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CHICAGO -- The American Medical Association (AMA) must continue to support young doctors and physicians in training as the coronavirus pandemic wears on, AMA president Gerald Harmon, MD, said Friday at the opening session of the virtual November special meeting of the AMA House of Delegates.

"The fear and the weariness in young clinicians' faces was not unlike what I witnessed in the medical arena in Iraqi Freedom and Enduring Freedom after 9/11 -- I'd call it battle fatigue," Harmon said, referring to what he saw during a "grueling, 7-day, 100-hour teaching rotation" he led at his own hospital in Georgetown, South Carolina, where he is a family physician. "Like combat, the unrelenting demands of responding to COVID patients has led to physical and emotional exhaustion and pushed physicians and our entire healthcare workforce nearly to the breaking point."

"During such uncertain times, it is critical that we find support and social connection," he said. "Where will physicians -- especially young doctors and those in training -- find that support? I would submit that we must be their support. We at the AMA ... and all the state and specialty medical societies who comprise the House of Medicine ... must be the allies our physician colleagues need right now."

He applauded what the association has done so far. "Throughout the pandemic, the AMA and our state and specialty medical associations have stepped up and bridged many gaps. We've gotten doctors and other healthcare workers the information, PPE [personal protective equipment] and other resources they needed, even as the state and federal governments struggled in a deficient public health system." Harmon continued, "We were a reliable source of evidence-based info on COVID physicians needed during a time of mixed messages; we talked with CMS [the Centers for Medicare & Medicaid Services] to expand telehealth and pause the regulations standing in the way; we pushed insurers to drop prior authorization requirements; and importantly, we fought against misinformation and disinformation at every step."

Harmon emphasized the role that individual doctors can play in combatting misinformation about the COVID-19 vaccine. "My state still only has a little over half the population vaccinated right now," he said. "Last month, I spoke to a group of maybe 50 employees about vaccines -- and used the point that many in the community had either trusted me personally, or their families had trusted me with their medical care, from sprained ankles to heart attacks to cancer. Yet they had some hesitations and questions about the COVID vaccine -- largely due to nonstop misinformation and half-truths -- and I reminded them they had sought my advice for decades. My advice remained to 'Take my advice! Take the vaccine.' Afterwards many of the vaccine-hesitant stepped up and thanked me and said, 'I'm convinced now, Dr. Harmon; where can I get my shot?'"

That story "speaks to the power we have as individual physicians, and in turn, the power, the reach, and the impact we can have as organized medicine ... as purveyors of truth on the side of science," he added.

In addition to the pandemic, organized medicine also faces other challenges, including a dysfunctional Medicare physician payment system, scope of practice expansion, issues with electronic health records and data transparency, prior authorization, and concerns about health disparities and equity, Harmon said. On the Medicare front, organized medicine must once again do battle against a looming cut in Medicare physician payments -- in this case, a 10% cut beginning next January. "It is about time that Congress passes a permanent solution to end these annual battles that threaten the solvency of physician practices," he said. "Congress must address physician budget neutrality and inadequate annual payment updates as the root causes."

Improving the prior authorization process is another high priority, according to Harmon. He mentioned a patient with "ill-defined symptoms -- slight cognitive impairment with intermittent complaints of difficulty walking, especially on the golf course. He was over 70 and had moderate hypertension and diabetes." Although other clinicians the patient was seeing were leaning toward a diagnosis of vascular dementia or Parkinson's, Harmon suspected normal pressure hydrocephalus and ordered a brain MRI, which the patient's insurer initially denied. Harmon eventually prevailed, and his diagnosis proved correct.

"If we had not fought this decision, the delay in care would likely have resulted in the patient's condition deteriorating and could have caused greater disability" or even death, he said. "But when an insurance company is making the decision rather than a doctor, it's probably going to be in favor of short-term financial gain. That's why the AMA is pushing for legislative action on prior authorization and step therapy reforms at the federal and state levels."

In addition to Harmon, AMA executive vice president and CEO James Madara, MD, also addressed the delegates, delivering some good news. "This year, we'll reach more than 26 million unique users on our AMA website; that's a 32% increase over last year," he said. "Additionally, daily listens to our podcasts are up five-fold from last year, while our daily videos have already surpassed 1 million views." On another front, AMA membership "has increased each year over the past decade. In fact, dues paying membership increased by more than one-third over the last 10 years." As to the possible reasons why, Madara noted that this year, public relations firm APCO Worldwide "ranked the AMA among the nation's best and most effective associations ... We were also lauded for our influence on health policy."

The evening ended with some official business for the delegates: consideration of 28 resolutions -- covering everything from discrimination in medicine against natural hairstyles to due process within the AMA itself -- for possible discussion during the next few days of the meeting. In separate votes, the more than 400 delegates voted against allowing any further discussion of each of the resolutions.

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