Pandemic response: AMA moved quickly to advocate, provide answers

Andis Robeznieks , Senior News Writer

The AMA House of Delegates, which had been scheduled to hold its 2020 AMA Interim Meeting in San Diego, is instead holding a virtual meeting Nov. 13–17, but pre-meeting activities have already started. These include the November 2020 AMA Section Meetings, a plenary session of which featured an appearance by Anthony Fauci, MD, along with a panel discussion featuring top AMA staff detailing the development of resources to help physicians maintain their spirit and their practice viability during the pandemic.

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Events kicked off with Dr. Fauci, director of the National Institutes of Allergy and Infectious Disease and the nation’s most high-profile physician during the pandemic, being interviewed by AMA Executive Vice President and CEO James L. Madara, MD. They discussed the status of efforts to develop COVID-19 treatments and vaccines, the math behind herd immunity, and what lies ahead for physicians and medical students.

Moderated by AMA President-elect Gerald E. Harmon, MD, the panel discussion with AMA physician experts informed delegates about the Association’s COVID-19 response in terms of advancing health equity, helping medical students, residents and faculty adapt to the new normal, advocating with the federal government for regulatory relief and financial support, and bolstering well-being among physicians and health care staff in the face of relentless stress.

Dr. Harmon, a South Carolina family physician with a 35-year career in the U.S. military, credited the AMA leaders on the panel with acting quickly, with flexibility and “exceptional, military-like precision” in their response to the rapidly changing conditions of the pandemic.

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AMA Chief Health Equity Officer Aletha Maybank MD, MPH, discussed how the pandemic has highlighted the importance of the work being done at the AMA Center for Health Equity.

“COVID has really exposed centuries-long structural inequities and injustices that are experienced by those most marginalized in our society,” Dr. Maybank said, adding that it has also further confirmed the “public health threat of racism.”

The pandemic has created a demand for meaningful resources for physicians and health care organizations to learn about inequities, the social determinants of health and inclusion. The center responded by launching a COVID-19 health equity resource center, which includes critical health equity resources to examine the structural issues contributing to and exacerbating already existing inequities.

Dr. Maybank noted that modules on health equity will soon be launched on the AMA Ed Hub™ and that the release of the Center’s study “Latinx COVID-19 Health Inequities Report: Insights for the Health Care Field,” has led to other collaborations.

These include a bilingual AMA campaign to improve patient engagement on COVID-19 in the Latinx community and attracting more Spanish-speaking physicians to help with outreach.

Susan E. Skochelak, MD, MPH, the AMA’s chief academic officer, said that “medical education has been disrupted at every level.”

In response, Dr. Skochelak described how the AMA:

  • Advocates for the safety of medical students and residents by advocating for personal protective equipment (PPE).
  • Works to clarify J-1 visa process for international medical graduates.
  • Develops resources such as webinars on leadership during a crisis or how to apply for medical school or residency virtually.

Residency training programs are also learning how to adapt their selection processes from in-person to online. Dr. Skochelak said a goal is to find ways to more “holistically select the right student for the right program that meets their needs.”

Another effort looks at how to transform old-style transitions from undergraduate to graduate medical programs into a more “structured handoff” that can evaluate where students may have gaps in their education.

“We all come in as incomplete when we go into residency,” she said. “We’re not fully krausened physicians yet.”

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Todd Askew, the AMA’s senior vice president of advocacy, detailed how the AMA continues to push for strengthening the Affordable Care Act (ACA), expand insurance coverage, and increasing graduate medical education (GME) funding.

“We will certainly continue to push that rock up the hill,” Askew said. The focus, for now, has been to defend against efforts to diminish or reallocate Medicare GME funding.

Regarding coverage, Askew said many people without health insurance are eligible for Medicaid or individual marketplace and premium subsidies, but don’t know it, so there is work to be done to get them enrolled. Other advocacy work includes:

  • Pressing “officials at the highest levels” to get PPE, more COVID-19 testing, testing supplies and testing guidance.
  • Fighting against Medicare payment cuts.
  • Expanding telehealth opportunities.
  • Combating vaccine hesitancy by working closely with the Food and Drug Administration and Centers for Disease Control and Prevention to ensure decisions on vaccine approval, distribution and administration are based on science.

Christine Sinsky, MD, the AMA’s vice president of professional satisfaction, warned that, “as a nation, we have a bill coming due with respect to the accumulated stress of the pandemic on our physicians and other health care workers.”

Good news includes survey findings that feeling valued by your organization and having a sense of purpose can protect physicians and others from burnout.

The AMA has developed a Coping with COVID Survey to help practices and organizations monitor the well-being of their physicians and staff.

It has also created 60 online toolkits providing practical and actionable steps on ways to reduce stress and anxiety and to promote staff wellness and practice sustainability.