POLITICO Q&A: American Medical Association President Jack Resneck

Resneck has also grappled over the past year with a workforce hollowed by pandemic burnout, the dilemma of whether and how to integrate AI into medicine, a wave of Covid disinformation and growing hostility to public health work.

As the mid-June end date to his one-year term as president approaches, he sat down with POLITICO to reflect on his tenure and share thoughts on how the field can adapt and rebuild after a brutal few years.

This conversation has been edited for length and clarity.

What’s top of mind as you near the end of your presidency?

People love their jobs but there are a lot of things getting in the way of what drew them to medicine in the first place — whether it’s government interference in health care, whether it’s all the disinformation they’ve had to fight back against in the last few years, whether it’s all the administrative burdens and Medicare payment issue. Frankly, it’s a lot for physicians to deal with.

But there are areas where we actually feel enthusiastic and see positive signs and momentum shifting. On Medicare payments, we’ve got a bill introduced. The news from the FDA advisory panels [on over-the-counter birth control pills] is a positive sign. We’ve got CMS dropping two rules on prior authorization that were transformative and the profession felt incredibly heard by the administration on what a burden this is for doctors and patients.

You recently wrote an op-ed about your fears that the legal challenge to FDA regulation of the abortion drug mifepristone could impact your members’ work more broadly. What specifically worries you?

The overall general assault on the doctor-patient relationship and the criminalization of health care has ended up being a rather large, unexpected piece of my presidency.

On the one hand, you have the reproductive health issue itself and mifepristone itself being a safe and effective drug that is absurdly being painted as something that it isn’t — and the implications both for medication abortions but also the management of miscarriages and all the threats and implications for public health.

And then what is getting less attention is the potential upending of the entire drug approval process that had been relatively stable for 85 years. I feel certain that if the entire Texas decision is not overturned, we could have [challenges to] contraception and vaccines and HIV drugs and cancer drugs and a whole line of other things following pretty quickly.

It’s a horrific thought, as a physician who is trying to practice medicine with things that we know work and are safe, to all of a sudden have individual judges with no medical or scientific training able to undo all of the expertise of the FDA.

Outside of the fight over the abortion pill, how else has the fall of Roe impacted your members?

In one category are the terrible impacts in restrictive states: people having to carry unwanted pregnancies, people with ectopics and miscarriages getting packed up in ambulances and sent across state lines or sent home until they get sicker, and doctors actually having to call attorneys to ask what to do next. But in the last few weeks, we also really started to see some of the downstream consequences that we predicted but are unfortunately coming to pass.

In Idaho, physicians are facing really hard decisions about having to abandon communities that they feel so connected to and so a part of because they just don’t feel like they can safely practice there anymore. Labor and delivery units in Idaho are closing and women are literally going to have to leave the state with any high risk pregnancies.

We’re also in that season of the year where medical students who have applied for residency get their match, and we’re seeing decreases of 10 percent or more [applications] in restrictive states — and that’s across the board, not just in OB.

There’s been a major uptick in physician advocacy and activism. What does that mean for the AMA? Does it change the nature of the group?

People think of us in our advocacy role in terms of the congressional and judicial litigation pieces and our work with the administration and our collaboration with state medical associations and state houses. But they don’t always think of our leadership for medical education, and the huge role the AMA has played in funding and convening medical schools around the country to reform their curricula, or our large, growing and very dedicated Center for Health Equity or our group that thinks about innovation in healthcare, the future of AI and digital health and how’s that going to happen in ways that actually advance health and help patients instead of harming patients. We depend on the involvement of grassroots physicians in addition to national leaders and each and every one of those areas.

To move forward, we need physicians to bring their background and their experience to running for local office, engaging with their school board when it’s thinking about public health policies in schools — all of those types of areas.

As you noted, doctors are working to change political debates, but the country’s political debates are also changing the medical profession. What are you seeing on that front?

The politicization of science that we have all seen in the last few years has affected us.

What we have had to do in that changing environment is relentlessly focus on science and evidence. That is our hallmark and our calling card is we always have to come back to the best science and evidence and use that as the basis of our judgment.

So, we’re engaging on gender affirming care and trans issues because there is overwhelming evidence from the medical community and from science and well done studies about the impact on trans adolescents in particular and depression rates and suicide rates. We know what makes a difference and helps our patients, so we have an ethical and moral obligation to speak up on those things.

Are you worried that physicians are losing their connection with a country that is seemingly less interested in evidence-based reasoning and more interested in politicized reasoning?

I think every physician, whether it’s from an organized medicine standpoint, or just working in their offices or hospitals every day and running into patients who have been influenced by sources of disinformation, is worried about the level of respect for science and evidence in the country. Whether it’s a politician doing it or whether it’s physicians actually being spreaders of disinformation, it’s been a wake up call. The public health community now realizes it has to fight back.

We can’t sit quietly and let these forces dominate the social media space or any other space. For example, we have to think about going all the way back to elementary and secondary education about science, and making sure we have a population that’s actually able to engage in these conversations — whether it’s about weather forecasts or the risks and benefits of any treatment or vaccine or preventative [care].

Was this month the right time to end the public health emergency?

This had to happen sometime. And it does feel like the country is in a different place.

Having an end date also meant there were some must-do things in order to protect patients, and a lot of those things have happened, including extensions for telehealth coverage for Medicare patients. But I think there are still ongoing concerns around patient access to testing, therapeutics, vaccines, etc. We need to make sure that patients who are insured continue to have access — preferably without co-pays or cuts to their deductibles — and we need good access for patients outside those coverage spaces. And then we still have a lot of questions and are doing a lot of work on [securing] ongoing federal funding for more vaccines and thinking about the next pandemic. We need public health departments actually funded and staffed and we need plans in place for future health emergencies — we continue to try to shine more light on that.

A major impact of the pandemic has been physicians burning out and leaving the field. What needs to be done to prevent shortages from getting worse?

This is what keeps me up at night as AMA president.

But there are things we can do to make a difference. I think of the workforce as a pipeline with two openings. There’s the incoming on the front end, and we have been fighting for a long time for more funding for residency positions, because even if nobody leaves medicine, we don’t have enough doctors to take care of baby boomers as they age — across primary care, specialty care, you name it.

The challenge there is that Congress does not tend to do things with an eye towards 10 or 15 years away but rather with an eye towards next week. We have to convince them that this is where they should put investment, even though it’s not going to pay off for a while.

So we have to grow more doctors, but oh my goodness, in the meantime, while we’re trying to do that and trying to get Congress to support more funding, we’re lopping off people at the back end early because they’ve gotten burnt out.

That’s part of what drives a lot of our work around [prior authorization] and it’s why we have to have Medicare payment reform.

If you look back 10 years at the focus on physician wellness, you saw health systems and hospitals offering yoga classes at lunchtime, offering free gift certificates to dinner with the CEO, and that’s lovely, but you can’t yoga your way out of severe burnout because you’re spending hours a day doing prior authorization. You can’t yoga your way out of having to let go of three of your front desk staff because Medicare payments are not adequate. So I think a lot of places get it now and are actually thinking about what obstacles need to get out of the way to actually support physicians and their work.

How do you think that the federal government should be approaching and regulating AI in health care?

There’s tremendous potential to advance health equity with AI but if you don’t start with that at the front end, we see a lot of examples of where that stuff can cause harm. As that [work] progresses, Congress may or may not have to step in.

What we don’t want, what would be a bad outcome, is to have a few spectacular failures of very hyped tools that end up leading Congress or others to just shut this whole thing down.

So we’re not being fuddy-duddies about AI. We’re pretty darn excited about it. But we think doing that homework at the front end to actually make sure that we mitigate the risks and have transparency will help us to avoid that outcome.

Source:Politico