Jesse M. Ehrenfeld, MD, MPH, discusses recent cyberattacks & their impact


How will the new HHS $50 million cybersecurity program help hospitals protect against ransomware? How does burnout impact the physician shortage? Is it getting worse? What is being done to remedy it? AMA President Jesse M. Ehrenfeld, MD, MPH, answers these questions and more during an appearance on MSNBC's Morning Joe.


MSNBC: The Department of Health and Human Services has announced a new $50 million program to encourage hospitals across the country to improve their cybersecurity. This comes amid an uptick in ransomware attacks against the health care industry. Just recently, Ascension, one of the nation's largest health systems, faced a significant cyber attack that knocked patients' records offline. Joining us now, the President of the American Medical Association, Dr. Jesse Ehrenfeld. Doctor, great to have you with us.

Dr. Ehrenfeld: Thanks for having me.

MSNBC: Let's start with the obvious, Want to say hello to your boys who are watching back home?

Dr. Ehrenfeld: Ethan, Asher, good to have you.

MSNBC: OK, we had to get that done for the boys. I don't think this is something most Americans are paying close attention to, but it's certainly something the health care industry has been very concerned about for some time time now. How bad is this problem of ransomware attacks, what are the implications, what are the consequences?

Dr. Ehrenfeld: We've got these one-two whammies. In February, we had Change Healthcare, UnitedHealth Care, experience a significant cyber event, and they process a third, a half of every health care transaction in the nation. Their systems are still down. I've seen five doctors the last couple of months, and none of them have been paid. Imagine the stress of trying to run a small practice, and you're not getting any revenue coming in the door. Then we have this latest issue with Ascension, where their electronic health record is down. I talked to a physician there last night who said, we have a job for you if you want to work with a hospital where you're back on paper. Imagine just trying to run a hospital with none of the systems up and running. The irony of health care in America is we've got the best doctors, we've got the best technology, the best medicines, yet, we've got this system that's on the brink of collapse because of issues like the cyberattacks. There are also challenges with Medicare payment. The Medicare system is unsustainable. 83 million Americans don't have access to a primary care doctor. And these things are weighing on physicians all across the nation, making it harder and harder to get patients access to what they need.

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MSNBC: Which is kind of amazing giving that America spends more on GDP than any other country in the world. Do we know who's behind these attacks? Is there a fear that this could become an organized state actor who decided to target the American health care system?

Dr. Ehrenfeld: I think there's a lot of concern that it may be state actors driving some of these things, but at the end of the day, we need to make sure that our systems are resilient and that we've go the tools and things in place to make sure that we can continue with continuity of operation, so that if you need to get your medicines at the pharmacy, you can actually show up. I remember the first five days of the UnitedHealthCare attack, my hospital couldn't fill prescriptions for five days. Imagine coming in for surgery, I'm an anesthesiologist, you can't walk out of the hospital without your prescriptions. It's terrible.

MSNBC: So there is a story line we followed each and every day during the height of the pandemic about doctors and nurses quitting the professions, burned out, couldn't do it anymore. And that led to a shortage particularly among physicians. Give us an update on that. Is that still the case? Is it getting worse? What is being done to remedy it?

Dr. Ehrenfeld: It's gotten a little bit better. But, it's not where it needs to be. Two out of three physicians were burned out at the height of COVID. We've seen a lot of people cut back their hours, choose to retire early. We have an aging population, but you guys know that. We've also got an aging physician work force. 45% of physicians in the U.S. are 55 and older. If you are burned out, tired, exhausted, you may make that decision that it's time to go and do something else, other than show up to see patients.

We need to support physicians and a big piece of that are underlying policy decisions, like how do we pay physicians through the Medicare program, how do we provide resources when there is a cyberattack so that things can keep going? How do we get rid of these really, really irritating problems like overused prior authorization? I feel all of you have had to fight with insurance to get things approved, get your colonoscopy done, all that kind of stuff. But, that's so frustrating. Obviously, that takes away the joy in medicine for a lot of people like me who went to medical school to put their hand on somebody's shoulder and get them through a difficult situation.

MSNBC: I am old enough to remember a time when the doctor in town or the doctor in your neighborhood drove a Cadillac and was one of the most respected figures you'd ever meet in your life. Now, you go to a hospital. If you're lucky enough to have a PCP, primary care physician, of your own, it's like being in the office of registry of motor vehicles. It's so busy. Where do we find, how do we get more primary care physicians for people and how do we get them to the point they are not taking— seeing a patient every six minutes—in order to make a living?

Dr. Ehrenfeld: We've got to expand the work force. We've had a lot more medical schools come online, which is great. We have not expanded residency training programs. So, you can go to medical school, but if you don't have a place to learn how to do your specialty, learn how to be an internist, primary care doctor, you're stuck. And actually most of the funding for residency programs is tied to Medicare. Fixed in the '90s, it has not budged significantly since that time period, and unfortunately, until there is more federal support, we're going to be in a position where we just don't have the doctors we need to take care of American patients.

MSNBC: Let's ask about artificial intelligence. For good reason, there's consternation on how it will be used, how it will be deployed in several corners of our lives. It has big benefits in the field of medicine, does it not?

Dr. Ehrenfeld: 40% of physicians are as excited as they are about AI as they are terrified. We know it's going to change medicine, it's going to change absolutely everything we do. We need to have the right guardrails, FDA process for approving AI-enabled algorithms and systems. I am excited about it. I have a background in clinical informatics. There is a lot of opportunity and we will see changes coming soon.

MSNBC: All right. The president of the American Medical Association making those boys proud back at home. Dr. Jesse Ehrenfeld. Thanks so much, doctor.

Dr. Ehrenfeld: Appreciate it.