Dr. Bruce Scott, the new president of the American Medical Association, has a one-year term to make a difference and has already identified a priority: making the industry less reliant on non-physician providers.
In an interview, the Kentucky-based otolaryngologist said he is concerned about the increase in providers who have not attended medical school, and one way to slow that trend is by addressing physician burnout. He also is targeting prior authorization.
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"I became a physician to take care of patients, that's why all physicians became doctors," he said. "Frankly, it's getting tougher and tougher every day to do exactly that."
The interview has been edited for length and clarity.
What do you see as the biggest challenges facing healthcare?
The healthcare system should help physicians provide good care, not get in the way. Unfortunately, the biggest issue facing healthcare and the country is exactly that: the challenges for physicians to be able to deliver care. We face an ever-growing list of administrative burdens and reimbursement issues at the same time.
Plus, it seems more and more people want to practice medicine, but do so without going to medical school. Those are issues that interfere with physicians delivering the care they were trained to deliver, in the style they know is correct for their patients. Those are the issues that I will tackle with my presidency.
How have healthcare roles that do not require medical school affected physicians?
Over the last few years, there's been a move to replace physicians, particularly in rural areas, with non-physician providers, whether that's physician assistants or nurse practitioners.
The level of training that a physician undergoes compared to the level of training of non-physicians is incomparable, the few 100 hours of clinical training of a nurse practitioner versus the literally thousands of hours over the course of three to nine years of residency of a physician. The four years of medical school, compared to what in some cases now are becoming an online programs for nurses to become advanced practice registered nurses or practicing registered physician assistants.
The thought that this was the answer has really just not panned out and what the answer is, is to improve the supply of physicians.
We do that in two ways: We reduce the number of physicians who are quitting and we increase the number of physicians at the beginning of the pipeline right away. We do that, and we reduce these burdens.
We need to do something to keep physicians satisfied and stop the burnout. Burnout rates went high during the pandemic and really have not come back down.
Why is AMA focused on prior authorizations and their impact on physicians?
As a practicing physician, I sit down with a patient or a family and go through history, listen to their concerns during the examination, review any images or studies that might be available to me, put that into my years of expertise and training, then have a discussion with the patient. We come up with a plan — and then I have to get on the phone and justify that plan to the person of the insurance company, who often has not gone to medical school, and explain to them why my patient needs this care.
The AMA, working with CMS, earlier this year was able to get a huge victory for physicians and patients. We got CMS to agree that starting next year, and in some cases starting in 2026, there's going to be some improvement in the prior authorization process to improve transparency, to expedite the decisions in federal plans.
What are some things you're seeing in healthcare or that AMA is working on that excite you?
Medicine is on the verge of true, life-changing innovation, with robotic surgery, precision medicine, the use of the genomics and the knowledge of genomics that are rapidly developing in digital medicine and augmented intelligence. We see great hope for augmented intelligence to be a wonderful tool for physicians to use, opening doors in terms of diagnostic specificity, diagnostic knowledge, treatment options — that is really a wonderful potential future.
We're also excited about some of the advancements we've had on the Medicare pay schedule. Physicians have faced almost a 30% cut in what Medicare pays physicians when adjusted for inflation since 2001. We have had legislation reintroduced, House Bill 2474, that is going to hopefully tie Medicare payments in the future to annual inflationary updates.
Last year, we saw some of the highest level of increased costs of practice that have been recorded. At the same time, we got a cut. I see my colleagues struggling, my practice had to take out a loan in order to be able to pay our payroll and our lease during the recent Change Healthcare attack.
I think we're on the verge of some positive changes. They'll eliminate some of the burdens that physicians face whether that's prior authorization or reimbursement issues.
What do you hope to accomplish in your year as president?
One of the things that I need is physicians to unify. We are bound together by our professional oath, our desire to take the best care possible for our patients. But sometimes we divide ourselves over issues that divide us as surgeons or primary care doctors or rural versus urban, academic versus private practice.
We need to really concentrate on those things that unite us and work together to fix a system that we're all dedicated to. We need to fix this for our patients and for our profession.
