AMA president urges physicians to turn anger into action

American Medical Association (AMA) President Bruce A. Scott, M.D., delivered the final speech of his presidency to the AMA House of Delegates, offering a frank assessment of challenges within our health system, and urging physicians to channel anger and frustration into advocacy and action.

Dr. Scott, an otolaryngologist from Kentucky, highlighted the broken Medicare physician payment system, out of control prior authorization, and an epidemic of physician burnout – pillars of the AMA’s Why We Fight campaign – while also touting immediate remedies required. He noted that Congress on the precipice of major Medicare reform that would connect reimbursements to the cost of running a medical practice, which has been a top AMA priority for years. However, he also lamented that the same bill threatens access to care for millions of Americans and would make medical school unaffordable for most students, despite the national physician shortage.

“I think the times call for some anger. Because despite the best efforts of everyone in this room, and colleagues across the country, our health care system is failing in fundamental ways,” Dr. Scott said in remarks as prepared for delivery. “It’s failing physicians, and more importantly it’s failing patients.”

“I’m angry because the dysfunction in health care today goes hand in hand with years of dysfunction in Congress.

“I’m angry because physicians are bearing the brunt of a failed Medicare payment system. And while our pay has been cut by more than 33 percent (PDF) in 25 years, we see hospitals and even health insurance companies receiving annual pay increases.

“Congress needs to know there is no ‘care’ in Medicare if there are no doctors.

“But here’s the thing. Being angry just for the sake of being angry doesn’t get us very far.

“We have to effectively channel our anger into action.”

Dr. Scott’s year as AMA President ends on Tuesday, June 10, when he will become immediate past president of the organization. 

His remarks as prepared for delivery are below. 

Madame Speaker, members of the Board, delegates, colleagues and guests. It’s an honor to speak to this House of Delegates for the final time as AMA president.

No president walks this journey alone—so before I begin my formal remarks, please allow me to recognize my fellow trustees for their leadership, the many members of this House who have stood with me and encouraged me through all these years, my partners at Kentuckiana Ear, Nose &Throat as I have juggled my clinical duties with the demands of this office.

My family and friends who have given honest feedback— sometimes a little too honest, I thank them all.

And, most of all, the one person I absolutely, continuously depend upon, my partner in everything, my spouse—Christy.

Now, those who remember my days as Vice Speaker and Speaker will not be surprised when I say—“play the video...”

From the tone of that video you might have guessed that this is going to be a little different than a typical presidential address.

For those of you expecting the usual humor from me, I’m sorry to disappoint you.

Tonight, you’re going to hear from Angry Bruce.

I think the times call for some anger because despite the best efforts of everyone in this room, and colleagues across the country, our health care system is failing in fundamental ways.

It’s failing physicians, and more importantly it’s failing our patients.

I’m angry because the dysfunction in health care today goes hand-in-hand with years of dysfunction in Congress.

I’m angry because physicians are bearing the brunt of a failed Medicare payment system. And while our pay has been cut by more than 33 percent in 25 years, we see hospitals and even insurance companies receiving annual increases.

Congress needs to know there is no “care” in Medicare if there are no doctors.

I’m angry because Medicare advantage plans are rewarded with a scheduled increase while doctors suffer yet another cut – or as one member in this House accurately described it “a gut punch to physicians.”

A health care giant suffers a cyberattack releasing private health information for almost half the country, pushing physician practices to the brink of failure, and then demands rapid repayment of loans made to these same practices?!

Reimbursement rates have been corrupted by a secretive, third-party entity for the benefit of insurance companies and at the expense of physician practices.

You bet I’m angry!

I’m angry because insurance companies – which are making record profits—are wasting our time and putting our patients’ health at risk by forcing us to argue with some bureaucrat over the care of our patients.

Not long ago, a woman came into my office with a large tumor in her maxillary sinus. The tumor was so massive that it was pushing into her eye.

After a thorough examination, I determined that surgery to remove the tumor was the best course of action. So, I sat down with her to go over her diagnosis and treatment plan. She understood it would be a major surgery, with significant risks, but also understood that it was necessary.

A week later, her health plan notified her, and me, that the surgery “was not medically necessary.”

Her insurance company said she should be treated with an antibiotic and nasal spray before they would approve surgery.

Are you kidding me?

An antibiotic and a nasal spray to treat her tumor?

Without seeing the patient, without talking to the patient, without completing even one year of medical school, this insurance representative determined that they knew more than her doctor, a board-certified subspecialist.

So, what are patients supposed to do? My patient was confused. She was stressed.

When I called her to explain that I had spoken to the medical director and gotten authorization to proceed, she said, “Doctor, you told me that I needed surgery, but my insurance company told me that all I needed was antibiotics.” 

Sadly, we all know cases like this are not outliers or isolated events. 

What insurance companies are doing to our patients is wrong…

Stepping between us and our patients is wrong…

Denying necessary and even life-saving care is just …plain… wrong.

It’s no wonder that so many physicians are frustrated at a system that is undermining our judgement and eroding our patients’ trust.

You better believe I am angry! And I’m not alone. 

We’ve all seen the numbers. Physicians are retiring early and leaving the profession in droves because eventually these frustrations and loss in pay become too much to overcome—especially for physicians like me in private practice.

As I have traveled America. I have heard the stories of physicians struggling to keep their practices afloat, and the tearful stories of them closing their practices. And how concerned they were for their patients after their doors were closed.

In November, I told you these stories made me sad. Now, they make me angry.

Our patients cannot afford to lose great doctors. Not one more!

Do you know who else makes me angry? The physicians who sit in their homes or offices and complain…complain about the broken health care system and about our AMA—often confused and clueless about our AMA and all we are fighting for.

Instead of sitting there complaining, join us in the fight!

But here’s the thing. 

Being angry just for the sake of being angry doesn’t get us very far.

We have to turn our anger into action.

I know our patience is being tested by this new administration and Congress.

It seems that for every battle we get close to winning—that new and equally urgent battles arise.

The same House bill that brings us closer to finally tying future Medicare payments to the rising costs of running a practice, also takes us backwards by limiting access to care for millions of lower-income Americans.

Medicare, Medicaid, and the Affordable Care Act are literal lifelines for children and families for whom subsidized health coverage is their only real option.

We must do all we can to protect this safety net and continue to educate lawmakers on how best to target waste and fraud in the system without making it tougher for vulnerable populations to access care.

We’ve launched a grassroots campaign targeted at the Senate as we work for improvements in this bill, and we urge you to add your voice.

We must also continue to educate Congress on why our nation should be working to bring down the cost of a medical education, not erecting barriers to deter brilliant young minds from pursuing this noble profession.

The proposed changes in student lending practices in the reconciliation bill now with the Senate would make medical school unaffordable for many students.

This is simply unconscionable when our country has a shrinking physician workforce to confront its growing health care needs.

I promise you that AMA’s advocacy on this legislation continues.

And so while I might be angry at our health care system as it currently exists, I am also confident that this House of Medicine can channel that anger into positive action.

You see, despite our frustrations, there are reasons for optimism. 

AMA advocacy— amplified by our Federation partners in this room—has brought us  close to achieving Medicare payment reform that ties future reimbursement to inflation, representing a foundational step toward reform that the AMA and our partners have long sought.

We urge the Senate to complete this first critical step on the road to permanent reform.

I’m confident that we’ll get there—just as we’re all angry at the slow pace of progress.

Meanwhile, the AMA and our Federation partners have achieved significant prior authorization reforms in states around the country.

Federal legislation has been reintroduced that will right-size the prior authorization process, add transparency and reduce delays—all with bipartisan support.

We urge Congress to pass this important legislation now!

AMA advocacy—again with your help—secured more than 180 scope of practice wins over the last two years.

We’ve helped prioritize physician well-being by persuading a majority of state licensure boards and over 600 hospitals to remove stigmatizing language around past mental health from their credentialing forms.

And our Joy in Medicine program continues to recognize hospitals and health systems that are setting new standards for physician support and blazing a trail for others to follow.

As a result of these and so many other efforts across our profession, physician burnout is now on the decline. 

And just this week, a federal court ruled that our lawsuit to hold MultiPlan accountable for its role in a price-fixing scheme could proceed.

We are demanding an end to the conspiracy that is suppressing out-of-network payment rates below fair levels.

We are seeing the results of our sustained advocacy. 

But there is so much more that needs to be fixed, right now.

The film clip played earlier is from the movie “Network,” where a fictional anchorman unleashes his anger. It was more than a cathartic tirade; it was a passionate plea against apathy.

A largely forgotten movie, but a memorable call to action.

Are we finally mad enough that we are not going to take it anymore?

Here’s our challenge: While screaming from the window feels good, it’s not going to achieve the lasting change our health care system needs.

That change will come from uniting as a profession. Channeling our anger into a unified voice.

That’s the work of the AMA.

Finding consensus on issues with disparate opinions—hat’s why we’re all here.

Our disagreements and debates aren’t symptoms of dysfunction; they are emblematic of our democratic process in action.

It’s what makes this House— and the policies that spring from it—so powerful, and so important.

It’s what intrigued me at my first AMA meeting 35 years ago and has kept me coming back ever since.

I recently read the obituary of a longtime AMA member … his loving spouse is here with us this evening. David was said to always be patient and kind and able to solve any problem. His famous saying was, “All you need to fix anything are the tools and the time.”

As physicians, we have the tools—our empathy, our compassion and our training, which not only earns us the trust of our patients but the hope that we will step up and lead the charge to heal our health system.

And we are committed to take the time to fight—for as long as it takes—because we understand the high stakes of what we do.

You and I would not be here today if we didn’t believe in the power of physicians, working together.

And so, we must meet the challenges of this moment with our own call to action.

True reform…lasting change …won’t happen without you.

But the wrong reforms will.

Our AMA needs you. I am asking you, and our profession is calling on you today, right here in this moment…

… keep telling your stories, those that anger you and those that inspire you, because the world is listening.

… keep advocating for your patients

… keep reaching out to your colleagues

… keep pushing for the future we all want.

Our profession is worth the fight.

Our patients are worth the fight.

It has been the highlight of my career to participate in, and later lead, the deliberations of this House of Medicine, to speak on your behalf… and to carry this mantle of leadership for our profession.

Thank you for the honor of being your AMA president.

It has been the privilege of a lifetime.