AMA Members Are 'Leaders Among Leaders' Says New President

June 13, 2016

CHICAGO, Illinois — Hand surgeon Andrew Gurman, MD, plays the flute and bassoon occasionally, and when he is closing a surgery, he will often sing along to whatever music he plays in the operating room. It could be opera. Or it could be a song performed by a Tibetan Buddhist nun.

"Sometimes my patients sing, too, which is really quite interesting," said Dr Gurman, who has a solo practice in Altoona, Pennsylvania.

On Tuesday, Dr Gurman becomes an orchestra conductor of sorts when he is inaugurated president of the American Medical Association (AMA) at its annual meeting being held here, which began June 11. The post represents the climax of a long climb in professional leadership for a physician who was elected president of his class at State University of New York Upstate Medical University. He has served as the president of his local county medical society and vice speaker and speaker for both the Pennsylvania Medical Society House of Delegates and its counterpart at the AMA level. For the past 12 months, he has been the AMA's president-elect.

Dr Andrew Gurman. Source: American Medical Association

Dr Gurman's known for his wit, which he says has helped him wield the speaker's gavel at the House of Delegates.

"I have a pretty good talent for presiding over deliberative assemblies," he told Medscape Medical News. "It requires a certain balance of knowledge of parliamentary procedure, a sense of where the House wants to go, and a little bit of zaniness or sense of humor to lighten the touch when you need to do that."

At the start of the annual meeting, Dr Gurman sat down with Medscape Medical News to talk about the challenges facing medicine, the value of the AMA in a time of professional crisis, and what he brings to his new job.

Medscape: Who are your role models for leadership? And why do you admire them?

Dr Gurman: I seem to admire people who had vision. Particularly, vision of things that did not yet exist. Abraham Lincoln envisioned a world without slavery. Ludwig von Beethoven envisioned the playing of music that the technology did not exist for at the time that he wrote it. Beethoven's fifth piano concerto cannot be played on the pianos of Beethoven's time. And yet, he had the vision to write the music anyway. I am absolutely taken by that.

Medscape: How do you apply that notion to the AMA? It's one thing to be a caretaker of the AMA, but what about envisioning something that doesn't exist right now?

Dr Gurman: Absolutely. We are in a world that is changing so rapidly that part of the AMA's job is to help physicians cope with those changes and adapt to the world that doesn't exist today, but will exist tomorrow.

Think about the advances in medicine — genomics, molecular understanding of disease, the ability to tailor therapies based on a patient's genetics. It's not just cancer, although that's the thing that pops to mind, but even things like anticoagulation, warfarin. It turns out that different people handle it differently, and you can identify that by doing a test to see, genetically, how they're going to respond. That helps you tailor dosage.

Medscape: What do you see as the most important issues that the House of Delegates is going to vote on this year?

Dr Gurman: Gosh, there is such a broad book of business for this House. I won't speculate because I have been a miserable handicapper in the past. Let me say this: I think that the two biggest issues in terms of public health that are facing us right now are opioids — prescription drug diversion and overdose — and MACRA [the Medicare Access and CHIPS Reauthorization Act] and its effects on patient care.

Medscape: I was going to ask you about MACRA. Have you heard of Dr John Halamka?

Dr Gurman: No, I haven't.

Medscape: He's the chief information officer at Beth Israel Deaconess Medical Center and a professor of medicine at Harvard Medical School. He wrote in his blog that the 962 pages of MACRA are "so overwhelmingly complex that no mere human will be able to understand them," and that "it's time to leave the profession if we stay on the current trajectory," This is a guy who is used to a lot of complexity, and he was throwing up his hands at MACRA. Is MACRA another case of good intentions but bad regulations?

Dr Gurman: At this point, the final rules on MACRA have yet to be written. So it may be premature to say that. The AMA has been very heavily engaged on behalf of physicians and on behalf of patients in understanding those 962 pages.

But you bring up a very important subject, and that is burnout. There are a number of specialties who have had [a] dramatic — meaning more than 10% — increase in burnout rates from 2011 to 2014. Urology, physical medicine, and rehab have had burnout rates of 63%; radiology, 61%; orthopaedic surgery, 59%. That's really terrible.

Medscape: What is the thing that worries you the most about the medical profession? I guess the burnout rate would be up there.

Dr Gurman: My worry is that the fundamentals of the doctor–patient relationship are under tremendous stress. I worry that the role of healer — what brought me to medicine and brings a lot of people to medicine — is taking on a very, very different role. I didn't go into medicine to be a data entry clerk. I didn't go into medicine to be an administrator. I didn't go into medicine to be a data collector, although data collection on behalf of research and quality improvement is certainly important. I went into medicine because I wanted to help people. Because I get a real charge out of making somebody better. In fact, we did a study with RAND, actually two studies, and the single take-home message is that what makes doctors feel good is making people feel better.

Medscape: And what is standing in the way of that?

Dr Gurman: Paperwork. Regulation requirements. Financial pressures. Administrative pressures.

Medscape: What about doctors who criticize the AMA for supporting the Affordable Care Act (ACA)? What do you say to those who argue that instead of protecting them from this law, the AMA sold them down the river? How do you win those people over?

Dr Gurman: The first part of the answer is that the data are, and were, incontrovertibly clear — people who have no health insurance live sicker and die younger. Everyone involved in this discussion accepts those data as real. The ACA was a vehicle — admittedly flawed — to provide insurance for people so that they would not necessarily live sicker and die younger. As a physician, how could you walk away from that? How could you not support that?

The second part of the answer is, remember, this was a process that unfolded over time. I would submit [that] most people, had they known the information that I knew when I knew it, would have decided to support it the same way I did. I also admit that there are some people who are philosophically and ideologically opposed to the notion of all of this. I respect that. We will have to simply agree to disagree. But I think that's a very small minority of the people that I talk to.

The third part of the answer is that the process that gave rise to this legislation was incredibly flawed and incredibly stressed. This was superimposed upon a bitter partisan divide in Congress. There was political calculus made to pass the Senate bill, which is what became the Affordable Care Act. People have to understand the way in which this was birthed.

The fourth part of the answer is, remember that Medicare, which was a sweeping piece of legislation, is 50 years old, and we are still tinkering with it. So the notion that the Affordable Care Act could be birthed whole, mature, and ready to take its college boards, is just naive.

Medscape: The AMA used to have more than 50% of practicing physicians beyond residency in its paid membership. Now the number is roughly 20%. Do you think the AMA can get above 50% again, and is that still important?

Dr Gurman: When the AMA had 50% or 60%, the environment was much different. To practice in hospitals, you had to be an AMA member.

Medscape: So hospitals required it to be on staff?

Dr Gurman: At one time that was the milieu. What does the AMA do? The AMA advocates on behalf of all physicians, whether they are members or not, and it does so based on the policy formulated by the House of Delegates. The House of Delegates is made up of 185 different geographic and specialty groups. Every physician in this country, essentially, is represented in the House of Delegates by at least one group. I am represented by six: Pennsylvania Medical Society, American College of Surgeons, The American Academy of Orthopaedic Surgeons, The American Orthopaedic Association, and then we jokingly say the right-hand society and the left-hand society — there is the American Association of Hand Surgery and the American Society for Surgery of the Hand.

But the point is that whether you are an AMA member or not, first of all, what the AMA does is incredibly important to you and incredibly important to your practice. And you have a hand in directly informing what the AMA does by virtue of your membership in your geographic society or your specialty society. If you're in the armed forces or the public health service, they have a delegate as well. So there are lots of avenues into the AMA house.

Medscape: How does the AMA or any kind of medical society appeal to young, hospital-employed physicians who have a different set of priorities than a solo practitioner or owner in a group?

Dr Gurman: We have a set of resources targeted toward their needs, which are available through the AMA website, through our AMA membership department. We also have a new section within our House of Delegates called the Integrated Physician Practice Section, which represents the concerns of those who are employed by the large hospital systems.

Medscape: Medscape has hundreds of thousands of physician readers, most of whom don't belong to the AMA. There's an active cadre of commenters who are always flagellating the AMA for not protecting them from all the things that ail medicine. Others are apathetic and don't have much to say. For this varied audience, what would you want to pass on to them?

Dr Gurman: I would summarize as follows. First of all, the AMA is doing a tremendous amount of work on their behalf. This is not the AMA from 20 years ago or even 10 years ago, or even 5 years ago. The AMA is working in three strategic focus areas in very exciting ways. Public health, particularly in the areas of diabetes and hypertension. So that's improving health outcomes. We are working to create the medical school of the future — the second focus area is transforming medical education. The third is in physician satisfaction and practice sustainability.

I think all physicians are leaders, but AMA members are leaders among leaders because they have chosen to engage in the process and put their shoulder to the grindstone to try to make the profession better. To those out there who are of the opinion that we are not representing them, lend us your voice. Tell us why. Let us tell you what we truly are doing. Andrew.Gurman@ama-assn.org. That's my email address.

Follow me on Twitter @LowesRobert

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