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AMA Update
AMA President Jack Resneck Jr., MD, talks Medicare payment, physician burnout & reproductive care
Jun 12, 2023
Featured topic and speakers
AMA President Jack Resneck Jr., MD, reflects on his presidency and shares what it was like to lead the AMA through the ups and downs of the past year, tackling issues like Medicare payment reform, fixing prior authorization, maintaining access to reproductive care and evidence-based medicine. American Medical Association Chief Experience Officer Todd Unger hosts.
Speaker
- Jack Resneck Jr., MD, president, AMA
Transcript
Unger: Hello and welcome to the AMA Update video and podcast series. Today I'm joined by outgoing AMA President Jack Resneck, Jr., reflect on his presidency and share what it was like to lead the AMA through the ups and downs of a very, very challenging year. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Resneck, welcome.
Dr. Resneck: Thanks for having me.
Unger: I think that went pretty fast.
Dr. Resneck: I would say so. Sure feels that way.
Unger: Well, when I think back to your presidency, there is one line that stands out in my mind—I almost leapt to my feet when I heard it—something like, we need to fix what's broken and it's not the physician. Tell me about what was going through your mind at that point in time.
Dr. Resneck: That line actually just got inserted hours before the talk. It was something that we came up with. And as I was sitting there and thinking about what physicians have been through these last few years and all the things that have driven burnout, and most of it is really about those things that get in the way of doing what brought us all to medicine in the first place, which is being able to take great care of our patients. And in part of that speech, I was reflecting on some of the efforts initially that health systems and hospitals had taken to try to address physician burnout. And all of them had focused on resilience and wellness, and the hospitals were offering yoga programs at lunchtime.
And that was all lovely. But in a way, it kind of blamed the victim, and said, "Hey, doctor, you just need to be more resilient and toughen up in order to be able to handle all of these insults and things that get in the way of you doing your job." So I just felt like it was time to tell the profession this is not your fault. I know that you are out there working hard to take care of patients. And we need to get those obstacles out of the way.
Unger: And that really was the genesis of the AMA Recovery Plan for Physicians. You talk about those underlying obstacles that are getting in the way of patient care, getting in the way of what doctors love to do most, which is help people get better. You've really been spokesperson for the Recovery Plan. Talk to us a little bit about what you see in terms of the progress that we've made over the past year.
Dr. Resneck: Yeah, the Recovery Plan has been a useful way, I think, for us to just frame a lot of the work that is in progress and that has been so much of our focus as we think about what it's going to take to keep physicians from leaving the workforce, to continue to have a pipeline of young people who want to go into medicine, and to really renew the profession for the next generation.
And I think some of the first steps we had to take was just building awareness, awareness in the public, awareness among policymakers of why everybody is so burnt out in medicine and what those obstacles are and coming out of the pandemic when physicians had really put their lives on the line and now to be facing Medicare cuts and prior auth taking up everybody's time all day. So we still got a lot of work to do. All the pillars of the Recovery Plan are not done and fixed.
One of the largest areas still remains Medicare payment reform. But we have had some progress. I think almost anybody you talk to in Congress now understands that physician payment rates have been frozen for two decades, that compared to inflation that's actually enormous cut, that we just had another 2% across the board cut in January, not even accounting for inflation.
We've got a bipartisan bill now introduced in the House that would tie future physician Medicare payments to the rate of inflation. So there's progress happening there. We really need to continue the national conversation and build support for fixing this in Congress to get it over the finish line. But that's one big piece.
Prior auth, which is another pillar of that Recovery Plan, people are now getting it. There's almost not a member of the public, a policymaker, anybody that I talked to who hasn't had their own experience with a health plan denying a really reasonable evidence-based prescription or test or colonoscopy or whatever it is. So I think people are on to insurers' game here, and I don't think policymakers are going to let this continue to happen.
So we've seen progress in multiple states who are now pursuing bills to kind of rightsize and get control of this absurd process that makes physicians send fax after fax and appeal phone call after appeal phone call just to get patients what they need. We've seen the Center for Medicare and Medicaid Services put out two rules this year to substantially constrain prior authorization in Medicare Advantage plans. So there's process happening there too. Telemedicine, with the end of the public health emergency, we managed to get some extensions so patients and physicians can continue to do seamless integrated care by telemedicine.
And there are a lot of successes that are happening outside the Recovery Plan as well. I just want to mention a couple of those. So we saw naloxone, which is really important in our battle against opioid use disorder and the opioid pandemic, get approval to go over the counter. That was a multi-year effort.
I think we might be on the verge of having the FDA do the same thing for contraceptives and be able to have the first available over-the-counter contraceptive. We saw the FDA finally decide to end many parts of its very outdated and inappropriate ban on blood donations for men who have sex with men. Lots of progress finally with the conversation changing around data privacy and digital health. So a lot of cool things that I'm really excited about that have been going on here at AMA.
Unger: So a year of tremendous progress. I'm curious if there are things that you didn't get to or wish we could spend more time on or what do you see as the big opportunities for the coming year?
Dr. Resneck: Well, on a lot of those things we were just talking about, a lot of work still has to happen to get some of them across the finish line. So we talked about Medicare physician payment. That is an enormous pillar of the Recovery Plan. It's going to be a heavy lift to get Congress to complete their work and fulfill their promises to both physicians and to Medicare beneficiaries around this country. So that's job one.
Finishing off this work on prior authorization. We still have physicians doing, on average, more than 40 prior auths a week. We got to fix that. And one thing I didn't mention that I'm really proud of in the last year is the work by our Center for Health Equity at the AMA to really advance health equity and racial justice, tremendous progress. I have seen that work not really siloed just in that center, but actually transforming the work across advocacy, medical education, litigation, chronic disease, all of our business units at AMA really integrating that work.
But we still have appalling inequities in health care in this country. So continuing to advance that work. We have a great group who's actually thinking about health equity within the digital health and augmented intelligence space, really, really important work. Another group we're rolling out called Rise to Health, which is a collaboration with hospitals, payers, multiple other groups, to really see how do we scale this work and make sure that it happens across medicine.
Unger: Now, as you entered your presidency, of course, you were already dealing with the emergence from the pandemic. So many presidents have been having many surprises. But, of course, there's always your share as you come into that. Among those, is, I'll say, intrusions into the patient-physician relationships, sometimes even criminalization of health care. I'm curious, how do you navigate something like that?
Dr. Resneck: I am really lucky that we have our House of Delegates, and that really is the North Star because they pass the policy. We bring the whole House of Medicine together a couple of times a year, have open, transparent, evidence-based, science-based debate. And that policy really grounds us in what we do and speaks to what the profession believes and what our ethics and moral responsibilities are.
The AMA has been very consistent for some time in standing up for just how special that doctor-patient relationship is and how dangerous it is for government or courts or others to really try to intervene in that relationship between doctors and patients.
And you mentioned surprises, so sure enough, the Dobbs decision dropped the week after I was sworn in as president. And with the Supreme Court leak and everything else, we had a sense that was coming. So it wasn't a complete surprise, but certainly a big disappointment.
And in the 12 months since that time, what we have actually seen is 20 or so states around the country racing, it almost would appear, to sort of outdo each other and getting in the way of that doctor-patient relationship. So whether it's around access to reproductive health care, whether it's around care for adolescent transgender patients, just on multiple fronts we have seen states passing some laws that have really gotten in the way of evidence-based health care, doctors and patients doing the work that we do on the front lines every day, sitting down together, making difficult decisions about a patient's health. So that has been, I'd say, the biggest surprise of the year if I sort of think back a few years as to what I would expect in this year.
But I think as an organization as a whole, we have been very clear on our messaging and very consistent in our action and taking this very seriously. So whether it's arguing and collaboration with states, and especially societies in state legislatures, about why some of these things are bad ideas, whether it's about briefing and federal courts to oppose some of these laws, whether it's about communicating with the public through newspapers and TV media and social media and other routes just to explain what we're doing, and that this is not partisan for us. This is not left or right, Republican or Democrat, red or blue. Our policies, again, come back to that House of Delegates and come back to our core position that these are really decisions that ought to be made between doctors and patients.
Unger: And one of the things I think you've just been such a standout voice on topics like this or with the FDA's decisions around mifepristone is just making people aware of the broader implications of decision legislation like that. Tell us a little bit more about how you explain to people the kind of trickle-down impact on patient care and the spot that it puts doctors in.
Dr. Resneck: Well, we're lucky at the AMA, we have a tremendous number of physicians in leadership roles. It is not just the president going out there and doing that. So I'm backed up by a tremendous board of trustees. We have councils and sections within our House of Delegates. So there are a whole chorus of voices singing along and doing that explaining so that it's not all just coming from one person who happens to sit in the president's chair for the year.
So that's part of what makes this job fun and interesting is actually getting to work alongside and collaborate with all of those folks. And I think all of us have just tried to be very clear and, again, to—it's hard at a moment like in this country where these issues have gotten so politicized. But again, we try to stick with the science, to stick with the evidence, to stick with our code of ethics and be really driven by those things, and to be really clear with the public that we recognize there's a variety of viewpoints on some of these more controversial issues.
But at the end of the day, legislating medical care, legislating and putting it into statute in ways that are locked into law those difficult decisions that doctors and patients make together really is dangerous. So we've talked about a lot of downstream consequences, for example, with some of the abortion decisions. What's it going to do to medical education?
We're now seeing physicians in the last residency match actually less likely to apply to OB/GYN residencies in some of those restrictive states. Who's going to be practicing and taking care of all patients in those states in the years to come? With the mifepristone case—this is the case that came before the Supreme Court and has now bounced back down to the appeals court in the Fifth Circuit—that not only would it affect access to this one critical drug not just for abortion but for miscarriage management, but that it overturns decades of precedent which basically says, hey, the FDA is the place where we gather expertise and make decisions about science. We don't turn to one individual judge in one little district in one state to overrule all of the experts and all the science about a drug like that. So we've really worked to make that clear to the public.
Unger: Now, one thing you talked about at the beginning—we were talking about your quote—the issue around physician burnout and physician wellness has obviously been a huge theme this year. We have record rates of burnout among physicians. We have many physicians, a big chunk of them, saying, maybe I shouldn't have gone into this profession. One out of five saying they might leave the profession. This is a huge problem. How do we address this?
Dr. Resneck: The numbers are alarming. That, probably more than anything, is what has kept me up at night as president of the American Medical Association. One in five doctors saying that they're likely to leave practice or reduce their practice hours in the next couple of years. We have, I think, about two in five saying that if they had it all to do over again, they would not even choose medicine.
Those are just frightening statistics to me. And the problem is real. And I would say it's beyond burnout. Some physicians are finding themselves in what we call moral injury, where it's that upsetting to be in this position where there are things that, as I said earlier, are getting in the way of actually being able to provide the best care to your patients. So we take this really, really seriously.
And I even understand it because I felt some of those feelings myself. I still love my job. I still feel it's a huge privilege to get to go in a room and sit down with patients on the days that I get to go home and still do that as AMA president. But I really understand what physicians are going through. And there are some things that we all share. We share a love for what we do, a passion for patient care.
And we have this responsibility to our patients. I think we have a responsibility to the future of the profession to keep putting everything that we have into fixing those problems and getting those obstacles out of the way. And as I said earlier, yoga is not going to do it. This really is about fixing prior auth, fixing Medicare payment, getting states out of interfering with health care so that doctors can get back to taking care of patients.
Unger: Now, just in closing, one of the other descriptions of how you saw your role in the AMA this year is being relentless and an entity and a group of folks who are not going to back down. As you look over the past year and you think about everything that you have gone through, do you have any final thoughts as you wind down your presidency on what it's like to have served physicians this past year?
Dr. Resneck: Well, I think I said at my inauguration that I'm a pragmatic optimist, and I have a pretty good sense for the real dangers that are out there. And I don't ever sugarcoat how real those challenges are. But I am still a deep believer that those who show up and who find and use levers of power to try to fight for a better health care system and a more equitable health care system and a system that is more supportive to physicians in their everyday practice, that that is how we can bring about change and that we have to keep trying and trying to do this.
In this year, I would say that this organization, this AMA, has seeped very, very deeply into my identity and into my veins. But I'm really happy to look at Dr. Ehrenfeld, who's the president-elect who will follow me, and all of the leaders in this organization and know that it's in very good hands. We have an incredibly strong management and advocacy team, all of the people who do the work every day behind the scenes to keep fighting for doctors and to keep fighting for patients. And so I'm holding on to that pragmatic optimism.
Unger: That's so great. Dr. Resneck, it's been such an honor to work with you this year. Thank you for everything that you've done for the AMA physicians and patients. I'll look forward to continuing talking to you in your new role as immediate past president.
That's it for today's AMA Update. We'll be back soon with another segment. In the meantime, you can 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.
