CHICAGO — American Medical Association (AMA) President Jesse M. Ehrenfeld., MD, MPH, today delivered the final speech of his presidency to the AMA House of Delegates, offering a stark assessment of a health system in crisis, while vowing continued AMA advocacy for Medicare reform, reduced prior authorization burdens, and extension of telehealth policies.

Dr. Ehrenfeld, an anesthesiologist from Milwaukee, highlighted those and other challenges as immediate threats to the physician workforce and health care access at a time of a national physician shortage. He also touted significant AMA accomplishments achieved over the past year including: major insurers reducing the volume of their prior authorization requirements; CMS issuing a final rule to change the prior authorization process for government-regulated health plans; a drop in drug overdose deaths for the first time in five years; and the defeat of more than 100 dangerous state-level bills that would have expanded scope of practice by nonphysicians.

“Reforming our broken Medicare payment system that punishes doctors for being doctors is why we fight,” Dr. Ehrenfeld said in remarks as prepared for delivery. “Medicare reimbursement has plummeted 29 percent since I was in medical school. 29 percent, and that’s after the AMA was able to claw back half of the planned cuts for 2024.

“Medicare reform is our top advocacy priority because it’s crippling the sustainability of physician practices, threatening patient access to care, and choking the pipeline for future physicians.

“I am proud to stand here before this House to tell you that momentum is shifting toward significant reform. And we are changing the conversation. Thanks to our AMA’s comprehensive Fix Medicare Now campaign, multiple hearings, media visibility, and our extremely persistent lobbying efforts, there is now broad acceptance that the current Medicare payment models don’t work. And there is growing support in Congress for Medicare reforms aligned with AMA’s models that seek to put physicians on equal footing with all other health care providers.

“We are keeping the pressure on because our current system is unsustainable and because physicians shouldn’t have to worry about how they’ll keep the lights on.”

Dr. Ehrenfeld’s year as AMA President ends on Tuesday, June 11, when he will become immediate past president of the organization.

His remarks as prepared for delivery are below.

Why We Fight

Dr. Speaker, Dr. Vice Speaker, Members of the Board, delegates, colleagues, and guests.

It’s my honor to be with you this evening and to address this House for the last time as your AMA president.

On inauguration night, one year ago, I took the oath of office fully aware of the privilege and responsibility that comes with a high-profile position like this one.

The responsibility to speak out against injustices that our patients and fellow physicians face.

The responsibility to stand up for science and the high ethical standards of our profession.

The responsibility to give voice to the everyday challenges physicians are experiencing, helping lead us to a better health care system that is more inclusive, more sustainable, and that better supports the needs of physicians so that we can take the best possible care of our patients.

This all sounds simple enough when I say it out loud, but work of this importance comes with incredible personal costs that I didn’t fully appreciate when I began this role. Late night meetings. Extended travel itineraries crisscrossing time zones and continents. Interminable flight delays. Nearly constant airport food. Prepping for interviews, podcasts, radio, reporter roundtables, live television appearances. Time away from home, my patients, and my practice measured in weeks, not hours.

These kinds of demands would take a toll on anyone, but when you’re a husband and a father to a 5-year-old and a 17-month-old, the weight of your decisions are magnified.

One night, after tucking my eldest son Ethan into bed, I let him know that I’d be on a plane later that evening and would miss breakfast the next morning. He turned to me and asked, “Why do you have to be AMA president?”

Every person in this room knows that a question like that from a child cuts through the heart. But it wasn’t the first time in our home that the question had been asked. Before deciding to run for this office, my husband Judd and I had conversations where we asked ourselves, “Why do this now?”

It's a question perhaps many of you have asked yourselves over the years as you’ve juggled your work and home responsibilities with this difficult job of physician advocate—a job that seems to get more complicated and challenging with each passing year.

For me, I keep coming back to the same answer: This moment in health care demands my attention—this is my fight.

This moment in health care demands all of our attention. It is all of our fight.

The stakes are high.

The risks to patients are growing.

The demands on physicians are unrelenting.

The world around us is mired in uncertainty, misinformation and mistrust.

And so, we summon our strength and speak out. We use our voice. We lean on one another for support and encouragement.

We fight for what we know is right.

A better health care system.

A more accessible health care system.

A more equitable health care system.

A more financially sustainable health care system.

I will take one more flight if it means unburdening physicians from the administrative headaches that are driving burnout and early retirements.

I’ll keynote one more conference if it means technology innovators have a greater understanding of what physicians need so that they design smarter digital tools that actually improve health and make our jobs easier.

I’ll take one more meeting on Capitol Hill if it means my husband and I and our boys and other LGBTQ+ families can get the health care we need in a system free from bias, stigma and discrimination.

I do this work—every one of us in this room does this work—because the future of our profession and our nation’s health cannot be left to chance.

This is why we fight.

Last fall, after we gathered for the Interim Meeting at National Harbor, I had the opportunity to fly to Greensboro, North Carolina, to meet with the Old North State Medical Society—one of the oldest medical societies for Black physicians in the United States.

Their work began in the years after the Civil War, spanned the Reconstruction period, Jim Crow, and the 1960s Civil Rights Era—and continues to this day.

I was invited to visit with them, meet their leaders, and deliver an address about our AMA’s work to advance equity and social justice in medicine.

I was honored by their invitation, but our AMA’s long and well-documented history of exclusion and discrimination weighed heavily on my mind. It’s why Black physicians created organizations like Old North State in the first place.

For much of our history, our AMA wouldn’t have received an invitation like this … and, if we had we would not have had much to say.

But on that crisp fall afternoon we had meaningful improvement to discuss. An update on our deep work to help solve long standing health inequities, address determinants of health, create pathways for a more diverse physician workforce, ensure that medical devices and technologies work for all patients, and the steps we’re taking to right past wrongs of our organization.

This spring, I was invited to meet with leaders from HHS, the Department of Labor, and the Treasury to share AMA views about a proposed rule that will finally end a 16-year battle with insurance companies who have failed to comply with the landmark 2008 mental health parity law.

More than a decade after final regulations were released, patients are still nine times more likely to have to go out of network for mental health, behavioral health or substance use treatment than for medical or surgical services. This is not mental health parity. And despite the efforts of the last two administrations, the health plans have flagrantly flouted the rules and compliance with little to no consequence.

A new rule will finally put some teeth into this law— and make it much easier for patients to access the mental health care they need and for physicians to be appropriately compensated for the care they provide.

On another day in New Orleans at the Uniformed Services Academy of Family Physicians, I spoke to hundreds of active-duty physicians about how our AMA was fighting drastic cuts to military medical personnel that could negatively impact military families, readiness, and national security.

Last fall, after the FDA lifted its ban on gay men donating blood—something our AMA had advocated for over many years—Judd and I made our first lifesaving donations … marking an important end to a hurtful and discriminatory practice.

On Match Day in March, I spoke to graduating medical students at Harvard at a time of heightened tensions over global events, challenging them to use their voice for good, in service to their patients and humanity.

And just yesterday, I was in the Oval Office at the White House, meeting with senior administration officials about how health systems must step forward to address the public health crisis of gun violence…a conversation that the AMA has been critical in advancing.

On these occasions – and so many others throughout my presidency – I was reminded of the importance of showing up. Of taking risks.

Of engaging in difficult conversations.

Of telling our story …. sharing our vision as dictated by the policies of this House.

That’s the power of what we do.

I show up.

You show up.

We show up.

In all the ways that matter to patients and physicians – the AMA shows up.

That is our mission.

I began my presidency talking about the important ways the AMA has evolved since I was a medical student —becoming a more inclusive organization and courageous ally to many, including myself, who faced prejudice or discrimination simply because of who they are, where they were born, or what they believe in. I am so proud of the AMA’s growth, and to have had a hand in helping us change for the better.

We still have consequential work ahead of us—barriers to break down, inequities to erase, and shared priorities to advance. Although the pace of change can be frustratingly slow, I want to assure you tonight that we are making meaningful progress and we are being recognized for lending our powerful voice to the cause of equity and justice.

Diversity as a concept, and people from different backgrounds in specific, are under attack: here in the United States, and around the world from extremist groups and movements that are surging in popularity.

Extremism, oppression, and discrimination including antisemitism which I have personally been the target of, are antithetical to the values of the medical profession and our AMA must always stand up for democracy, pluralism, equity and human rights.

This work is an essential part of who we are as physicians, and what we are as an organization.

We continue to follow the science and evidence, explore new ideas, move in new directions, right past wrongs.

We lead with ethics and our values. We advocate for patient-centered design in new technology.

We’re defining the guardrails for safe and effective health AI and innovation.

We’re developing strategies to revolutionize medical education and training … defending patient and physician autonomy … and speaking out against medical discrimination.

As our nation continues to grapple with the drug overdose epidemic, our AMA is showing up to change policies and save lives. And last year, we saw a drop in overdose deaths for the first time in five years… a welcome sign of progress in this long and deadly battle.

When one of the nation’s largest health insurers was suddenly hit by a cyberattack, and the process to submit health care claims for reimbursement was frozen, physicians were lost and didn’t know where to turn.

Once more, our AMA showed up … creating resources for physicians desperate for information while pushing federal agencies and insurance companies to take immediate action to solve the payment debacle.

This is why we fight.

We do more than just combat problems, we also drive the change we are striving to create.

AMA recognized 72 hospitals and health systems through our Joy in Medicine program last year, creating an unmatched understanding of best practices and solutions to solve the burnout crisis that health systems across the country can learn from and implement.

Solving the crisis of physician burnout and ensuring that medicine remains a highly desired profession is why we fight.

Reforming our broken Medicare payment system that punishes doctors for being doctors is why we fight.

Medicare reimbursement has plummeted 29 percent since I was in medical school. 29 percent, and that’s after the AMA was able to claw back half of the planned cuts for 2024.

Medicare reform is our top advocacy priority because it’s crippling the sustainability of physician practices, threatening patient access to care, and choking the pipeline for future physicians.

I am proud to stand here before this House to tell you that momentum is shifting toward significant reform. And we are changing the conversation. Thanks to our AMA’s comprehensive Fix Medicare Now campaign, multiple hearings, media visibility, and our extremely persistent lobbying efforts, there is now broad acceptance that the current Medicare payment models don’t work. And there is growing support in Congress for Medicare reforms aligned with AMA’s models that seek to put physicians on equal footing with all other health care providers.

We are keeping the pressure on because our current system is unsustainable … and because physicians shouldn’t have to worry about how they’ll keep the lights on.

Protecting our patients from unsafe scope of practice expansions by nonphysicians is why we fight.

These bills are relentless—optometrists seeking to perform eye surgery … naturopaths pushing for the authority to prescribe medication. Our AMA helped defeat more than 100 of these outrageous scope bills last year, and dozens so far in 2024.

We know that scope expansion directly impacts our most vulnerable patients, including my fellow veterans, which is why I testified in a Congressional hearing on veterans’ affairs to discuss how these expansions threaten the quality of care that our veterans, my shipmates, and I receive.

Our patients’ health is why we fight.

Eliminating physician busywork is why we fight.

We all have horror stories to share about the overused prior authorization process that results in delay after delay until, too often, patients give up and abandon necessary testing and treatments altogether. We as physicians and the patients we serve deserve better.

That’s why we welcomed news last year that United Healthcare and Cigna each reduced the volume of their prior authorization requirements by at least 20 percent … and why we celebrated a CMS final rule that makes long-overdue changes to the prior authorization process for government-regulated health plans and reduces decision times.

These changes will save physician practices and our health care system an estimated $15 billion over the next 10 years—never mind the countless hours and incalculable frustration of physicians and our patients. This simply would not have happened without AMA advocacy.

Lately some of our country’s largest chain stores and pharmacy retailers have decided to scale back—or end entirely—their experiments in health care by closing many of their walk-in clinics.

Despite their stated goal of expanding health care access to patients with limited options, these corporations were unable to create a health care model that was financially viable. And now, their closures are creating gaps in care for thousands of patients who came to rely on them.

Think about that. These are some of the largest, for-profit companies in the world, and they can’t make today’s primary health care model sustainable.

If they can’t make it work, how can we possibly expect physicians to?

That’s a challenge I will continue to prioritize as I leave the presidency.

How can we make the practice of medicine sustainable? How can we ensure access to care? How can we continue to recruit and support the best and brightest into medicine?

This is why we fight.

Our families are why we fight.

Our patients are why we fight.

Our colleagues and our profession are why we fight.

And why we’re going to keep fighting until this work is done.

Thank you for the honor and the privilege of serving as your AMA president.