In his first speech as the newly inaugurated president of the American Medical Association, Jesse Ehrenfeld, M.D., M.P.H., chose to highlight the importance of the AMA’s increasing focus on health equity.
Ehrenfeld is a senior associate dean, tenured professor of anesthesiology and director of the “Advancing a Healthier Wisconsin Endowment” at the Medical College of Wisconsin. He also has an appointment as an adjunct professor of anesthesiology and health policy at Vanderbilt University in Nashville, Tenn., and as an adjunct professor of surgery at the Uniformed Services University of the Health Sciences in Bethesda, Md.
Ehrenfeld began his address to the AMA meeting by telling the story of his son Ethan, who needed a blood transfusion when he was just a few weeks old. The new AMA president said he “was struck by the painful reality that, even though I was a physician and now, a father … neither I, nor my husband, could donate blood – simply because we are gay. Discriminatory policies – policies rooted in stigma, not science – barred us from doing the most humane of acts, donating our blood. Thankfully, Ethan got the blood he needed. But that feeling of helplessness lingered with me for some time. I tell this story because I want people to understand what we mean when we talk about inequities and injustices in medicine.”
He noted that this was just one of many experiences he and his husband have had with health inequities. “I know that too many of my colleagues and too many of the patients we care for also suffer from discrimination and discrimination in health care on a daily basis,” Ehrenfeld said. “It’s the reason why Black women in the U.S. are at least three times as likely as white women to die during pregnancy… why Black men are 50 percent more likely to die following elective surgery. It’s why LGBTQ teens and young adults suffer higher rates of mental health challenges, both diagnosed and, far too often, undiagnosed.”
In Milwaukee, where he works and lives, the infant mortality rate for white families is 3 per 1,000 births. For Black families, it’s 18 per 1,000 births. “So many injustices in healthcare remain – and are the focus of our AMA’s advocacy on health equity and much of my personal work leading the Advancing a Healthier Wisconsin Endowment,” he said.
“Just recently, the FDA, thanks in large part to a decade of advocacy by our AMA and others, rescinded some of these discriminatory practices, making it possible for my husband and I to give someone else’s child a much-needed blood transfusion. This kind of advocacy is why I am so proud to lead our AMA at this moment.”
The AMA has made tremendous strides in recent years to recognize past wrongs, to take a stand against discriminatory practices in medicine, to stand on the side of justice and equity, and to partner with allies who are committed to advancing the rights of all patients to receive equitable care, Ehrenfeld stressed.
Ehrenfeld said the AMA has a duty to call out politically appointed judges “who would upend 80 years of FDA precedent and threaten access to critical drugs long proven to be safe and effective.”
“We have a duty to push back against legislative interference in the practice of medicine that is leading to the criminalization of care. We have a duty to fight for the Recovery of America’s Physicians in the aftermath of the pandemic, pushing to fix our broken Medicare payment system, reform prior authorization, and end the stigma around physician burnout,” he added. “We have a duty to make sure that the human connection that is so essential in medicine remains at the center of our increasingly digitized world.”
For too long medicine has been an unsafe place and an unwelcoming environment for far too many people, he said. “Although the work is difficult, slow, and imperfect, our AMA continues to strive to change medicine for the better, and to make the exam room a safe place for everyone who seeks our help.”
New policy on AI and prior authorization
In other news from the AMA annual meeting held in Chicago, the AMA House of Delegates adopted a policy calling for greater regulatory oversight of insurers’ use of artificial intelligence in reviewing patient claims and prior authorization requests. “While the AMA supports automation to speed up the prior authorization process and cut down on the burdensome paperwork required by physicians, the fact remains that prior authorization is overused, costly, inefficient, and responsible for patient care delays,” the organization said.
The new AMA policy calls for insurers to require a human examination of patient records prior to a care denial. "The use of AI in prior authorization can be a positive step toward reducing the use of valuable practice resources to conduct these manual, time-consuming processes. But AI is not a silver bullet,” said AMA Board Member Marilyn Heine, M.D., in a statement “As health insurance companies increasingly rely on AI as a more economical way to conduct prior authorization reviews, the sheer volume of prior authorization requirements continues to be a massive burden for physicians and creates significant barriers to care for patients. The bottom line remains the same: We must reduce the number of things that are subject to prior authorization.”
