Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
AMA Chief Experience Officer Todd Unger speaks with AMA President Patrice A. Harris, MD, MA, President-elect Sue R. Bailey, MD, and Immediate-past President Barbara L. McAneny, MD, on updates regarding COVID-19 including the impact of COVID-19 pandemic on the patients of AMA's past, present and incoming presidents.
Learn more at the AMA COVID-19 resource center.
Unger: Hello. This is the American Medical Association's COVID-19 update. It's been an historic year for the AMA, first with three women serving as our past, present and incoming presidents, and it's also been an historic time in medicine with the rise of COVID-19.
Today we're going to discuss how the pandemic has impacted these AMA leaders and their patients. I'm joined today by Dr. Patrice Harris, AMA's president and a psychiatrist and former county health director in Atlanta, Dr. Susan Bailey, AMA's president-elect and an allergist and immunologist in Fort Worth, Texas and Dr. Barbara McAneny, AMA's immediate past president and a medical oncologist and hematologist in Albuquerque, New Mexico. I'm Todd Unger, AMA's chief experience officer in Chicago.
Dr. Harris, Dr. Bailey, Dr. McAneny, your patients come to you for very different reasons and COVID must be affecting them and you in very different ways. Dr. Harris, let's start with you. Tell me what you're seeing through your psychiatrist lens, relative to your patients.
Dr. Harris: Well, absolutely Todd, but first let me say what an honor it is to be with my two colleagues here. I've dubbed this as week three, and this will be one of the last times the three of us get to share a stage. So it has certainly been an honor to be in the position of being in between these two wonderful, talented women.
Yes, COVID-19 has uncovered a lot of gaps in our health system, and one of those gaps is the mental health system. And I am worried about the mental health of the public, our patients and my colleagues. Certainly, we know the public is feeling anxious, feeling stress, isolated and worried. And I'm quite concerned about post-traumatic stress disorder in my colleagues because you know what, it is not a matter of if, it is a matter of when. But I'm certain that the AMA will be ready to partner with other organizations to address these issues, both now and post-pandemic.
Unger: Dr. Bailey?
Dr. Bailey: As an allergist/immunologist, a significant portion of my practice is asthma, and these patients are very concerned about an increased susceptibility to severe disease, should they contract COVID-19. There's still so much we don't know. There's lots of different types of lung disease. There's lots of different types of immune disorders, and which ones really predispose people to severe disease, which ones might not be quite so higher risk, so all we can do is just assume that the patients are going to be at high risk.
We have been aggressively, aggressively advocating people to stay home, to wear masks, to wash their hands, to do everything they can to keep from getting the disease. People are, like Dr. Harris said, they're stressed, they're anxious. A couple of patients I've seen through telemedicine, I'm concerned have been clinically depressed because of all of it and it's an amazing time.
Unger: Dr. McAneny?
Dr. McAneny: Well, the patients that I take care of with cancer and blood disorders are already immuno-suppressed. And recent studies have shown that a cancer patient who acquires COVID has a three-fold increase in the risk of dying. So we've decided, in my practice, that it is our duty to our patients to stay open and to continue cancer treatments, because cancer doesn't wait for COVID, and to be able to continue treating them, but very aggressively keeping them away from the emergency department and away from the hospital. So we continue to treat a lot of things in the office.
For example, people who have fevers that are related to their immunosuppression, if they stay home and monitor it because they're concerned about COVID, they will die of the immuno-suppressed fever. So we had to implement processes where we screen first by telemedicine and then decide whether the risk is likely to be COVID. We set up with our local lab, a special testing site, a secret site, we can send our patients to, to get rapid turnaround requests for immuno-suppressed people, so that we would be able to manage it.
One of the places that I'm particularly worried about is our clinic in Gallup, New Mexico. This little town of 30,000 people with severe health disparities before the COVID epidemic, has now more cases developing daily than Albuquerque, a town of a million people. It is just terrifying. It is a social experiment that shows if you are unable to do the social-distancing, if you are unable to alter your living situation, to isolate, and to have good hand washing, et cetera, that you will not do well. And comparing Gallup with places that can socially isolate, shows the importance of all the things that we're currently doing.
Unger: Let's talk a little bit more about the health disparities that you're seeing. Yesterday we did have a chance on the video update to talk about the disparities with treatment for Native Americans.
Can you all tell me again, what are you seeing in terms of health disparities and outcomes for vulnerable communities?
Dr. McAneny: Well, Gallup is a great example of that. We decided today that we would, as of Monday, stop seeing routine visits of people who were just scared about their cancers and wanted to be seen. We can't do telemedicine in Gallup because the internet is not adequate across the reservation. So we can do phone visits, and we're grateful that we have the ability to contact our patient by phone, but we don't even have Skype or anything like that with these people. So it really makes it difficult. It just shows that if you have social disparities beforehand, you have social disparities in spades after the coronavirus's attack.
Unger: Dr. Harris, any thoughts on that?
Dr. Harris: Yes, absolutely. Again, this pandemic is uncovering or amplifying what were already preexisting conditions. We know that initially, there were reports and stories of a disproportionate impact on African Americans for many reasons, preexisting conditions. I just read a story this morning that in Georgia, where I live, 80% of those who have been hospitalized have been African American. And so again, we see the health inequities really amplified during this COVID-19 epidemic.
Unger: Dr. Bailey, any additional thoughts?
Dr. Bailey: The fact that the elderly, people over the age of 65—and so I'm close to that, so I'm a little sensitive about that word—are definitely adversely affected disproportionately. And that population, even in a large, relatively sophisticated urban area where there's great internet access, they're not particularly internet savvy and don't feel real comfortable doing telemedicine appointments.
So that has been an interesting part of my population that we can at least reach out with phone calls. Sometimes they'll try to get on telemedicine and then they aren't able to, they can't figure it out. Their kids or grandkids can't come over to help them figure out how to sign on. And so it's been an interesting social experiment, if you will, to try to care for a very high-risk population that has the hardest time accessing care.
Unger: Speaking of social experiments, we do have a number of states pushing to reopen, which some consider prematurely, Georgia, Texas. How are you all feeling about the path that we're on in those particular locations?
Dr. Bailey: Well, I'll jump in first. Our governor has decided to open up May 1, but there are parameters for every community because Texas is such a diverse state. We have counties that have had no cases, and we've had counties with thousands of cases, and the way each of those areas deals with opening back up, if you will, are going to be different.
I was on a call last night with the minister and some leaders from my church, and we had our mayor's chief of staff with us, and all of the other physicians on the call and the mayor's office, all agreed that Tarrant County-Fort Worth is not ready to open up because we are not seeing a decline in cases and our ICUs are completely full. But 90 miles south of us, Waco was in a completely different situation.
So we just are hopeful that the communities will follow the science, will listen to their physician leaders and not get too hasty. I'm telling personally my patients, "Don't change anything that you're doing. Keep your same behaviors. Just pretend like May 1 is not a big date on the calendar. Stay in, wash your hands, wear your masks."
Dr. Harris: Well, I am worried here in Georgia because as unlike Texas, we do have a one-size-fits-all approach. And of course, I live in the metro area where we have had a high number of cases, but there's also a rural area in south Georgia, southwest Georgia, that also has had a number of cases. And so I would be—I'd feel better about our opening if cities and states and counties that had a higher number of cases could decide for themselves, again, based on science and data about what should open.
Also, many folks have heard that for some reason our beauty shops and barber shops were allowed to open first, and I believe that our health infrastructure should be allowed to open first and be prioritized. Physicians and patients have put off procedures, and we need to make sure they have the PPE that they need, and so we need to make sure that health care and physician practices are a priority. I'd like to get my hair done just like anybody else, but the priority should be health and physician practices.
Unger: Yes, I need a haircut substantially, but I agree with your priorities immensely.
Dr. McAneny: Oncologists are well aware that hair is just there for decoration, and that the strength of our patients is their true beauty. Our governor is keeping us very much locked down. I think that's wise in New Mexico. We do not have the resources to be able to handle a surge, and she is very wise to do that.
So we do think that perhaps one of the earlier businesses that could open up is to encourage physician practices because physicians understand social-distancing and good hand washing and taking precautions to protect infections, and that would assist with patients who have chronic diseases that are going neglected during the COVID pandemic, to be able to get in and make sure their diabetes is not out of control, that their hypertension is not run rampant, and that their asthma and other diseases are getting taken care of.
We would like to see people get visits with their primary care doctors, both so they can get their screening done and see what is that lump that they're concerned about? We'd rather it not grow too much before we fix it. And also, because primary care and surgical practices are really struggling economically right now, we need to help them survive this epidemic as well.
Unger: Well, let's talk a little bit about that. As leaders in the AMA, you've been overseeing a full court press, the resources of this organization to help physicians and patients. Can you talk a little bit about some of the top line things the AMA is doing to help during the pandemic?
Dr. Harris, why don't you start?
Dr. Harris: Yeah, so since the beginning, we have been advocating for physicians to have the personal protective equipment that they need. We have been advocating for adequate testing for everyone. Again, an adequate testing and a robust public health infrastructure is important for us to open up, and we all do want to loosen some of these restrictions. As Sue and Barbara have said, the AMA has been advocating for increased funding for physicians. So certainly the motto that I've mentioned often, "nothing about us, without us," plays here.
No policy regarding physician practices should occur without physician input, and the AMA has been right there all along the way.
Unger: Dr. McAneny?
Dr. Bailey: I'll give a big amen to that.
Unger: All right, Dr. Bailey. Yes.
Dr. Bailey: When we first started looking at ways to see patients, unfortunately we had not been doing any telemedicine in our practice, and suddenly just had to kind of flip the switch and start doing it right away. The AMA's resources and their advocacy to get telemedicine better paid for than it has been in the past, it was an incredible help. It helped in working with our state societies and our specialty societies altogether, to get that guidance out there on how to do telemedicine, how to get paid, how to participate in the various programs of have the stimulus programs, the CARES Act, et cetera, and just the wealth of resources on the AMA's COVID-19 resource page. Also, JAMA. JAMA has just been phenomenal in terms of how it has rushed things into print in a record, record period of time.
Dr. McAneny: I think also, our work with the administration and with CMS on getting some of these payments out to physicians has been incredibly helpful. It's not easy to do the paperwork. We did it, and we got the money, so it's possible. I can attest to that. But I think it's important to recognize that not all specialties take Medicare, so doing a Medicare billing does not help pediatricians and obstetrician/gynecologists and other entities that don't bill Medicare. And our AMA is advocating to make sure that all physicians and all practices can get that.
The Payroll Protection Plan is incredibly important. We have actually given an additional sort of hazard pay to our employees to keep them here because we recognize that so many of our employees have spouses who also work who have now been laid off. There's going to be huge economic hardship from this, and people who lose insurance because they can't afford to pay their COBRA payments are really top of mind. The AMA is working and is sending letters to advocate for assistance with patients to be able to maintain their health insurance at this time when we most need it.
I've also shared the AMA telemedicine criteria because in the rush to telemedicine, we're all thrilled to have it as a tool, but if we just open it wide up and keep it that way afterwards, we will lose the value of a physical exam and of touching patients and having that communication, and we also open ourselves up for abuses, or for pill mills, and second opinion mills from people out of town, out of state. The AMA has great policy on how to safely do telemedicine, so we absolutely have to be at that table when the rules are rewritten after COVID.
Unger: Exactly. I find that all three of you come from very different backgrounds and different practices, but one thing you do very much have in common is your opinion about the role of the physician in defining and shaping the future of medicine.
Dr. Harris, you talked a little bit about that and the policy that affects medicine has to be shaped by medicine and by doctors. Any additional thoughts on that before we close?
Dr. Harris: Well, I would just say that I hope that everyone who hears this webcast will also take on the individual responsibility of being engaged at your local level in this and ensuring the physician voice is heard. Certainly as you've heard from all three of us, the AMA is there partnering with our state societies to make sure. And I'll just repeat one more time, “nothing about us, without us.”
Unger: Dr. Bailey? Dr. McAneny? Any final thoughts?
Dr. Bailey: I just want to add onto Dr. Harris's sentiments with the importance of physician autonomy and how that has been threatened during the pandemic with physicians being told not to wear PPE because it might frighten patients, physicians being disciplined or health care workers even being fired for doing things that they wouldn't have done before.
Physicians need to be a part of the planning. They need to be allowed to take care of themselves because what's really important to us is our patients. And if physicians can't be physicians and protect themselves and their patients in the way that they feel as best, then we're all in trouble. So I'm very thankful for the role that the AMA has played in encouraging physician autonomy and helping us take better care of our patients.
Dr. McAneny: I think it's interesting that I haven't heard too many private practices furloughing their doctors, and no one can fire me from my own practice. So I think there is some security there that will allow us to—but we, like small businesses everywhere, small, taxpaying businesses, need to be accepting and obtaining this Payroll Protection money that is out there so that we can continue and create the infrastructure.
Right now, I think we have to think about the future and to look at what the the blanket of COVID has uncovered in our health care system. There are so many flaws, so many people left behind. The AMA needs to be the truthsayer in terms of not only the science, we need to be a trusted source for our patients as to what actually works and what does not, and that is more needed now than ever, but we also need to look at what our health care system will really need to do well going forward as we face this epidemic and future epidemics.
Unger: Well, thank you very much Dr. Harris, Dr. Bailey, Dr. McAneny, for being here today and sharing your perspectives, and for all the work that you're doing on behalf of patients and physicians.
We'll be back on Monday with another COVID-19 update.
In the meantime, for additional resources like our Quick Guide to Telemedicine, go to the AMA COVID 19 resource area on AMA's site, ama-assn.org/COVID-19.
Thanks for joining us today.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.