Each November, the American Medical Association (AMA) Interim Meeting of the House of Delegates is held. The House of Delegates is a policy and legislative body comprising nearly 500 elected physicians. The House of Delegates nvenes under one roof with delegates from each state and specialty society to discuss the direction of medicine and medical advocacy for the coming six months. The following topics were at the forefront of negotiations at this meeting in November 2023.
Medicare
“Fix Medicare Now” was the anthem that rang out through the halls of the AMA House of Delegates upon calling to session the interim AMA meeting. Physicians were facing an additional 3.37% cut in pay after already being cut 2% this past year. AMA President Jesse M. Ehrenfeld, M.D., M.P.H., stated, “The payment system year after year inflicts harm on the ability of physician practices to stay afloat. We also are aware of the First Law of Holes. When you find yourself in one, stop digging. We are in a veritable crater. Cutting payments is only taking us deeper.” Since 2001, physician pay has fallen by 26%, an unprecedented amount that most any other profession would simply not be able to survive. Medicare pay cuts will decrease reimbursements and only increase this gap. This message will be central to the advocacy work in Washington, D.C., during this coming year.
Clinical Trials
Physicians voted at the meeting to “allow out-of-network referral of patients with Medicare Advantage for the purpose of consultation for enrollment in a clinical trial, require covering plans to pay for such consultations, and that these consultations be considered administratively as participation in a clinical trial.” What this means is that patients who are covered under Medicare will be able to participate in clinical trials without undue burden to themselves. This is not only a step forward for physicians but also their patients.
Physician Burnout
Physician burnout was addressed two ways during this meeting by adding one layer of protection to the medical students, and a separate layer for residents and fellows. Discussions centered around the fact that not all medical schools or residency programs have defined parental leave policies, leaving some individuals without a plan. The new policy calls for all medical schools and residency programs to have “flexible, clear, equitable compassionate-leave policies.” The policy encourages 12 weeks of paid parental, family and medical leave within any 12-month period.
Artificial Intelligence
Don Cinotti, M.D., spoke for the section of ophthalmology regarding artificial intelligence and its potentially inappropriate use in providing medical advice. For example, “If you ask [an AI bot]” ‘I have glaucoma; I have cataracts or eye disease, who should I see?’ the answer comes back as optometrist.” The AI-generated answer is incorrect and can lead to confusion among patients in seeking care. This statement is only one example. Using AI in medical contexts can be dangerous and inaccurate, and inaccurate descriptions of health professionals’ roles and responsibilities perpetuates confusion and delayed care, and weakens the health care provider and patient relationship. The Section of Ophthalmology used this as an opportunity to demonstrate the inaccuracies of AI and their consequences.
Health care administrators have slowly gained power in the health care system over the past decade. The AMA has long held the stance that physicians who take an oath of “do no harm” remain autonomous in their decision-making to allow them to act in the best interest of their patients to ensure high-quality care. The AMA code of ethics emphasizes the importance of the physician-patient relationship to maintain the welfare and health of the patient. However, according to a report put forth by the AMA Board of Trustees, the growth of positions for health care administrators has surpassed the growth of physicians. David H. Aizuss, M.D., stated, “Traditional physician autonomy in patient care is now being influenced by pressures motivated by cost versus high-quality patient care.” The key concern here is that the decision-makers in medicine are shifting from physicians to administrators who lack the physician-patient relationship. The report stated that the AMA should “strongly oppose any encroachment of administrators upon the medical decision-making of attending physicians that is not in the best interest of patients.” This statement demonstrates the AMA’s continued commitment to maintaining an untainted physician-patient relationship that will continue to maintain patient care as the highest priority.
The AMA Interim Meeting held discussion on these topics and many more that will direct medicine throughout the next six months and allow for medicine to continue to move forward. Debate, discussion and passion continue to be the centerpiece of each AMA meeting. You can find more information about the AMA and its efforts at ama-assn.org.
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