Throughout his address at the opening session of the 2024 AMA Interim Meeting, Bruce A. Scott, MD, recounted the stories he has heard from colleagues about the struggles of practicing medicine in a broken health care system.
Days after his inauguration as the AMA’s 179th president in June, Dr. Scott met with a physician for a consult who vented about falling pay, rising administrative burdens and feeling powerless against insurance companies. When Dr. Scott asked if he was an AMA member, the physician said he quit years ago, disillusioned by something he read about the organization.
“Ignoring all my media training, I said back to him, ‘Well, the first step to fix it is for you to join, so we can fix it—together.” Dr. Scott told the AMA House of Delegates (read the full speech). “Thankfully, the people here in this room know that the work to fix what’s broken in health care belongs to each of us, and to all of us.”
Read the “AMA Advocacy Impact Report 2024” (PDF) to learn how the AMA is fighting for physicians now.
Turning the tide on physician shortages
The statistics about attrition in the profession are alarming. Among them: one in five physicians hope to leave their practice in the next two years; one in three plan to reduce their hours; and 40% of medical students are unsure they ever want to enter clinical practice.
In a poignant moment, Dr. Scott read a letter a colleague sent to patients when they decided to close their ob-gyn practice. The physician expressed gratitude for the trust that patients had placed in them and sadness for the circumstances causing the practice’s closure. Those circumstances—the difficulties and financial pressures that come with running an independent medical practice—are hardly unique, Dr. Scott said.
“We cannot afford to lose even one more doctor,” said Dr. Scott, an otolaryngologist and head-and-neck surgeon in private practice in Louisville, Kentucky. ““This letter broke my heart. But the financial strains and reality expressed in this letter have become all too common.”
Dr. Scott touted the AMA’s work on physician payment reform as a measure to help stem the tide of physicians leaving the profession.
Since 2001, Medicare payment to physicians declined (PDF) 29% after accounting for the effects of inflation in medical practice costs. This also affects Medicaid, which in most states is tied to Medicare rates. Aware of the decadeslong spiral in Medicare payments, private payers often tie their physician contracts to the Medicare payment schedule.
“This puts us in an impossible position,” Dr. Scott. “Either turn away patients, or reduce our hours, or close our doors for good. And in each of these scenarios, it’s our patients who suffer, particularly our nation’s elderly and disabled persons.
“This is why Medicare payment reform has been the AMA’s top advocacy priority, and why it will continue to be until meaningful reforms are achieved.”
The AMA is leading the charge to reform the Medicare payment system. Following AMA advocacy, a bipartisan group of House members in late October introduced the Medicare Patient Access and Practice Sustainability Act of 2024. The measure would eliminate the 2.8% cut for 2025 and provide an update based upon the inflationary cost of practicing medicine. Dr. Scott urged Congressional action in the upcoming lame duck session.
“Make no mistake, this is going to be an uphill battle,” he said. “But I believe that with the unified voice of physicians from across the country, from every state and specialty—together, we can fix it.”
Removing obstacles to care
The AMA also is fighting to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles. Dr. Scott championed the AMA’s efforts on the issue, which have resulted in more than two dozen prior authorization reform bills enacted in states since 2023. Broadly, those bills seek to streamline patient care, decrease the volume of prior authorization requirements, reduce delays in patient care, improve transparency and increase reporting of prior authorization data.
“On a federal level, when we couldn’t get Congress to fix it, we went straight to CMS,” he said, referencing the Centers for Medicare & Medicaid Services. “And our advocacy was instrumental in a CMS final rule for 2024 for government-regulated health plans to reduce the timeframes for prior authorization decisions, to improve transparency, and for payers to move beyond fax machines. Congress is finally hearing our message.”
Fighting for Physicians
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In addition, the AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety.
As Dr. Scott noted, patients prefer being treated by a physician and data indicates that nonphysician providers use more resources, overprescribe antibiotics and opioids, and order unnecessary diagnostic tests and imaging. The AMA has been instrumental in defeating more than 80 bills related to scope of practice in 2024.
“Let’s be clear: changing your name from physician assistant to physician associate does not mean that you went to medical school,” Dr. Scott said.
In his concluding remarks, Dr. Scott touched on a second interaction he had with that physician consultant who had quit the AMA years earlier. After speaking with Dr. Scott and doing some research, the doctor recognized that the AMA was, indeed, fighting for the profession. He proudly showed off his AMA membership card.
“This work, to advocate for our profession, for our patients, belongs to all of us,” Dr. Scott said. “To all of you. To all in our profession.
“At my first AMA meeting, I saw the power that physicians have when we come together as a unified body. All these years later I still believe the AMA makes a difference for our patients and our profession. I still believe in the power of a unified profession. I still believe it because I have seen our advocacy in action. I have seen the results. I truly believe that together we can fix it.”
Read about the other highlights from the 2024 AMA Interim Meeting.
