Q&A With New American Medical Association President

By Christopher Cheney

Physicians are facing many challenges, including the fallout from a long pandemic, barriers to care, Medicare reimbursement cuts, and workforce shortages, says Jesse Ehrenfeld, MD, MPH, the new president of the American Medical Association.

Ehrenfeld, a practicing anesthesiologist in Wisconsin, was inaugurated as the 178th president of the AMA last week. He succeeded Jack Resneck Jr., MD.

This week, HealthLeaders talked with Ehrenfeld about a range of issues, including the top priorities of his AMA presidency, health equity, and physician shortages. The following transcript of that conversation has been lightly edited for clarity and brevity.

HealthLeaders: What are the top priorities for your AMA presidency?

Jesse Ehrenfeld: After three long years of dealing with the coronavirus pandemic, people are burned out in a lot of jobs but especially those of us who work in healthcare. We have had the COVID pandemic and a pandemic of bad information. Doctors and nurses have an important job to keep people healthy, but we have a healthcare system that is in crisis.

There are many barriers to care. We have insurance companies that are denying necessary care for patients. We have workforce issues where many doctors are saying they are going to reduce their hours or retire. We have Medicare cuts that are threatening the viability of practices. And, increasingly, we have legislators who are trying to impact the practice of medicine through acts that are being passed across the country.

We have to make sure that we can support physicians in recovering from the pandemic, and that is why the AMA adopted the Recovery Plan for America’s Physicians. It is our top priority to make sure we are committed to rebuilding the nation’s healthcare system.

HL: What are the top threats in the medical profession?

Ehrenfeld: We have real challenges around physician burnout. We have a Medicare payment system that is unsustainable and threatens healthcare access for seniors. We continue to have threats to safe care through the inappropriate expansion of scope of practice. We have real challenges around administrative hassles such as prior authorization, which places burdens on patients and practices as well as creates delays in care for individual patients. Those are the things that are continuing to threaten how we keep Americans healthy.

HL: What are some of the primary steps that need to be taken to advance health equity?

Ehrenfeld: Health equity is a priority for the AMA. Certainly, as we look at how care is delivered, we recognize there is much more that we need to do. As the first openly gay person to hold the office of AMA president, issues of LGBTQ health and equity are close to my heart and have long been a focus of my work in medicine.

The AMA continues to push forward a lot of work in this area. We need to make sure care is advanced in ways that eliminates longstanding inequities and improves outcomes for patients who have been historically marginalized. It requires us to address structural racism in the healthcare system. It requires us to equip physicians with the knowledge and the tools to confront health inequities and advance health equity across all aspects of the healthcare system.

There are important cases before the U.S. Supreme Court that likely will be decided this month, including the consideration of race in higher education admissions that will include medical schools. We have concerns about limiting the ability to consider race as a factor in admissions to colleges and medical schools, which could affect the ability to have a diverse physician workforce that we know impacts patient outcomes.

HL: How do you feel about being the first openly gay person to serve as AMA president?

Ehrenfeld: It is an exciting moment for the AMA. I know there are people in the country who are struggling because they happen to be gay or identify as LGBTQ, and I hope the visibility that I bring to my leadership of the AMA—the nation’s oldest and most influential physician group—can give these people some hope and sense of possibility. I want to make sure that all patients can get the healthcare that they need, but that is only going to be possible if physicians and patients are able to make decisions together without the interference of lawmakers telling us how to do our jobs and second-guessing the science behind medicine.

HL: By multiple accounts, the labor market for physicians is tighter than ever. What can be done to reduce physician shortages?

Ehrenfeld: We need to make sure that we can expand the physician workforce. There are steps that we have long advocated for to expand the number of training slots particularly at the graduate medical education level as well as the expansion of medical school classes. These are important advocacy points at the AMA to make sure that we have the physician workforce that can meet the needs of our patients.

The AMA has invested significantly in our accelerating change in medical education portfolio of programs and grants over the past decade. We are trying to not only expand the workforce but also to transform how we train doctors today to make sure they can take care of patients tomorrow.

HL: Can physician assistants and nurse practitioners help address physician shortages?

Ehrenfeld: Absolutely! We strongly support physician-led, team-based care. Each team member has unique knowledge and makes valuable contributions to enhance patient outcomes. I experience this every week when I put on scrubs and go into an operating room to work with nurse anesthetists and anesthesia assistants.

However, it is important to point out that nurse practitioners and physician assistants, while valuable members of the team, are not a replacement for physicians and never will be. Removing physicians from a care team only results in higher costs and lower quality of care.

HL: What can be done to address physician burnout and mental health conditions among physicians?

Ehrenfeld: Unfortunately, we are at a crisis point. There continues to be stigma around accessing mental health services for physicians. Following the passage of the Dr. Lorna Breen Health Care Provider Protection Act last year, which is a bill we strongly supported, we continue to push for regulatory and legislative solutions to make sure we can direct more resources and more funding to support the mental health needs of physicians.

It is important to point out that the fundamental cause of physician burnout is not individual physicians having failures. It is working in a system that is ill-equipped to support the practice of medicine, and we need to have reform at the system level. We need to reduce burdens such as prior authorization and other administrative hassles that do not add value to what we do as care providers. We need to make it more enjoyable to practice medicine to reduce the burnout that people are experiencing.

HL: Are there things that health systems, hospitals, and physician practices can be doing to reduce physician burnout?

Ehrenfeld: Absolutely! The AMA has resources that can help health systems, hospitals, and practices address burnout. They can change workflows. They can reimagine how work is performed to better leverage tools and technologies. They can get physicians back in front of patients and reduce the amount of time they are doing administrative tasks.

HL: In your inaugural address, you said you embraced optimism regarding the challenges facing the medical profession. Why are you an optimist about these challenges?

Ehrenfeld: There are a lot of challenges, but I have seen physicians across the nation step up in incredible ways over the past three years in spite of the challenges and unbelievably difficult circumstances. They have been on the frontlines, working day in and day out to keep people healthy and to save lives. Among the residents and the medical students I work with, I see optimism and enthusiasm.

At the AMA, I know we can have an impact. I know that we can make things better for all Americans, and I look forward to leading the AMA over the next year.

Despite our healthcare system being in crisis and despite so many of my colleagues being at their breaking point, I am optimistic about the future. We can get this right.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.