Updates from the AMA Meeting I



AMA Builds on Efforts to Expand Funding for Graduate Medical Education to Address Physician Shortages

CHICAGO - The American Medical Association (AMA) adopted policy at its Annual Meeting reaffirming the need for an increased number of medical residency slots to ensure that patients have access to an adequate physician workforce. As new medical schools have been established and enrollment in existing schools has expanded in recent years to help ease existing and predicted physician shortages, the new policy calls on legislators, private sector partnerships, and existing and planned medical schools to create and fund graduate medical education (GME) programs that can accommodate the equivalent number of additional medical school graduates, consistent with U.S. workforce needs.

"Current data show that the number of U.S. medical student graduates is growing at a higher rate than the number of residency slots. Without expanding the number of residency positions available to future classes of medical school graduates, the number of graduates seeking positions will eventually exceed what is available," said AMA Board Member and medical student Karthik V. Sarma, M.S. "The AMA will continue to vigorously advocate for the continued and expanded contribution by all health care payers at the federal, state, and local levels, as well as private sources, to adequately fund GME. We believe that it is imperative that efforts to expand the number of medical school graduates also address the need to ensure the availability of an adequate number of GME slots to meet the newly created demand."

The new policy asks medical school accrediting bodies to prospectively and retrospectively monitor medical school graduates' rates of placement into GME as well as GME completion. In order to better prepare students entering a physician workforce that may have constraints in its capacity to grow, the AMA also encourages medical schools to increase their efforts to educate students concerning educational debt, medical specialty choice, and potential career paths. The new policy specifically encourages all existing and planned medical schools to thoroughly research residency Match statistics and other career placement metrics when developing these career guidance plans.

The AMA has been a long-time advocate for modernizing GME. This includes increasing funding for medical residency slots, developing innovative practice models, and creating residency positions that reflect patient and societal needs. Most recently, the AMA urged support for two federal bills. These include the Resident Physician Shortage Reduction Act of 2017, which would expand Medicare funding for 15,000 additional residency positions, and the Advancing Medical Resident Training in Community Hospitals Act of 2017, which would close a loophole in GME cap-setting criteria affecting hospitals who host small numbers of residents for temporary training assignments, also known as "resident rotators."

The AMA also supports the maintenance and expansion of GME as part of its SaveGME campaign. This initiative urges Congress to protect federal funding for graduate medical education, which supports access to care in undersupplied specialties and underserved areas.

Launched in 2013, the AMA's Accelerating Change in Medical Education initiative also addresses some of these issues by supporting medical school projects aimed at accelerating student progression through medical school allowing them to enter residency sooner and contribute more rapidly to addressing physician shortages.


AMA Adopts New Public Health Policies to Improve Health of Nation

CHICAGO - The American Medical Association (AMA), the premier national physician organization in the country, voted this week to adopt new policies aimed at improving the health of the nation. The new policies were approved during the voting session of the AMA's Annual Meeting.

The policies adopted by the House of Delegates include:

Preventing Further Spread of Vector-borne Illness

With an increasing number of people in the U.S. becoming ill from mosquito, tick and flea bites--known as vector-borne diseases, the AMA adopted policy aimed at addressing this emerging health care concern. According to a May 2018 report by the Centers for Disease Control and Prevention (CDC), cases of vector-borne disease tripled across the country between 2004 and 2016, and nine new germs spread by mosquitoes and ticks were discovered during this same time period.

However, despite increases in vector-borne disease, the CDC reports that more than 80 percent of the nation's vector control organizations lack the resources they need to prevent and control these diseases, and cites the need for a strong national infrastructure that includes comprehensive vector programs. Under the new policy, the AMA will advocate for local, state and national research, education, reporting and tracking on vector-borne diseases.

"It has become clear that our country is unprepared to properly control mosquitoes, ticks and other sources of vector-borne disease that are causing more and more people to become ill," said AMA Board Member Willarda V. Edwards, M.D., M.B.A. "We must ensure that local health departments and other vector control organizations are equipped with the resources necessary to prevent and control vector-borne diseases and protect our citizens from illness."

Opposing Racial Housing Segregation Policies to Reduce Health Disparities

Epidemiologic studies have linked racial housing segregation to adverse health outcomes, including increased rates of infant mortality, obesity, hypertension, asthma, lung cancer, mental health stressors, and psychiatric disorders. To help reduce health disparities amplified by segregation of ethnic or racial minority communities, the AMA adopted policy this week opposing policies that further enable racial housing segregation.

Under the new policy, the AMA will also advocate for continued federal funding of publicly-accessible geospatial data on community racial and economic disparities and disparities in access to affordable housing, employment, education and health care--which includes the Department of Housing and Urban Development's Affirmatively Furthering Fair Housing tool. Geographic Information Systems data has been shown to be an effective way for public health researchers to illuminate and act on health disparities by using the tool to help co-locate demographic and mapping data, including housing segregation, with health outcomes. For instance, this type of mapping data was used after the Flint water crisis to identify the disproportionate impact of lead exposure on African American neighborhoods.

"It is critical that researchers and the public have access to geospatial data on racial segregation that persists in many communities across the country. We urge the federal government to continue funding the collection and maintenance of this publicly-available data that will be imperative to improving health outcomes in minority communities," said AMA Board Member Willarda V. Edwards, M.D., M.B.A. "The AMA remains committed to eliminating health disparities in this country in order to achieve health equity and will continue to push for measures that improve the health of the nation."

Preventing Targeted Marketing of Unhealthy Foods to Youth to Decrease Health Disparities

A 2006 report by the National Academy of Medicine, formerly known as the Institute of Medicine, found that food and beverage marketing targeted to youth puts children's long-term health at risk through the promotion of food products that are low in nutritional value and high in calories, fat, sugar, and sodium. To help address the negative health consequences associated with food advertising to youth, especially among vulnerable populations, the AMA adopted policy in support of legislation that limits targeted marketing of products that do not meet nutritional standards as defined by the U.S. Department of Agriculture.

Research has also shown that food companies disproportionally target their advertising for junk food towards African American and Hispanic youth--with one report finding that African American children and teens in particular are exposed to 70 percent more food-related TV advertising than their white peers, and view twice as many TV ads for candy, sugary drinks, and snacks, according to the Rudd Center for Food Policy & Obesity at the University of Connecticut, the African American Collaborative Obesity Research Network and the University of Texas Health Science Center at San Antonio.

"Children are constantly exposed to advertising for foods and beverages that are unhealthy and low in nutritional value, which can lead to increased consumption of these foods--putting them at higher risk for obesity and diet-related diseases," said AMA Board Member Ryan J. Ribeira, M.D., M.P.H. "By limiting food ads targeted to children and teens, we will help reduce the amount of fast food and sugary beverages that they consume and ultimately improve health outcomes."

Standardizing Food Labels to Prevent Food Waste

According to the U.S. Food and Drug Administration, food waste in the U.S. is estimated at between 30 to 40 percent of the food supply--representing approximately 133 billion pounds and $161 billion worth of food wasted in 2010 alone. To help prevent further food waste, the AMA adopted policy this week to support the federal standardization of date labels on food and beverage products to ensure that the labels address consumer safety concerns. The policy aims to help consumers differentiate between when a food is no longer safe to eat versus the manufacturer's recommendation for when the food surpasses peak quality.

"The food wasted each day not only has a lasting negative impact on our environment, but also diverts foods away from people in need. By having one standardized expiration date label on all foods that indicates the date when a food is no longer safe to consume, our country will be able to cut down the amount of wasted food and ensure more people have access to nutritious foods," said AMA Board Member Ryan J. Ribeira, M.D., M.P.H.


Supporting Inclusive and Culturally Competent Sex Education

The AMA furthered its policies this week to support sex education that is inclusive of more populations of people. This includes encouraging schools to provide culturally competent materials for Limited English Proficiency (LEP) students, or non-native speakers of the English language.

"Comprehensive, evidence-based sex education helps promote healthy sexual relationships, lower rates of teenage pregnancy and reduce risky sexual behavior. Culturally competent sex education could reduce disparities in teenage pregnancy and HIV diagnosis rates - both of which are high in the Latino community," said AMA Board Member Willarda V. Edwards, M.D., M.B.A.

The AMA also updated its current policy to encourage all schools to offer LGBTQ sex education alongside heterosexual sex education.

"Inclusive sex education helps increase awareness, dispel myths and break down stereotypes without judgment or stigma," said Dr. Edwards. "Doing so creates a space for formal and honest discussions about sexual orientation and gender identity."

Efforts to Alleviate Chronic Homelessness

More than 550,000 people experience homelessness in the U.S. on a single night, according to the 2017 Annual Homeless Assessment Report to Congress--with most staying in emergency shelters or transitional housing programs and approximately 35 percent staying in unsheltered locations. In an effort to alleviate chronic homelessness throughout the country, the AMA expanded its policy in recognition that stable, affordable housing as a first priority--without mandated therapy or service compliance--is an effective way to improve housing stability and quality of life among people who are chronically homeless.

"It is important that we take steps to improve the health and well-being of people who are facing chronic homelessness, and focusing on housing first may help do that," said AMA Board Member Ryan J. Ribeira, M.D., M.P.H


AMA Passes First Policy Recommendations on Augmented Intelligence

CHICAGO - The promise of augmented intelligence (AI) in spurring technological innovation in medicine has generated growing interest among health care stakeholders. It also has spurred a range of concerns about the novel challenges in the design, implementation, and use - especially how AI will be incorporated into the practice of medicine and affect patients. With those varied perspectives, the American Medical Association passed its first policy addressing AI at its Annual Meeting, adopting broad policy recommendations for health and technology stakeholders on this issue.

"As technology continues to advance and evolve, we have a unique opportunity to ensure that augmented intelligence is used to benefit patients, physicians, and the broad health care community," said AMA Board Member Jesse M. Ehrenfeld, M.D. M.P.H.. "Combining AI methods and systems with an irreplaceable human clinician can advance the delivery of care in a way that outperforms what either can do alone. But we must forthrightly address challenges in the design, evaluation and implementation as this technology is increasingly integrated into physicians' delivery of care to patients."

The policy states the AMA will:

  1. Leverage its ongoing engagement in digital health and other priority areas for improving patient outcomes and physicians' professional satisfaction to help set priorities for health care AI.
  2. Identify opportunities to integrate the perspective of practicing physicians into the development, design, validation and implementation of health care AI.
  3. Promote development of thoughtfully designed, high-quality, clinically validated health care AI that: a. is designed and evaluated in keeping with best practices in user-centered design, particularly for physicians and other members of the health care team; b. is transparent; c. conforms to leading standards for reproducibility; d. identifies and takes steps to address bias and avoids introducing or exacerbating health care disparities including when testing or deploying new AI tools on vulnerable populations; and e. safeguards patients' and other individuals' privacy interests and preserves the security and integrity of personal information.
  4. Encourage education for patients, physicians, medical students, other health care professionals, and health administrators to promote greater understanding of the promise and limitations of health care AI.
  5. Explore the legal implications of health care AI, such as issues of liability or intellectual property, and advocate for appropriate professional and governmental oversight for safe, effective, and equitable use of and access to health care AI.

The AMA's ongoing engagement with digital health offers insights for understanding, from physicians' perspectives, what is at stake in integrating AI systems into the delivery of health care. A recent AMA survey of physicians about barriers to adoption of digital health technologies suggests that physicians are most receptive to digital health tools they believe can be integrated smoothly into their current practice, will improve care, and will enhance patient-physician relationships. Earlier AMA research into physician professional satisfaction found that frustrations with electronic health records (EHRs), especially usability issues, were a major source of dissatisfaction in physicians' professional lives.

AI systems need to be developed and evaluated in keeping with best practices in user-centered design. The focus must be on users' needs, and usability should be tested by participants who are demographically representative of end users.

"To reap the benefits for patient care, physicians must have the skills to work comfortably with health care AI. Just as working effectively with EHRs is now part of training for medical students and residents, educating physicians to work effectively with AI systems, or more narrowly, the AI algorithms that can inform clinical care decisions, will be critical to the future of AI in health care," Ehrenfeld said.


AMA To Push for Evidence-Based Treatment in Opioid Fight
Physicians Urge Removal of Prior Authorization Barriers, Adherence to Parity Laws

CHICAGO - The American Medical Association (AMA) adopted policy at its Annual Meeting to ensure that patients with substance use disorders receive evidence-based treatment - whether that treatment is in clinics, drug treatment facilities, hospitals, correctional settings or the physician's office.

"The AMA wants all physicians to be leaders in the fight against the opioid epidemic," said AMA President-elect Patrice A. Harris, M.D., chair of the AMA Opioid Task Force. "This means they must fight to end stigma surrounding substance use disorder and medication assisted treatment (MAT), which has been shown to decrease overdose mortality, reduce transmission of infectious disease, and reduce general health care expenditures."

The AMA urges removing administrative barriers to MAT, including prior authorization that causes delays or denials of care. The AMA also urges enforcement of mental health and substance use disorder parity laws. Only 10 percent of patients with a substance use disorder receive the necessary treatment, and the AMA urges all stakeholders to help reduce these barriers.

The AMA has extensive policy, backed by the work of the AMA Opioid Task Force, to help end the opioid epidemic. The AMA website, endtheopioidepidemic.org, offers nearly 400 resources and educational material for physicians on a wide range of issues including prescribing opioids appropriately, starting patients on MAT, using naloxone and safe storage and disposal of opioids.

Delegates approved the following policies that directed the AMA to:

  • Advocate for legislation to ensure that patients have access to all FDA-approved medications or therapies in all settings such as drug treatment clinics or facilities. It also called for a public campaign to increase awareness that medical treatment of substance use disorder with MAT is a first-line treatment for this chronic medical disease. MAT is an evidence-based treatment that is effective and should be available as part of any treatment for substance use disorder.
  • Work with the American Hospital Association and other relevant organizations to identify best practices to treat opioid use disorder as a chronic disease. The groups will identify patients with this condition; initiate or provide opioid agonist or partial agonist therapy in inpatient, obstetric and emergency department settings; provide cognitive and behavioral therapy as well as other counseling; establish appropriate discharge plans, including education about opioid use disorder; and participate in communitywide systems of care for patients and families affected by this chronic medical disease. It also called for the AMA to advocate for states to evaluate programs that have received government funding to assist physicians, hospitals and their communities to coordinate care for patients with opioid use disorder.
  • Advocate for the expansion and improved access to evidence-based treatment for substance use disorders during pregnancy. The AMA has longstanding policy strongly supporting that pregnant women should not be penalized for having a chronic medical disease, including a substance use disorder. Delegates said the AMA should continue resisting efforts to criminalize substance use disorder by leveling criminal penalties or punitive measures against those with this chronic disease.
  • Ensure medical students, physicians-in-training, and practicing physicians receive education on opioid prescribing. The policy calls for the AMA to develop opioid education resources in conjunction with the Association of American Medical Colleges, American Osteopathic Association, Commission on Osteopathic College Accreditation, Accreditation Council for Graduate Medical Education and other interested professional organizations.


AMA Adopts New Policies at 2018 Annual Meeting

CHICAGO - The American Medical Association (AMA) today voted to adopt new policies related to immigration, gender equity in medicine, and increased access to naloxone on commercial airlines, among other items, during its Annual Meeting.

The AMA's House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, medical students and residents representing every state and medical field. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.

The policies adopted by the House of Delegates include:

Opposition to Separating Children from Their Caregivers at the Border

Delegates voted to oppose the practice of separating migrating children from their caregivers at the U.S. border, a practice on the rise and one that physicians said could cause trauma in children. The resolution calls for the government to end its policy of treating these children as "unaccompanied minors," separating them from their caregivers and sending them to federal government facilities.

"Children leaving the chaos of their home countries should not be further traumatized by the U.S. government policy of separating children from their caregiver. It's inhumane and risks scarring children for the rest of their lives," said AMA Board Member Bobby Mukkamala, M.D.

Advancing Gender Equity in Medicine

Documented gaps exist in compensation and career advancement between male physicians and their female counterparts, even after accounting for other factors and characteristics. New policy adopted by the AMA seeks a wide array of solutions to the persistent problem of gender equity in medicine.

The sweeping new policy includes specific directives to reduce gender bias, promote objective criteria for equal base pay, create guidance for instructional transparency of compensations, and establish educational initiatives on institutional and structural bias within medicine.

"As the nation's largest physician organization, the AMA not only wants to advance gender equity in medicine, but also set an example by committing to pay equity for its own employees," said AMA President Barbara L. McAneny, M.D. "I am proud that many women have joined me in leading the AMA at the highest level, and have contributed a strong voice to our comprehensive efforts."

Currently, 30 percent of the AMA Board of Trustees are women, including AMA President Barbara L. McAneny, M.D. and AMA President-elect Patrice A. Harris, M.D. The AMA will continue its commitment to provide leadership opportunities for women physicians to shape the national discussion on health care issues.

Promoting Diversity in the U.S. Medical Workforce

With large areas of the country facing a physician shortage, the AMA called on the government to clear the backlog for conversion from H1-B visas for physicians to permanent resident status. There is a backlog of international medical graduates who are actively practicing in the United Sates and waiting to receive a green card. The policy builds on AMA policy aimed at ensuring an adequate physician workforce and promoting diversity in the U.S. medical workforce.

"Opening the door to more qualified physicians would benefit patients, many of whom have difficulty accessing care because of a physician shortage where they live," said AMA Board Member Bobby Mukkamala, M.D. "One in four physicians in the U.S. is an immigrant physician. Immigrant physicians do not replace American workers; instead, they fill gaps in U.S. health care, create more jobs, and serve rural and underserved areas."

Reporting Child Abuse and Neglect in Military Families

Rates of maltreatment of military children continue to climb. In the past five years alone, military child abuse and neglect rose from 4.8 incidents per 1,000 children to 7.2 incidents. The high rate of relocation among military families exacerbates the issue further, making it difficult to track these cases. To address the issue, the AMA adopted policy supporting state and federal-run child protective services in reporting child abuse and neglect to the Family Advocacy Program (FAP) within the U.S. Department of Defense.

"It is no wonder that abuse and neglect goes unreported - only 15 states currently have laws or policies intact that require state child protective services to report cases to the FAP. We hope our new policy helps close that loophole and ensure cases do not fall through the cracks," said AMA Board Chair Gerald E. Harmon, M.D.

Increasing Access to Naloxone on Commercial Airlines

The Federal Aviation Administration requires commercial air carriers to carry onboard emergency medical kits, but the opioid overdose antidote - naloxone - is not a required item in these kits. As a potential life-saving measure, the AMA adopted policy supporting the addition of naloxone to airline medical kits.

"The AMA has been a longtime supporter of increasing the availability of naloxone for patients, first responders and bystanders who can help save lives and seeks to bolster efforts to increase access to this medication," said AMA Board Member Albert J. Osbahr III, M.D. "The AMA will encourage all U.S. airlines to include naloxone in their airline medical kits."

The AMA's dedication to reducing deaths from overdose is a part of the organization's broader efforts to combat the opioid epidemic, while at the same time preserving access to medically necessary treatments for pain.

Ensuring Free Access to Feminine Hygiene Products for Incarcerated Women

The AMA will work with state and specialty societies to advocate for free access to feminine hygiene products for incarcerated women and will encourage the Internal Revenue Service to classify feminine hygiene products as medical necessities.

"Feminine hygiene products are essential for women's health, and yet, at prisons and jails across the country, it is not unheard of for them to be unavailable to incarcerated women," said AMA Board Member Georgia A. Tuttle, M.D. "Some state legislatures are tackling this issue, but more must be done to ensure access to feminine hygiene products to ensure the health and dignity of women everywhere."

Opposing Lock-Out Provisions in Medicaid Waivers

As states pursue waivers to modify and tailor their Medicaid programs, the AMA announced its opposition to "lock-out" provisions that terminate Medicaid patients' coverage - for up to six months in some states - for failure to comply with administrative requirements. In states pursuing lock-outs, patients can be barred from Medicaid and lose important access to health care services for failing to meet deadlines, satisfy burdensome work requirements, or make premium payments on time - even if they subsequently comply with the requirements within the lock-out period. In many cases, lock-outs will punish patients who fail to keep up with paperwork but otherwise continue to meet the underlying eligibility criteria for coverage. The AMA believes that Medicaid policies should support continuity of care, and Medicaid patients should be permitted to reapply immediately for redetermination if coverage is terminated.

"Discontinuing health care for thousands of our most vulnerable citizens for failure to meet administrative burdens is a cruel, bureaucratic response to our neediest patients. As physicians, we recognize that many of our Medicaid patients lead complicated, difficult lives, and we should value empathy over rigid adherence to red tape," said AMA Board Member William A. McDade, M.D., PhD.


AMA Continues Efforts to Incorporate EHR Training in Medical Schools, Residency Programs

New AMA policy builds on organization's robust efforts to transform medical education nationwide

CHICAGO - Addressing concerns that many medical students and residents lack sufficient training in their medical school and residency program electronic health record (EHR) systems, the American Medical Association (AMA) adopted policy at its Annual Meeting aimed at ensuring that medical students receive quality clinical documentation experience using EHRs. The new policy builds on the AMA's efforts over the last five years to transform medical education and ensure future physicians are prepared to meet the needs of patients in the modern health system.

"Unfortunately, despite a growing awareness within the medical education community that medical students and residents need to learn how to ensure quality clinical documentation within an electronic health record, some institutions continue to restrict access to the EHR due to a variety of concerns," said AMA Board Member and medical student Karthik V. Sarma, M.S. "There is a clear need for medical students to have access to - and learn how to properly use - EHRs well before they enter practice. That's why, even as we continue to work to improve EHR usability for all physicians and physicians-in-training, we've been working over the last five years with medical schools across the country to ensure our future physicians are better equipped to provide care in a practice environment of rapid progress, new technology, and changing expectations both from government and society--directly impacting the way health care is delivered nationwide."

According to the AMA's new policy report on the quality and effectiveness of clinical documentation training for medical students and residents, there are concerns about the effects of the EHR on student and resident relationships with patients, in that students and residents may be more engaged with the chart and computer than with the patient. Additionally, the report notes that students may receive poor role modeling from faculty, as well as from the entire care team, on appropriate use of and best practices for EHRs.

To help ensure that future physicians receive sufficient training using EHRs, the AMA's new policy encourages medical schools and residency programs to design clinical documentation and EHR training that provides evaluative feedback regarding the value and effectiveness of the training, and that can be evaluated and demonstrated as useful in clinical practice. The policy also encourages medical schools and residency programs to provide EHR professional development resources for faculty to assure appropriate modeling of EHR use during physician/patient interactions.

The report also notes that any training should provide students, residents and physicians with institutional policy regarding copy and paste functions or any other functions that have local guidelines.

The AMA launched its Accelerating Change in Medical Education initiative in 2013 to bridge the gaps that exist between how medical students are trained and how health care is delivered in the modern health care system. The AMA has since awarded $12.5 million in grants to 32 of the nation's leading medical schools to develop innovative curricula that can ultimately be implemented in medical schools across the country. These innovative models are already supporting training for an estimated 19,000 medical students who will one day care for 33 million patients each year.

The next phase of the AMA Consortium will be announced later this year. Additionally, as part of the AMA's commitment to improving physician training across the continuum of medical education, the AMA will also soon begin work to ensure that the changes being made to medical school curricula will offer students a seamless transition into residency.


AMA passes resolution in support of making birth control available over the counter

The American Medical Association just signaled growing support for making birth control available off the shelf by approving a resolution encouraging drug companies to submit applications to the Food and Drug Administration to make the switch.

In the resolution, the nation's largest physicians group also affirmed their support for removing cost-sharing obstacles to over-the-counter birth control and full insurance coverage of all contraception without regard to whether it's obtained with a prescription or off the shelf.

Right now, over-the-counter birth control is an option in more than 100 countries, but not the U.S. An over-the-counter pill could prevent gaps in birth control use and eliminate the need to schedule a doctor visit to get or refill a prescription. An Oral Contraceptives Over-the-Counter Working Group was formed in 2004 to improve access to contraception by making a low-cost oral contraceptive product available over the counter in the U.S. As part of that effort, the Working Group has partnered with the pharmaceutical company HRA to submit a birth control pill to the FDA for approval for over-the-counter use.

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