10 years later, how AMA’s strategy changed us—and health care

James L. Madara, MD , CEO and Executive Vice President

Our nation’s long fight against COVID-19 brought new urgency to the AMA’s celebrated mission of “promoting the art and science of medicine and the betterment of public health.” But the seeds of that work began in earnest a decade ago when we created a new long-term vision for the AMA built around a simple concept of what was best for patients, best for physicians, and best for the health of our nation.

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The AMA helps physicians build a better future for medicine, advocating in the courts and on the Hill to remove obstacles to patient care and confront today’s greatest health crises.

The result was three dynamic, carefully constructed strategic priorities—later to be known as the strategic arcs—that more closely aligned the work of the AMA with our mission:

  • Removing obstacles that interfere with patient care.
  • Confronting chronic disease and eliminating health inequities.
  • Driving the future of medicine by reimagining medical education and lifelong learning.

Each arc is powered by the cross-cutting accelerators of advocacy, equity and innovation. Advocacy is how we work to influence the regulatory environment by elevating the concerns of physicians and patients at the state and federal levels.

Advancing equity is our drive to use AMA’s influence and power to create a more equitable future so that all people and communities can achieve optimal health. And helping lead innovation is our work giving physicians a platform to influence the design and creation of new digital tools to ensure the tools work as promised in the clinical world.

Since their launch in 2012, these strategic arcs—powered by three accelerators—have brought sharper focus, and impact, to the AMA’s work. And a decade later, that impact continues to reverberate across health care in new and exciting ways, influencing not only how physicians work in this rapidly changing clinical environment but how patients experience our 21st-century health system.

The strategic arcs were the solution to a vexing problem that had long plagued the AMA.

The structure of our organization—with an elected and ever-changing Board of Trustees and a new president sworn in each June—meant that our work meandered from year to year. Each president brought his or her own priorities to the role, and our organization often shifted focus when a new president took office.

An internal audit of AMA’s work in the years before our new strategic plan revealed more than 100 different projects in varying stages of completion, many unrelated to one another and modest in scale. If we were ever going to be the organization that physicians and patients needed us to be in the rapidly changing health care environment, we needed a new approach.

The responsibility to create this new approach, by crafting a long-range strategic plan for our organization, became mine when I was hired as the AMA’s CEO and executive vice president in 2011. And in accepting this responsibility, I fully understood our AMA had been given the opportunity to not just change health care for the better, but the world. It would turn out to be a rewarding, and humbling, experience.

What I later learned was that much of our strategic direction had already been charted through existing AMA policies passed by the AMA House of Delegates. In the early days of this process, we zoomed out, as if using Google Earth, and took a bird’s-eye view of our policy compendium. In doing so, we discovered metasignals of policies, that is, groups of a dozen or more that followed similar themes and could be easily aligned.

But doing so would require a seismic shift for the AMA—moving to an organization focused more on outcomes than on process, and more on doing things rather than simply being a convening body for others.

This was key to our efforts, and it laid the groundwork for a new long-term strategic vision for the AMA that was also deeply rooted in and that built upon the work of generations who had come before us.

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How far has the AMA traveled in the 10 years of our strategic arcs? It’s impressive to consider.

Take the strategic arc of professional development, for example—that is, driving the future of medicine through improved physician education training. This arc initially focused on undergraduate medical education with the thinking that medical schools were a tightly circumscribed universe, largely unchanged in a century, that had shown little appetite for innovation or future-oriented thinking.

Our work to transform medical school education began with 11 schools and eventually expanded into a consortium of 37 medical schools dedicated to developing new and innovative ways to teach aspiring young physicians. It grew and evolved with the creation of the third science of medical education—health systems science—and other innovations now being broadly integrated into school curricula.

It expanded with an additional consortium of 11 integrated health systems focused on reimagining physician residency training with the singular goal of optimizing the transition from medical school to residency, and from residency to practice. 

And it evolved even further with the creation of the AMA Ed Hub™ for digital education. We’re early on in this work, but already we offer more than 9,000 online resources developed from nearly 40 trusted sources—including 13 medical associations that are part of the Federation of Medicine—and with the additional participation of numerous specialty boards, state licensing boards, and other institutions such as the Centers for Disease Control and Prevention (CDC) and other outside partners.

So, from one humble idea of transforming medical school education, you can see how the arc grew and matured in the 10 years since its launch to creating a cohesive and well-coordinated pipeline of learning that physicians need in the 21st century.

Similarly, the arc dedicated to improving the clinical environment for physicians by removing obstacles that interfere with patient care began with a focus on factors that drove physician satisfaction and dissatisfaction, as uncovered in a landmark study in partnership with RAND. This still a very important aspect to this work, but it now includes the entire scope of work in the AMA Recovery Plan for America’s Physicians that we launched earlier this year, along with other core advocacy priorities.

It also encompasses the AMA’s imprint on digital health and technology, foundational in the Silicon Valley-based Health2047 innovation firm that has already spun out six companies into the ever-expanding digital health marketplace. It also includes the Physician Innovation Network online platform, which has attracted more than 18,000 physicians, tech innovators and business entrepreneurs to share ideas and collaborate on new digital health solutions.    

The third arc, focused on chronic disease, began with a focus of helping patients at high risk for heart disease better manage their blood pressure and helping people better understand their risks for type 2 diabetes.

Over the last 10 years, we’ve accomplished this and much more, helping create national public information campaigns about the of risks of chronic disease in partnership with the American Heart Association, the CDC, the American Diabetes Association, the National Medical Association, the Association of Black Cardiologists, the Ad Council, and others.

We launched our AMA blood pressure quality improvement program with peer-to-peer coaching and a digital dashboard that is being used in health systems around the county. This work has demonstrated positive impact on BP control when used in collaboration with physicians.

And with the American Heart Association we created Target BP, recently recognizing 1,300 health care organizations that have committed to focusing on blood-pressure control. Together, these organizations help more than 8 million people with hypertension improve their heart health.

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Our long-term strategic arcs have succeeded in the decade since their launch for three important reasons.

First, they are dynamic, and the framework of the plan evolves based on the needs of our ever-changing health care environment. Second, their existence allows the AMA to tackle short-term and urgent health needs such as COVID-19 without losing site of our long-term focus. Balancing focused, long-term goals with the needs of the moment is the art of what we do.

And finally, and perhaps most importantly, they work because they are built upon an incredible foundation of AMA essentials. From physician membership and our industry-leading medical research published in the JAMA Network, to the day-to-day activities of the organization—finance, the office of the general counsel, communications, health, science and ethics, and a dozen other core business units, as well as our dedicated staff, inside the AMA working to support the arcs and our mission.

It's impossible to predict what our health system will look like a decade from now, let alone by midcentury. But I do know this much. If physicians don’t have a better practice environment supportive of their efforts in patient care, if we don’t train and educate physicians for the needs of 21st century medicine, and if we don’t get a handle on the ever-growing tsunami of chronic disease, then the consequences are predictable. Patients will suffer, physicians will become more frustrated and burned out, and our nation’s health care system will function even worse than it does today.

It's this thinking that led to the creation of our long-term strategic arcs a decade ago and continues to drive us today. What began as an effort to make the AMA more impactful and focused has also made us more relevant than ever in the lives of patients and physicians. That will always be the truest measure of this vision and our work.