WASHINGTON — “Humbling, exhausting, and exhilarating.” That’s how Jesse Ehrenfeld, MD, MPH, president of the American Medical Association (AMA), described his experience so far, 8 months into his 1-year tenure.
Although it has been interesting to be on “some pretty big stages,” some of the more meaningful experiences have come in the lesser-known destinations, Ehrenfeld said here Tuesday during an interview at the AMA’s annual advocacy conference.
One example was his visit to Gainesville, Georgia the previous week to give a named medical humanities lecture at the Northeast Georgia Medical Center, the state’s third-largest graduate medical education sponsor. Ehrenfeld received an email from a family member of the person for whom the lecture was named, “and it turned out that the family member was a former colleague of mine from Vanderbilt, who I worked with, and I didn’t make the connection until I was right about to go, so I got to meet his sister and family — she’s a pediatrician and he’s a cardiologist,” Ehrenfeld said during the interview, at which a press person was present.
“I got to meet with about 35 family practice residents who have such passion for working in the community and for making a difference,” he added. “It was just a very special evening, and that was a bit unexpected.”
A similar thing happened in Greensboro, North Carolina, where Ehrenfeld also was invited to speak at a meeting of the Old North State Medical Society. “It’s the oldest historically Black county medical society that has still maintained itself and is very vibrant,” he said, noting that the organization also was responsible — through a lawsuit and other activities — for the end of segregation in hospitals nationwide. “And they invited the attorney general from North Carolina and [me] to talk about health equity. So I described the AMA’s journey … and what it means to me personally, as an LGBT person in medicine, to be at this moment in society. It was a treat to be a part of it.”
But the experience has also had its downsides, according to Ehrenfeld. “It has been frustrating, obviously, watching how unproductive Congress [is],” he said. “You know, we have members who get it; we have bipartisan support for so many important things,” such as legislation related to J1 visas for healthcare workers.
“People understand why this stuff just makes sense, but there’s just no will to move forward on much of anything in Congress right now,” he added. “And that’s been frustrating because I spend a lot of time and our team spends a lot of time, and physicians spend a lot of time, educating members, and putting in the time to make the visits. And then we just have such dysfunction … We need people to govern; that’s what they’re here to do.”
The dysfunction is particularly evident in the effort to reverse the cuts in the Medicare physician fee schedule, said Ehrenfeld. “Congress is failing the American people, and that is just very frustrating, and hard to watch.”
Workforce development is another area that Ehrenfeld continues to work on, especially given “the incredible workforce shortages that are here,” he said. “It’s going to get ugly. And we have to do things to keep the people that are in practice still practicing. We’ve got to expand the pipeline to make sure that we have more physicians in the workforce, more nurses in the workforce, and more pharmacists in the workforce. And we have to rethink how we deliver care using technology. There is no way to get ourselves out of the problem that we’ve created using the same approaches — we’ve got to rethink the delivery system.”
Along those lines, “there is some interesting work happening in the Defense Health Agency across military treatment facilities — where they have a closed system and control of budget and workflows and resources and people,” Ehrenfeld said. “There is some truly innovative system redesign work that we’re keeping an eye on as potentially an opportunity to really reimagine how healthcare could be delivered.”
Artificial intelligence (AI) — or “augmented” intelligence, as the AMA calls it — is another concern of his. “You know, it’s easy when you watch a plane crash because of a system failure. Or if you watched the Super Bowl and you saw the ad with the self-driving car that ran into a child, because it passed a stopped school bus — it’s easy to see those problems,” he said. “What worries me and keeps me up at night is embedded AI systems and algorithms in medical devices and electronic health records, that we can’t see the insidious harm that is caused to patients because [the AI is] de-prioritizing who’s going to the ICU, or it’s making the wrong care recommendation around an antibiotic, or a pacemaker isn’t operating the way that you expect it to. Those are the things that scare me.”
On a personal level, maintaining the balance between his AMA duties and home life can be a challenge, said Ehrenfeld, who is a father to two young boys. “The older one knows I’m AMA president, and he sometimes asks why I have to be the AMA president, because he’d rather me be home playing with him,” he said. “But he’s also gone on some trips with me, and those have been pretty special opportunities.” Ehrenfeld credited his husband, Judd Taback, with doing a “superhuman” job as a solo parent when Ehrenfeld is away.
“It breaks my heart because I know that there’s a lot that I’m missing out on in terms of the kids,” he added. But “we’re making it work … And I will say, my husband supports my work, because he knows that we both want there to be a healthcare system to take care of our kids when we’re not around. And it’s not clear to me that if we don’t do this work — that if I don’t do this work — that that will be the case.”
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