Over the past year, Lesneck has also explored the workforce hollowed out by pandemic burnout, the dilemma of whether and how to integrate AI into healthcare, the wave of coronavirus disinformation, public health It has also grappled with growing animosity towards work.
As the end of his one-year presidency nears mid-June, he sat down with POLITICO to reflect on his tenure and share his thoughts on how the field can adapt and rebuild after a grueling few years. shared.
This conversation has been edited for length and clarity.
As the end of your presidential term approaches, what are you thinking about most?
People love their jobs, but many obstacles stand in the way of what drew them to medicine in the first place. Whether it’s government intervention in healthcare or disinformation they’ve had to fight back lately. It will take years, including administrative burdens and Medicare payment issues. Frankly, doctors have a lot to deal with.
But there are areas where we’re really enthusiastic and where we see positive signs and momentum shifts. Regarding Medicare payments, a bill was introduced. News from the FDA Advisory Board [on over-the-counter birth control pills] is a positive sign. CMS has repealed his two rules on pre-approval, which is transformative, and experts have heard the government incredibly hard on how much this is a burden for doctors and patients. I felt that
You recently wrote an op-ed about your concern: legal objection FDA regulation of the abortion drug mifepristone could have an even broader impact on members’ work. What are you worried about specifically?
The general assault on the doctor-patient relationship and the criminalization of medicine has been a pretty big and unexpected part of my presidency.
On the one hand, there is the problem of reproductive health, and although mifepristone itself is a safe and effective drug, it is absurdly portrayed as something it is not. It also affects not only medical abortion, but miscarriage and the management of all diseases. Threats and impacts on public health.
And what gets less attention is the potential upside-down of the entire drug approval process, which has been relatively stable for 85 years. If the entire Texas decision hadn’t been overturned, I’m sure we could have: [challenges to] Birth control pills, vaccines, HIV drugs, cancer drugs, and a string of others soon follow.
As a physician trying to practice medicine with something known to be effective and safe, an individual judge with no medical or scientific training could suddenly invalidate all FDA expertise. It’s scary that you can.
What else could have happened to the collapse of the world besides the war over abortion pills? egg Did it influence your members?
One category includes horrifying effects in restrictive states. People have to have unwanted pregnancies, people with ectopic or miscarriages are crammed into ambulances and sent across state lines, or sent home until their condition worsens, and doctors actually I had to call my lawyer and ask. What next? However, in the last few weeks we have begun to see some of the downstream impacts we had predicted, which are unfortunately becoming a reality.
In Idaho, doctors are faced with the very difficult decision of having to abandon the community they feel deeply connected to and part of because they no longer feel safe to practice. ing. Idaho’s maternity department is closed, meaning women with high-risk pregnancies will literally have to leave the state.
It’s also the season for medical students to apply for residencies, but their numbers are down by more than 10%. [applications] In states with restrictions, that applies across the board, not just OB.
there was a big event Physician Advocacy Increases and activism. What does that mean for the AMA? Will it change the nature of the group?
People think of us as advocates in terms of litigation in Congress and the judiciary, working with the administration, working with the State Medical Association and the State Legislature. But they don’t believe in our leadership in medical education; I don’t always think about the National Health Equity Center or us. A group that thinks about innovation in healthcare, the future of AI and digital health, and how it happens in ways that actually improve health and help patients, not hurt them. We rely on the involvement of national leaders and fields, as well as grassroots physicians.
To move forward, doctors must apply their background and experience to running for local government offices and work with school boards in considering public health policy in schools. all such areas.
As you pointed out, doctors are working to change the political debate, but the national political debate is also changing the profession of doctors. What do you see beyond that?
The last few years have affected us all with the politicization of science that we have all witnessed.
What we have had to do in this changing environment is a constant focus on science and evidence. That is our hallmark, our calling card is that we must always return to the best science and evidence and use it as the basis of our judgments.
So what we do about gender-affirming care and transgender issues is the overwhelming impact of medical, scientific, and well-done research on the impact of transgender youth and depression and suicide rates in particular. because there is evidence. We know what makes a difference and helps patients, so we have an ethical and moral obligation to speak up about them.
Are you worried that doctors are losing touch with a country that seems less interested in evidence-based reasoning and more interested in politicized reasoning?
Every doctor, whether it is from an organizational medical perspective or simply working every day in an office or hospital and encountering patients affected by disinformation sources, is the science and evidence in this country. I think you are concerned about the level of respect for . . Whether it’s politicians doing it or it’s doctors actually spreading disinformation, this is alarming. The public health community now knows it must fight back.
We cannot allow these forces to dominate social media and other spaces. For example, we must think about science all the way back to primary and secondary education, and think about ensuring that the public can actually participate in these conversations, whether it be about weather forecasts or the risks and benefits of treatments. yeah.vaccine or prevention [care].
Was this month the right time to end the public health emergency?
This was supposed to happen someday. And it feels like this country is in another place.
Having an end date means there are some things that must be done to protect patients, and much of that has been done, such as extending telemedicine coverage for Medicare patients. I was. But I think there are still concerns about patient access to tests, treatments, vaccines, etc. We need to ensure that patients with insurance continue to have access (preferably without copayments or reduced deductibles). Patient access outside these scopes. And we still have a lot of questions and a lot of work to do. [securing] The federal government continues to fund more vaccines and thinks about the next pandemic. We need to really fund and staff public health departments and plan for future health emergencies. We keep trying to shed more light on this.
A major effect of the pandemic is that doctors have burned out and left the scene. What should be done to prevent further shortages?
This is why as the AMA president I can’t sleep at night.
But there are things we can do to make a difference. I think of the workforce he thinks of as a pipeline with two entrances. New people are coming into the front end. We have been fighting for more funding for residency positions for a long time. Because even if no one leaves medicine, there won’t be enough doctors to care for the aging baby boomers throughout their primary education. Care, specialty care, whatever.
The problem is that instead of looking 10 or 15 years ahead, Congress tends to look ahead to next week. You have to convince them that they should invest here, even if it won’t be profitable for a while.
So we have to get more doctors, but hey, we’re cutting back-end people early while we’re asking Congress for more funding for that. I’m burned out.
That’s part of the driving force behind many of our workarounds [prior authorization] That’s why we need Medicare payment reform.
Think back to a decade ago when doctors focused on health, medical systems and hospitals offered yoga classes at lunchtime or free gift certificates for dinners with CEOs. That’s great, but yoga is not the way out of severe symptoms. Spending hours each day on pre-approvals can lead to burnout. There’s no getting around having to lay off three of his front desk staff because Medicare isn’t paying enough. So I think a lot of places are getting it now and really thinking about what roadblocks they need to get out of the way to support doctors and their work.
How do you think the federal government should approach and regulate AI in healthcare?
The potential for using AI to improve health equity is enormous, but there are many examples of how AI can cause harm if it doesn’t start on the front end.As it [work] If there is progress, Congress may or may need to intervene.
What we don’t want, the bad outcome, is that a highly hyped tool will fail in some spectacular ways, eventually leading to Congress and other agencies shutting this whole thing down.
So we’re not making a fuss about AI. I am very excited. However, we believe that doing some homework on the front end to reduce risk and ensure transparency can help avoid such consequences.