AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
Featured topic and speakers
What's being CEO of the American Medical Association like? What are doctor CEOs doing? How has medicine and the American Medical Association changed?
After leading the AMA for 14 years, CEO and Executive Vice President James L. Madara, MD, steps down at the end of this month. In this episode, Dr. Madara reflects on his time at the AMA, shares his proudest accomplishments and most memorable moments, and looks ahead to what’s next for the AMA. AMA Chief Experience Officer Todd Unger hosts.
- Watch AMA Update for health care news for physicians, residents and medical students.
- Not a physician? Join the Patients Action Network.
- Stay up to date on all the latest advocacy news by subscribing to AMA Advocacy Update.
- The AMA is your powerful ally, focused on addressing the issues important to you, so you can focus on what matters most—patients. We will meet this challenge together. Join us.
- Learn more about our AMA advocacy priorities, including:
- Reforming Medicare payment
- Fighting scope creep
- Fixing prior authorization
- Reducing physician burnout
- Making technology work for physicians
Speaker
- James L. Madara, MD, CEO and executive vice president, American Medical Association
Transcript
Dr. Madara: The intrinsic motivation that physicians have, which is taking care of patients, spending time with patients, sending people home better than they came in. Well, that's a great thing to have in your field.
Unger: Hello, and welcome to the AMA Update video and podcast. Today, we're talking with the AMA's CEO and Executive Vice President Dr. James Madara as he prepares to step down from his role at the end of the month. We'll look back at the legacy he's leaving behind and discuss what's next for the AMA and for the future of health care. I'm Todd Unger, AMA's chief experience officer. Dr. Madara, it's a pleasure to have you today, and congratulations on 14 years at the AMA.
Dr. Madara: Thanks, Todd. It seems a while, but great to be here.
Unger: Well, you have quite a list of accomplishments. When you look back over your tenure at AMA, let's just start by talking about what do you think was the driving force behind your work here?
Dr. Madara: Well, in coming to the AMA, the search committee was pretty clear. They wanted the mission statement to come to life in a more vibrant and powerful way. Doing that is one thing that I think we can all be really proud of.
Unger: Excellent. You certainly have done that. Is there anything in particular that you are most proud of?
Dr. Madara: Well, there are different levels of things. So I would say there's a foundational element. So we have to be strong and vibrant financially. We have to have operations capacity. We have to have membership that grows. I mean, these are foundational elements that are really important for the success of other elements.
And then the other elements is, secondly, would be these mission elements of education, chronic disease, removing obstacles from patient-physician interactions. Third level would be products that were made through those, and anything from the Ed Hub to how we approach group membership. And now, again, the products, because I'll forget, five things, because there are so many of the products, new products. VeriCre credentialing product, Reconnect educational product, et cetera.
And then lastly, layering over that and allowing those other three layers to mature is a spirit of innovation throughout the organization, the crown jewel of which is probably our Health2047 innovation studio in Menlo Park.
Unger: Well, I love the way that you described that in terms of the layers because you certainly did translate what you saw here into a cohesive strategy that did encompass those mission areas, as you talked about. The organization is financially secure and stable. Membership in your tenure has grown 30%. Is there anything, now that you look back over those 14 years, was either easier or harder to get done than you thought?
Dr. Madara: I think one thing that's always harder is keeping focus, and particularly in an organization where there's so much churn and leadership. We just met with the new board members, 20% of our board is turning over this year. We have a new board chair every year, a new president every year.
So maintaining focus is always hard. It's even harder when you have a organization with such a broad mission statement, at the same time, so much churn.
Unger: Well, it's a good thing nothing in medicine changes on top of that. That is certainly not true. You have witnessed a great deal of change in medicine over the past 14 years that complicates and causes the need for an organization to continue to evolve. When you look at that landscape of medicine and how it's changed, is there anything that really stands out as having been a particular challenge or opportunity in your mind?
Dr. Madara: Well, I think the challenges and opportunities both go together at times. Include the amazing new tool set that we have in medicine, whether they be new drugs that are coming out that are more precision drugs, the biological approaches of gene editing, CRISPR, these kinds of elements that we have to work with.
The fact that when I came here, robotic surgery was kind of a niche field. Now robotic surgery is old hat. At the same time, we have more and more chronic disease in our population. We're more tooled to bricks-and-mortar acute disease. Getting our arms around how we're going to deal with this threat of huge chronic disease burden in the next half-century is a challenge.
Unger: So it is a huge amount of change. When you think about the trajectory that we're on right now into the future, where do you think the biggest impact for a place like the AMA is going to be?
Dr. Madara: I think as being in the mix and relying on something that we have that is really precious to us, and that is knowing what the intrinsic driver, the intrinsic motivators of physicians are. And that is doing well by patients, spending as much time with patients as possible, spending as little time doing administrative work as possible.
And we know if we can get the time right for how physicians spend their time, we have the amplitude of this intrinsic motivator behind it that drives—and I think that's really a promising, exciting thing for the future, and a driver to get the time right.
Unger: Now you have also had your chance to experience your share of curveballs that have been thrown over the course of this 14 years, with the pandemic being, of course, one of those. That must have had a tremendous impact on how you thought about the organization and the role it can serve in a very critical time. Do you have any reflections on that particular period and how it changed you or this organization?
Dr. Madara: I was really taken by the ability to pivot. So one day we were all working, and then due to the senior management team's planning for a week or so, the next day, we were all remote. That the focus areas that we had in our strategic framework also pivoted. What's medical school like without the medical school? How do we deal with chronic disease during this time?
And then the wild things that came up, like no personal protective equipment. And things that would happen along those lines, we would find out that there would be physicians being fired from hospitals because they were bringing in personal protective equipment from home because the hospitals didn't have any.
And so that sounds nonsensical, and then you think about it probably is coming from risk management at the hospital. So you get in touch with the American Hospital Association, talk with the group that links to their councils, and yes, it's true, that they were enforcing these rules that didn't really apply to a pandemic era where something's better than nothing.
Lastly, I think of a conversation I had with someone early in the pandemic in the emergency department of a hospital in New York where they had basically a dozen bays, but maybe 60 cots with patients in, asking him what would he have done differently now that he knows the challenge of the pandemic?
And what he said was learn how to more nimbly put together respirators. So these things that we just wouldn't have predicted that were unique. And how everyone came together and got it done, I think, was really an impressive lesson of what the health system could do.
Unger: Do you think any lessons that you in particular learned about how to be more nimble in the face of an emergency like that?
Dr. Madara: Just always realize that you're never going to have perfect information in a crisis. And the seeking for perfect information or the next level of information shouldn't stop you from acting during a crisis.
Unger: Now one of the things that I personally remember about working with you was after the pandemic was over and there was this sense that we have just gone through this calamity, and we're at the end of our rope, we need more support out there, and that's where the idea of this—the Recovery Plan for America's Physicians came into being.
You had such a good feeling about where physicians' minds are right now. How do you counsel this organization and folks out there to stay in touch with how physicians are feeling and what they need?
Dr. Madara: Well, I think a critical thing that happened with that recovery plan was the work that you and your team were doing. And I remember you coming into the office and saying, here's an idea. Let's synthesize something in a very sharp way that has these components that everyone's going to understand, but it has a phrase to it that people can relate to.
And so understanding the market dynamics and what people are looking for, I think, is the lesson to take home there, and that's true of all the work in the organization. That we sometimes think, particularly if someone is a subject matter expert, that I would imagine the market would want this as opposed to going out and seeing what it is people actually want.
Unger: Well, this is, I think, one of the biggest surprises for me over the course of the last eight years that I've had a chance to work with you. Your background is in pathology. You've run health systems. You've been involved in venture capital. You've been running the AMA for 14 years. And I just want to say thanks for how in touch you are with what people actually need and how to translate the power and impact of this organization to helping them.
Dr. Madara: Well, that's really generous of you, Todd, but the secret, from my point of view, is just getting people around you that are better than you are, and then it all works out just fine.
Unger: Well, that is important. And you have built a great team here, and we're surrounded by so many terrific physicians out there. But I would just say, especially now, and maybe you have a different perspective on this. The news just feels like an endless cycle of negativity. How do you remain positive about the future in the face of this?
Dr. Madara: Well, I think there are things like the motivation, the intrinsic motivation that physicians have, which is taking care of patients, spending time with patients, sending people home better than they came in. That's a great thing to have in your field. The other thing that I think we have is that we in medicine tend to be behind other fields, and so we can cheat a little bit by copying other people's homework.
One thing that really stands out to me, and I have a New England Journal paper coming out that makes this point, is that of all the other sectors, we're a sector that doesn't have real-time learning in the provision of care. Just like real-time learning occurs in the making of cars and the manufacturing of steel. That's a wonderful opportunity for us.
Unger: That is, and that's so aligned with reinventing transforming medical education to think about really on-demand and more personalized, and I know that's been a big part of what you've done here.
So what's next? What do you do next after accomplishing so much at a place like this?
Dr. Madara: Well, I don't have anything so granular as I could talk about what happened here. I think in general, my pivot is really just organically toward innovation venture as it relates to health care. And we need a lot of new ideas, and we need much more of a system function in health care. So there are a lot of opportunities there.
Unger: Well, I'll just put you on the spot and just say, I hope you'll continue to be my mentor in the years to come. It's been really exciting to work for you, and I know, on behalf of all the team here, how important our relationship has been with you and how much we've been able to get done together.
Dr. Madara: I appreciate that. And I also view mentoring, as always, bidirectional. So same thing back at you.
Unger: You've got it. All right. Thank you so much, Dr. Madara, for joining us during your final days at the AMA, and for everything that you've done for us, and for physicians and patients everywhere. You've really left a mark on medicine, and it's been an honor to work with you.
To support the ongoing work of the AMA, please consider becoming an AMA member at ama-assn.org/joinnow. And that wraps up today's episode. We'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
Subscribe to AMA Update
Get videos with expert opinions from the AMA on the most important health care topics affecting physicians, residents, medical students and patients—delivered to your inbox.
