Conclusion

We at the AMA are proud of all of these activities.

But we are also well aware that we need to continue growing in new directions -

And in this case, we need to grow along with our minority population and its influence.
" As we make and reshape our policies and fight for them in the national arena we need young physicians like you to guide us.

Physicians who:

  • Understand the language and cultures of minority patients firsthand
  • Care passionately about the health of these patients.
  • And have the potential to be advocates for the millions of minority patients who don't yet have a voice in the public sphere commensurate to their numbers.

We need to hear what you think about what the AMA is doing and where it could do more.

We need you to help point us and the nation in the direction of optimal health care for all.

To do all this and more we need you to continue to be active members of the House of Medicine.

And we need you to be in positions of authority and influence in other realms to help the AMA and all of organized medicine learn and grow as in a direction that will help our minority physicians and patients.

Our joint efforts on issues that are fundamental to public health fundamental to our patients' well-being fundamental to our calling as physicians

These make the folks in Washington and in the state capitals pay that much more attention to the other issues that affect us as physicians.

Please help us to make it happen.

Learn more about us and what you can do to help at our Web site: www.ama-assn.org.

And if you're not an AMA member, join us. Together, we are stronger.