The American Medical Association, one of the largest physician lobbying groups in the U.S., wrapped up its annual meeting earlier this month, setting new policies on augmented intelligence, the physician workforce and health equity.
Jesse Ehrenfeld, the association’s newly-elected president, sat down with Healthcare Dive to discuss hot topics for doctors, including the AMA’s position on abortion restrictions, burnout in the wake of the COVID-19 pandemic and how to develop guidelines on AI in healthcare.
This interview has been edited for clarity and brevity.
Healthcare Dive: There's been a lot of concern about physician burnout and staffing shortages. How would you characterize the situation, and what can the U.S. do to prop up its physician workforce?
Ehrenfeld: We have got to expand the number of physicians in America. The way to do that is by expanding graduate medical education, the number of residency and fellowship training spots.
There has been a cap on the number of federally funded spots for decades. We finally in 2021 got a slight increase of 1,000 additional positions. But we need an order of magnitude more to make sure that we have the health workforce that we need. There are congressional opportunities to start to move that forward that we're optimistic about trying to pursue. We've brought a lot of medical schools online in the last 10 years. But we haven't expanded training spots at the rate we need to at the graduate level. And so that has been a barrier.
In terms of burnout itself, we have had some progress. We were able to support the passage of the Dr. Lorna Breen Health Care Provider Protection Act last year. But we've got to make sure that we've got the resources to support the mental health needs of physicians.
It’s been about a year since Roe v. Wade was overturned. OB-GYNs say the decision is impacting patient care and they fear legal backlash. What do you think the AMA's role is here?
Ehrenfeld: Let me state unequivocally that we oppose strongly the interference of government in the practice of medicine. And we oppose strongly any law that prohibits a physician from providing evidence-based medical care that is in the best interest of their patient.
It's been really important for us to help physicians understand how they meet their ethical obligations to help a patient choose the optimal course of treatment through shared decision making, that is fully informed by medical science, shaped by patient autonomy, but also how to deal with these restrictions that have been put into place.
We've been working with our state medical society partners, the American College of Obstetrics and Gynecology and others, to support physicians across the nation who are trying to understand what they can and cannot do, and how to respond to the restrictions.
We've also been very active in the courts. We had filed amicus briefs in a number of these cases. We've been highly visible in the media to explain the implications of the Dobbs decision from last year.
People think about the Dobbs case and what that does to abortion access, but the implications are much greater, because it impacts all of women's healthcare. We're seeing OB-GYNs make the very difficult decision to leave practice in states where care is restricted.
I was on the phone yesterday with an emergency physician in Texas who had a patient come and see them with ongoing abnormal bleeding and who was not able to access an OB-GYN. This was going on to the point where the patient got dizzy, felt lightheaded and their hemoglobin was markedly abnormal so they had to get admitted to the hospital. All those things were totally manageable, preventable upstream. But we're starting to see more and more because of the challenge around having access to OB-GYNs.
The AMA has decided to develop recommendations around augmented intelligence in healthcare. How will that process go, and what are the most pressing issues in AI and healthcare to address?
Ehrenfeld: It's a really exciting space. I'm an informaticist, so I've spent decades leading development teams to create digital tools and do AI development work. So I see the promise. I also see potential challenges if we don't get the regulatory framework right. We've got to make sure that we help physicians understand what these tools are doing, so that they can appropriately supervise and manage them.
We actually are really partial to describing AI as augmented intelligence, not artificial intelligence. And the reason being that we don't believe that these tools should ever or can ever replace humans and the important personal connection that is established with the patient-physician relationship. But what they can do is they can boost our capacity and potential.
While we're excited about it, we want to make sure that liability issues are sorted out. So when a tool goes wrong, who's on the hook? If I work in a large health system, my health system bought an algorithm that was developed by a third party, implemented it into my EHR. I relied on that tool and may not even know that it's there. And there's a problem for me to be on the hook. We don't think that's appropriate. And so we've got to make sure that these regulatory issues are sorted out, so that we have tools that are safe, effective and appropriately managed.
