EP. 153: A COLLECTIVE VOICE FOR ALL PHYSICIANS

WITH BRUCE SCOTT

Jul 4

WITH BRUCE SCOTT, MD

The 2024 – 2025 president of the American Medical Association shares how a childhood injury propelled him to becoming a surgeon, how he navigates the polarization and politicalization of American medicine, and how all physicians can help shape the future of healthcare.

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The relationship between physicians and the larger healthcare system is incredibly complex, raising difficult questions about patient care, advocacy, and the role of doctors in shaping public policy. In this episode, we explore these critical issues and the realities faced by healthcare providers today.

Our guest is Bruce Scott, MD, an otolaryngologist and 2024 – 2025 President of the American Medical Association (AMA). Motivated by a serious childhood injury and the life changing care he received, Dr. Scott subsequently pursued a career dedicated to surgery and health care advocacy. In this conversation, he shares his experiences as a surgeon, dealing with intricate procedures and urgent decisions, and discusses the importance of physician involvement in healthcare policy amid today's deeply polarized environment.

Dr. Scott reflects on his own path to leadership within the AMA and underscores the impact that organized medicine can have on public health, health care access, and physician well-being. He provides insights into how the AMA navigates complex political challenges, addresses physician burnout, and promotes practical solutions to administrative burdens. We also discuss emerging issues such as the responsible integration of artificial intelligence in clinical settings, rebuilding patient trust in medical expertise, and the broader implications of physician burnout and mental health.

Bruce A. Scott, MD was the president of the American Medical Association from 2024 - 2025. As president he became known as an outspoken advocate for practicing physicians and their patients. He continues as a member of the AMA Board of Trustees, now for his 11th consecutive year.
Dr. Scott has been a leader in medicine throughout his career — prior to being president, he served four years as speaker and four years as vice speaker of the AMA House of Delegates, presiding at the meetings of delegates from every state and specialty as they crafted policies for the medical profession.
Dr. Scott is the president of his six-physician independent private practice group, medical director of a multispecialty ambulatory surgery center and holds a clinical appointment at the University of Louisville School of Medicine. His commitment to change in medicine is grounded in the barriers to care he strives to overcome in his daily practice.
A graduate of Vanderbilt University, Dr. Scott completed his medical education and residency at University of Texas Medical Branch in Galveston, Texas, and a fellowship at the University of Texas Health Science Center at Houston. Subsequently he returned to his hometown of Louisville, Ky., to practice. He is board-certified in both otolaryngology and facial plastic surgery.
Dr. Scott has been happily married for over 30 years and is a proud father and grandfather.
In this episode, you will hear about:
• 2:48 - The life-changing injury that led Dr. Scott to a career as an a surgeon
• 14:34 - How Dr. Scott became involved with advocacy at the American Medical Association
• 21:27 - How the AMA’s work has been altered by the high levels of politicization around medicine
• 28:27 - The challenges that physicians struggle with today
• 32:47 - How the AMA works to maintain the public’s trust in doctors and the medical establishment
• 37:33 - The AMA’s plan for navigating AI integration in a way that benefits doctors, not healthcare and insurance companies
• 42:33 - How the AMA approaches the epidemic of physician burnout
• 49:14 - Dr. Scott‘s recommendations for how to get involved in policy and advocacy.
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:03] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives, those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine, we will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] The relationship between physicians and the larger healthcare system is incredibly complex, raising difficult questions about patient care, advocacy, and the role of doctors in shaping public policy. In this episode, we explore these critical issues and the realities faced by healthcare providers today. Our guest is Doctor Bruce Scott, an otolaryngologist and current president of the American Medical Association. Motivated by a serious childhood injury and the life changing care he received, Doctor Scott subsequently pursued a career dedicated to surgery and health care advocacy. In this conversation, he shares his experiences as a surgeon, dealing with intricate procedures and urgent decisions, and discusses the importance of physician involvement in healthcare policy amid today's deeply polarized environment. Doctor Scott reflects on his own path to leadership within the AMA and underscores the impact that organized medicine can have on public health, health care access, and physician well-being. He provides insights into how the AMA navigates complex political challenges, addresses physician burnout, and promotes practical solutions to administrative burdens. We also discuss emerging issues such as the responsible integration of artificial intelligence in clinical settings, rebuilding patient trust in medical expertise, and the broader implications of physician burnout and mental health. This conversation offers thoughtful perspectives for anyone concerned with the current state and the future direction of healthcare. Doctor Scott, thanks for taking the time to join us and welcome to the show.
Dr. Bruce Scott: [00:02:45] Well thank you. It's a pleasure to be here with you.
Henry Bair: [00:02:48] So this will now be our third interview with consecutive presidents of the American Medical Association. And we are really fortunate to be able to hear each of your stories and what you hope to contribute to American medicine. Can you start us off by telling us what initially drew you to becoming an ear, nose and throat surgeon?
Dr. Bruce Scott: [00:03:08] What's interesting in retrospect? As a teenager, I suffered a pretty severe injury to my hand. My brother and I enjoyed building and then flying small radio control model airplanes, and we were working on one of those planes one day, and I was in our garage and I was up on a ladder getting something down, and the ladder slipped and I fell, and I naturally just grabbed for anything to catch myself, to stop my fall. And what I wound up grabbing successfully was a sharp hook that went all the way through my left hand. So here I was in the garage with my brother screaming, me screaming, blood streaming down my arm. A hook that literally had like spark plugged wrenches and other tools hanging from it coming out of the back of my hand. And, uh, once my mother came out after she almost fainted, they rushed me to the local emergency room where the E.R. doctor looked at me, and then a general surgeon came in, and, you know, he stepped outside of those curtains. You know, the curtains we all see. And emergency departments that you need to realize are not as soundproof as we doctors sometimes pretend they are. And so here I am, my my young teenage self, hearing this conversation as the doctor is telling my parents that I'm going to lose the use of my hand, certainly might lose a finger or two.
Dr. Bruce Scott: [00:04:37] And knowing my life is going to be forever changed. Uh, my parents didn't like those answers, so they they took me to the Cleaner and Hand Care Center, a world renowned hand center and microsurgery center here in Louisville. And make the long story shorter. They did surgery. They removed the hook. They restored the function of my hand. And here I am, years later, a surgeon using that hand. And I think it was at that point that I realized the ability of a of a physician, of a surgeon to save people's lives, to change people's lives in ways that only a physician could. I always love science, and I'm a person who likes to fix things. So, uh, medicine and surgery was a way for me to do that with the most important things I could think of fixing. And that's my my fellow humans and my patients. So that's kind of what pushed me down this road. And, you know, years later, it's it's it's amazing to me to think back on, you know, how physicians can change people's lives and what a special profession we have the honor to be part of.
Henry Bair: [00:05:48] Thank you so much for that. That, uh, incredible story, uh, very personal story. As we talked about earlier. You ended up specializing in ear, nose and throat surgery. Now, I don't know what it was like for anyone else, but I don't think I knew what that branch of medicine and surgery entailed until I got the chance to rotate through it in medical school. It was part of my general surgery, required a rotation. And as part of that, you know, I did. I did half of that was in just general surgery, and half of that was in a specialty surgery, and I was assigned to ENT surgery. I didn't know what to expect. You know, I exposed my previous exposure to you and to ENT was very limited. It was okay, sinusitis, it was ear cleaning, etc. hearing disorders. But what I was absolutely blown away was how much delicate surgery there was involved in ENT. I mean, they, they were doing like, you know, head, face, neck dissections that were so intricate and so, so delicate and precise. I definitely see that that connection between the surgeons who repaired your hand and the kind of work that a lot of ENT surgeons do doing very complicated, multi-layered, um, you know, neurovascular microsurgery on the face and head and neck. Can you share with us what drew you to operate on that area, in particular of the human body?
Dr. Bruce Scott: [00:07:12] Well, many of the things that you say, Henry, are exactly right. You know, the complexity. I mean, even from the first year of medical school and the anatomy, we spent a third of the year working on the face and the neck, not including the brain. You know, that was a different part of neurosurgery and the complexity. So I was drawn to that complexity. But the other thing I think was that through medical school, I enjoyed seeing patients and the office and the clinical setting and the diagnostics, and people don't think about it. But the beauty of otolaryngology is the incredible opportunity to care for a variety of patients. You know, we're a small regional specialty, if you will. But in a given day, I may see a newborn who has a problem that they're born with, or perhaps a hearing problem or something as simple as ostomy tubes. Then my next patient is a middle aged person who just wants to breathe better through their nose, or even just look better. And then my next patient is a person who has head and neck cancer, or perhaps has a skin cancer that's been resected by the dermatologist, and it needs to be reconstructed.
Dr. Bruce Scott: [00:08:21] Or in some cases, you know, allergy. So it's like this variety of patients from basically every age, from a variety of acute conditions, chronic conditions, complex conditions. And I think that's also one of the things that really makes otolaryngologist, if you will, really well suited for leadership in organized medicine, because, you know, I can relate to the primary care doctors I, I bill for my office visits. I can relate to my surgical colleagues. I can relate to the hospital based positions. You know, because I go to the hospitals, I go to the surgery centers, and I work in my office. So it really for, again, a very niche specialty, if you will. It's incredible variety. And I've always been a person who really wanted to fix things. And most of the things we deal with in otolaryngology are a single, defined, fixable problem. Now, not so much if we're talking about tinnitus and dizziness, but for most of the other things, it's an opportunity at the end of the day to really feel like you've helped people.
Tyler Johnson: [00:09:31] So we have had a number of surgeons on the program, and I've discussed this with some of them, but it still is something that fascinates me, you know? So I'm a medical oncologist, and certainly it's the case that medical oncology involves a risky type of medicine. Right. We give chemotherapy, which clearly has a lot of side effects and can have very serious side effects. Having said that, though, the one thing I guess psychologically about medical oncology is that we virtually always get to make our decisions at a little bit of a remove, right? So even if I see a new patient who has a relatively urgent cancer diagnosis or, you know, needs to start therapy quickly, I still have hours, usually days, sometimes even weeks, to make important decisions and to kind of think about things and sort of analyze the problem. And if I want to, I can, you know, talk to various colleagues about it, or I can look up articles or studies or whatever. All of which is to say that from the very first time that I entered in or as a medical student and all the way through to detailed discussions that I have now with my surgical colleagues, which I have those all the time. Right, because I, I work hand in hand with surgeons for, you know, a majority of my patients. The thing that is always so striking to me is the idea of being a surgeon and being in the operating theater, having the person, you know, you have made your initial dissection, you're in there doing the surgery, and now the person's fill in the blank is on the line, right? Their sense of smell, their sense of hearing, the appearance of their face, or sometimes even their life.
Tyler Johnson: [00:11:12] Right. The ability for their face to look the right way, or to have a restored sense of hearing or a preserved sense of hearing or whatever is dependent on decisions that you as a surgeon, make in the moment, right then, right there. And, you know, depending on the circumstance, you know, sometimes if you make the wrong decision, that could have disastrous consequences. And only if you make a series of a thousand correct decisions, you know, with expert technique and all the rest of it, does the thing turn out the way that everybody wants it to? Two. So I guess two questions. One is how do you cope with that reality? And two is what about that drew you to want to do this as a profession like that? That just feels inherently overwhelming to me. It makes my palms sweat just to think about it, let alone to actually be there with somebody, you know, fill in the blank hanging in the balance based on my expertise and technique. So how how is that a thing that you know that you love and that you train for so many years to be able to do?
Dr. Bruce Scott: [00:12:12] Well, Tyler, thanks. You just stressed me out to the max, I tell you. Putting that all down together and really laying it out. And I probably just convinced all the medical students listening to avoid surgery. The answer is, is that, you know, I think that, you know, surgical training is thorough and long, and it's an experience that you draw upon. And the fact that, you know, through residency, there's there's someone always above you to call. All, I would tell you that one of the most stressful days was the my first day as a faculty member at the VA. You know that that July, early July, where everybody transitions and the person who was a medical student yesterday is a resident now, and the person was a resident the day before. Is is now the faculty a pretty scary time? And, um, it hit me that wait a second. I'm the person they're calling when when bad things happen and, you know, you always have someone else there. You know, it's interesting. I will tell you that at in those moments, uh, where there is complexity, muscle memory and experience, it just kicks in. And I will tell you that I both during, uh, I certainly dealt with more acute, severe trauma during my, my residency.
Dr. Bruce Scott: [00:13:32] I did a fellowship in Houston at Ben Taub Hospital where there was plenty of knife and gun club. And then I also trained down in Galveston, where we had lots of trauma. And you just kick it in and afterwards, sometimes you think, how did I do that? And I would tell you that I've had some really difficult, uh, facial nerve dissections where I've been trying to remove a tumor. I mean, I definitely believe in a higher being in some cases, I, I come out of the operating room and I tell my wife, you know, when I get home, I know God was with me today because I don't believe I could have done what I did without, you know, something above. And I believe in that. And I definitely, you know, think that that's real. I think you compartmentalize it. But I know you know and you know that there are a lot of physicians who are burned out right now because of that stress. And it's an issue that we'll probably talk about in this conversation and something that we need to deal with.
Tyler Johnson: [00:14:34] So because you are the president of the AMA American Medical Association, I do want to then talk about. Okay. So you to be clear, right. For those who are maybe still going through training, it's a lot of years to become an ENT surgeon, right. And yet then, you know, on top of all of that, you add this other layer of becoming interested in public policy and in public representation of the medical profession and in the, you know, very complicated world of sort of how do we, as a body of doctors, interface with the rest of the public? So I guess to begin with, how did that all get started? Like, why did you not turn out to be a surgeon who does surgery all the time, or you know, and sees people in the clinic and whatever? How did the public facing and the policy and organizational aspect, how did that come to be important to you?
Dr. Bruce Scott: [00:15:31] What's interesting, I mean, there certainly was no 35 year plan or something back then. I was a fourth year medical Student and I had been involved in research, and I was chosen to be the director of a of a research forum that was funded by the AMA. And so I actually went to my first AMA meeting as a medical student, simply to thank them for the grant and to, as all of us do, as for them to renew the grant for the following year. We needed money to be able to continue the program. And, uh, I went to the meeting and I was waiting my turn to have my say, and I was standing in the back of the room. And I have to tell you, I was just in awe of the process taking place in front of me, of practicing physician students and residents from every walk of life, from every state, every specialty, working together to improve the lives of the nation's patients and physicians. I was hooked. Uh. And I've been back. Now, believe it or not, to 73 consecutive meetings since then. Over the course of 35 plus years, I guess, you know, I caught an illness that I wish more people would catch, and I've not been able to shake it. You know, I spoke earlier about the incredible ability to change lives that an individual physician has as a surgeon or as an oncologist.
Dr. Bruce Scott: [00:16:55] You know, you you know that. But as a physician, an individual, I can only impact one patient at a time or a few patients during the course of the day. But through organized medicine, you know, I can change a community or maybe even the whole health care system with the things that we implement. And you look around medicine and health care and there's there's a lot of things that need to be changed. And there's always been challenges. Maybe now more than ever. But the the ability to really impact that. Um, and that was the first thing. The second thing is that I, I'm an individual through my life have been always involved in rhetoric and debate. I actually went to Vanderbilt University on a partial debate scholarship and was on their championship debate team. Uh, everybody else was going to become a lawyer or a politician. They were all, uh, litigators, if you will, all of which probably make a whole lot more money than me and probably mostly retired now living in desirable areas. But yeah, so I always enjoyed rhetoric and and debate and discussion. And this became my hobby, if you will. This was my way to fulfill that desire, that need of mine. I've been involved ever since.
Henry Bair: [00:18:13] Along the course of your journey, your career, but also even today, what are some of the issues that that really drive you, that make you feel like these are the issues that I can contribute, I can contribute to solving? Like, what are the things that that that really matter to you?
Dr. Bruce Scott: [00:18:29] Well, I'll go back and I'll say, you know, I was elected to be the chair of the Resident physician section many years ago, and I got a phone call one day from a resident at a large training program who was reaching out to the AMA because he didn't know who else to reach out to, who had converted to HIV from a needle stick. Now, this was in the 1990s, where HIV was a death sentence, but it also was stigmatizing because the identified groups that had HIV. And he called me because his program had fired him. He had no disability insurance, no life insurance and no health insurance because they told him that, you know, as a person who had Aids, he couldn't be a doctor, he couldn't be a resident. And so he was summarily dismissed. So we we looked into it and sure enough, we found that there were a lot of residency programs that did not provide Aid for residents the same basic benefits they would provide for their housekeepers. And we went to work and working through the AMA, we were able to change that. We were able to get requirements in that. For you to be in an accredited residency program. You had to have protection for students, for residents. That sort of a victory gives you a feeling that keeps you going for a while.
Dr. Bruce Scott: [00:20:01] I was also involved in some of the early stuff to to fight the tobacco companies. I mean, a big, powerful force, the tobacco companies, to try to get Joe Camel removed from the billboards near the grade schools where he was pushing the tobacco products, and we were able to get that changed. You know, flash forward to some contracting benefits and such that I pushed through when I was the delegate from the Young Physicians section to help protect young physicians who were going out in practice and were signing contracts that they didn't realize what they were signing. And some of that, unfortunately, continues to this day. But we definitely got improvements in that. Student loan forgiveness. So those are all things years ago. And then things now, like we're fighting for things that are so important to protect our patients, whether we're talking about continued coverage for telehealth or continued access to care. And we're fighting for physicians in our profession as well to try to limit administrative burdens of prior authorization and utilization management that basically denies and delays care for our patients. And something as straightforward as Medicare payment, which is a major problem and needs to be fixed. So these are the things that, you know, that we're working on, the things that we've worked on. If I reminisce years ago.
Tyler Johnson: [00:21:27] So of course it has always been the case. If you draw a Venn diagram, there is overlap between the world of medicine and the world of politics. Right? Politics is the way that we get things done as a society in society. And of course, you know, within medicine there are questions where politics has something to say. But I also feel like it is the case that over the past ten years and arguably in in the sphere of public medicine, especially since the advent of the pandemic, it feels like anything that was not previously politicized is now politicized, and anything that was already politicized is even more politicized and often quite polarized. Right? So that, for example, during the pandemic, we saw things which really there's no obvious intuitive reason why, for example, vaccines should have a political valence or wearing a mask should have a political valence, or, you know, certain ways of approaching whatever school closures or restrictions on gathering or whatever. But somehow all of those things came to take on a political valence. And in fact, you know, I feel sort of like emblematic of that is the fact that we recently read in the newspaper that the new president has revoked the Secret Service protection for Anthony Fauci, you know, ostensibly because he is viewed as a sort of a political actor who is now disfavored or what have you.
Tyler Johnson: [00:22:54] And so if there is any organization in the United States that sort of claims the mantle of speaking for, quote, physicians, unquote, as a collective body, I think traditionally it has been understood to be the American Medical Association. And so I guess the question that I have is when presumably even within the body of physicians, many of these questions that have become deeply politicized and sometimes even polarized, there are presumably Physicians all along the spectrum of the way that in terms of how they think about the way that doctors as a collective body should approach any of these and we could name, you know, three dozen other issues should be approached. How does a single organization think about approaching any of those involved problems in a way that seeks to find enough consensus to be able to feel like the organization is, in fact, speaking for physicians as a body, rather than feeling like it's just, you know, one organization over here doing whatever it chooses to do.
Dr. Bruce Scott: [00:24:05] Well, again, Tyler, I give you the award for asking tough questions. Uh, you know, the answer is it's very, very challenging. The American Medical Association seeks to represent physicians of every specialty. We represent physicians of every political bend. Uh, we are truly a nonpartisan organization. Uh, and it's interesting. Over the course of the years, we've we've had people quit because we're too conservative. And we had people quit because we're too liberal. And I've had people quit on the same day because we were on opposite sides of an issue, typically not even knowing where we stood on the issue. All of the policies of the AMA that become our action are adopted by the House of delegates. So for those who don't know the House of delegates, people say, oh, the AMA doesn't represent me. Well, every specialty society, every subspecialty society, every geographic organization is represented within our House of delegates. About 700 voting delegates come together. That's the meeting that I was watching those years ago. And they vote based upon what they believe is best for medicine. Over the last number of years, we've added in special sections for people who represent particular modes of practice. We have a independent practice called the Private Practice section. We have a section for organized medical staff leadership. We have a section for retired physicians or senior physicians, a section for integrated physician groups.
Dr. Bruce Scott: [00:25:45] And then we have a women's physician section, a student section, a resident section, a young physician section, an LGBTQ plus section. And all of these special groups get representation within this mix. So that's how we develop policy. And so the challenge is, is that we are a remarkably democratic organization in that we have a vote. And unfortunately, sometimes the vote is very close. And you recognize, particularly when you take on divisive social issues, that you're going to make people angry and you're going to make other people happy. And then on the next issue, you may flip who you make angry. And so people quit. And it's frustrating because the AMA is the only organization that can speak for all of the physicians. And I think maybe if people understand how the policy is developed. So over the course of my presidency, I have really pushed doctors to look at stop focusing on what divides us, stop focusing on these issues that are primary care versus surgeon, that are liberal versus conservative, and instead think about the things that bind us together, the professional oath that we all took. Our dedication to our patients, our commitment to provide the top quality of care and recognize that as long as we're divided, we will lose.
Dr. Bruce Scott: [00:27:14] And if we unite, physicians can have a powerful voice. There are lots of other people who want to have a have voice in health care, you know. And I say to people, I say, you know, when you say the AMA doesn't represent you, do you want to be represented by the insurance companies? How about the pharmaceutical firms? Well, we could let the venture capital and the private equity people speak for us, or we could just let the legislators figure it out on them on their own. And I think the answer is no. All of that is unacceptable. We need to step forward and lead as a profession, to try to fix what's broken in health care. And whether you like it or not, AMA is that voice. And if you don't like what that voice is saying, talk to your representative. Come to the meeting. Anybody can come to the meeting who's an AMA member and can express their opinion. Join us. We meet every year in June and Chicago. Come and give us your opinion. We will listen. But the most important thing is that after we listen and we decide what is best for the profession, what's best for the patients, then we have to be united or else the other forces will win.
Henry Bair: [00:28:27] As you described what the AMA does, it's important to emphasize that physicians are not a monolith. A family medicine doctor in rural Oklahoma and a trauma surgeon in downtown Philadelphia, and an ophthalmologist in private practice in West Palm Beach, could not be more different from one another in terms of their day to day. How do you, as the elected leader of this disparate group of individuals, communicate and connect with everyone and make them feel represented?
Dr. Bruce Scott: [00:28:57] Well, I think it's what I said, that you try to concentrate on the things that bring us together. You know, as a leader, I try to work from consensus, but at the same time, you know, I have strong principles. And so it's a balance between consensus and conviction, if you will. There are definitely doctors out there who have what I would consider marginal opinion on on issues. And sometimes you try to educate them and get them to see the other side, to walk in the other person's shoes for a day. But again, I think, Henry, the key is for us to focus on those things that bring us together, rather than on the things that do divide us as a trauma surgeon or a pediatrician or a primary care doctor, because there really is a lot that binds us together.
Henry Bair: [00:29:45] As you look at all the trends in medicine today, what are some things that really concern you?
Dr. Bruce Scott: [00:29:51] From a medicine perspective, the thing that concerns me the most is continued access to care. We know that people who don't have access to care live sicker and and die younger or die prematurely. And so it's everything that gets in the way of a physician providing care to their patient. It's the economics of medicine right now where Medicare is paying physicians over 30% less in 2025 than they paid us in 2001. When you adjust for inflation and it's unsustainable. The result of that is physicians are quitting. I mean, physicians are leaving practice or they're leaving private practice. I hear these stories of physicians struggling. The friend of mine who's an obstetrician or was an obstetrician in rural Ohio who closed her practice at the end of October because she could no longer financially sustain keeping the office open and her her husband was no longer willing to, in effect, foot the bill from his business to support her business. This is not hypothetical anymore. There are 1100 counties in the United States where there is no obstetrician, and Aamc is estimating a shortage of 87,000 physicians by the year 2035. Now that's ten years away. But one of the things that I talked to legislators about is it takes ten years to produce a doctor.
Dr. Bruce Scott: [00:31:26] We can't wait to 2034 and say, oh my gosh, there's going to be a shortage next year of 87,000 physicians. So we need to begin tackling that right now. The waste of physicians time, the administrative burdens, the prior authorization. The average primary care doctor spends over 12 hours a week worrying about prior authorization to get the care needed for their patients. The administrative struggles take two hours for every one hour. The average physician has to care for patients. So, you know, I don't live in the dream world. Totally. Maybe I do sometimes. But if we could give back half of that time, if we could give back, cut out half of the administrative burden, if we could focus and be more selective with prior authorization. I mean, it's frustrating physicians, but but it's harming the patients. The care that they need is delayed or in some cases totally denied that they need to go forward. And so it's everything. It's the government interference between the patient and the physician. All of these things that impact a patient ability to get care are the things that are need to be the focus. Right now, the top priorities of the AMA and of medicine in general.
Tyler Johnson: [00:32:47] So given that you are, as we've said, the president of what I think most people would agree is sort of the most prominent public facing coalition of physicians in the United States. There are three specific, particularly salient current issues that I wanted to ask for. Your opinion about that, I think are things that are really important in terms of sort of the the way that doctors interface with the public. So let me just go through these three things. So the first one is I referenced this a little bit in a sense when I was talking about changes during the pandemic. But one thing that is, I think, unquestionably true is that just culturally, we are going through a period of distrust in established organizations of pretty much every kind. Right. So if you look at like Pew data about to what degree does the public trust everything from, you know, the popular press to organized religion to the government, any of the I choose your branch of the government to pretty much any organization. There is a very high level of distrust in that. And by the same token, there is a distrust even of people, just of other people. And there is also a distrust of expertise. Right? There is a lot of questioning of what really constitutes expertise. Who gets to claim expertise, whether people who have, you know, had a lot of years of fancy schooling or really the kind of people that we should be trusting to make, you know, large societal decisions, etc.. And it would seem like those three factors distrust in other people, distrust in organizations, and distrust of education and expertise is sort of a perfect storm for operating conditions that would make it very difficult for the AMA, because the AMA represents all of those things, right? It is literally educated, experienced, expert people in an organization trying to help other people. So how in an age of so much sort of corrosive distrust, how does the AMA try to push back against that and win back or keep the trust of the public towards both individual doctors and medicine as an establishment?
Dr. Bruce Scott: [00:34:59] Well, you're correct that trust in physicians, in general medicine, science has been reduced and has been damaged by the last number of years. But what hasn't been damaged is individuals trust in their individual physician. Those numbers remained very, very high. That people trust their individual doctors now. You can say the same thing even for politicians. People trust their senator. They don't trust the other senators or the general senators in public. So this is not a unique phenomena, but it it is essential. It is crucial that people trust the word of their individual doctors, because when the doctor says, you know, this is a step you need to take, this is a medication, you really will benefit from that. They trust that, but that trust needs to be built by working with the patient. I mean, I'm not a very paternalistic type of doctor, and that I really like to have a conversation with my patients and involve them in the treatment options and involve them in the care. I think one of the things that is unfortunately happened, and I know it's easy to blame social media, but I do believe that part of the polarization that has occurred is because you are fed what you believe, and if you click on something that that says that the earth is flat, you start getting more information that says the earth is flat.
Dr. Bruce Scott: [00:36:33] Whereas if you click on the fact that you think the earth is really round, you don't get any information about the Earth being flat. And I'm using a silly example, but you can imagine how this translate weather, you know, whatever the issue is that your social media sends you, in effect, what you want to read, what you want to hear. You know, sometimes I will have fun when I rarely get to watch television, but I will flip between certain liberal news channels and certain conservative news channels. And you wonder if you're if you're hearing about the same story because it's so different and that's what their particular audience wants to hear. And, you know, physicians need to work to educate their patients. They need to reality set their patients. And that's not always easy, particularly in the polarized world in which we practice right now.
Tyler Johnson: [00:37:33] All right. So that was one of three. Here's number two. So you know, we are, I think, on the precipice of the widespread uptake of the use of artificial intelligence into medical practice. And in some places here in Silicon Valley, we're already starting to see that. Right? I already have colleagues who use, for example, artificial intelligence based scribes or are beginning to debut that in their clinics. If we look back 15 years ago to the time when Barack Obama was the president, there was a widespread federally A mandated effort for uptake of electronic medical records. And on the one hand, I think, uh, there's nobody who probably wants to go back to the time when complicated patients had, you know, ten, two inch, three ring binders holding their medical records. Right. And it was like going to the archives in Rome or something to try to get somebody's medical history. I don't think anybody thinks that's a good idea. But it is also the case that the advent of the of the widespread adoption of electronic medical records has led to a whole bunch of unintended consequences, chiefly that I think most physicians and we've talked to many experts and individual physicians about this on the program, feel that the electronic medical record, at the end of the day is optimized for profit for health care companies and to maximize billing potential.
Tyler Johnson: [00:38:53] It is not optimized for patients and it's not optimized for physicians. And so as a consequence, everybody who is in health care knows what most doctors end up doing now. And you referred to some of this earlier, is that you spend however much time you spend taking care of patients. Then you go home and you know, whatever. Have dinner and put your kids to bed and then spend hours after that doing, you know, coding and whatever in the electronic medical record. In effect, to ensure that the entity for which you work is able to maximize its, you know, billing or that you're able to recoup your costs if you're in private practice. And so all of that is to say that as we're looking to figure out how AI is going to be integrated into healthcare, how does the AMA plan to try to help ensure that the ways that in which AI is integrated are better optimized to serve physicians and patients, rather than serving health insurance companies and other corporate entities that stand to profit off the way that it's used.
Dr. Bruce Scott: [00:39:53] Right. I think it's a great question. You know, and and you've introduced the analogy that I use. I, I talked to audiences about that. We don't want to create another problem of pardon me, but epic proportions. As every physician will appreciate the pun, if you will, the electronic medical record was forced down physicians throat. We didn't want it. We didn't welcome it. And the reason we didn't was because we weren't involved in the development of it. And even to this day, it doesn't work well in our clinical settings. It is, as you described, a billing system, a documentation system, and we could talk about all the flaws. So the AMA is very concerned that we not let this happen again. And in terms of AI, we like to call it augmented intelligence rather than artificial intelligence and augmented intelligence in order to emphasize the human role, the fact that the physician needs to be at the center of this and that I, you know, ChatGPT the computer is one more tool, and physicians should be involved in the early stages of development, and then it should. They should be involved in the implementation of this, making sure that it actually works in my office.
Dr. Bruce Scott: [00:41:20] And there are great opportunities here. Opportunities, as you already mentioned, for reducing the documentation burden that has been put upon us. Passive listening that helps you write your note, perhaps some improvement in terms of diagnostic management and differential diagnoses and some really. One of the things I'm excited about, I don't don't want your listeners to leave depressed to God. That AMA guy said. There's a lot of problems, there are a lot of problems. But we're at an exciting time in medicine. You know, we're we're unlocking the genome, digital surgical, robotics and all the AI and technology opportunities we need to make sure that physicians are involved. I mean, at the end of the day, what doctors want to know is, does this work? Does it help my patient? Does it help me deliver the care to my patients? And more importantly, does it work within the reality of my practice? And I think that's the key in getting physicians to buy in to whatever the new technology is. And that's what wasn't done when the EHR was implemented.
Tyler Johnson: [00:42:33] So the third question of my three, which I think is the most important of them. You know, it's really striking to me, you mentioned from your time when sort of early on in your your policy work in the AMA, that one of the things that you were doing was working to combat the influence of big Tobacco. You talked about Joe Camel and all of that. And what is really striking to me is that, you know, if you think about back about the 60s, 70s, 80s, I think everyone would agree that one of the most important and successful public policy pushes from that era was precisely the push against Big Tobacco. Right. And it's it sort of jarring for us to recognize, like, if you watch old movies or whatever, that smoking used to be seen as glamorous and that some celebrities even touted it as having health benefits and whatever. And that big tobacco is, you know, we know now hid the ill effects and. Et cetera. Et cetera. But what is striking to me is that, in a sense, you can make an analogy between that the big tobacco of 30, 40, 50 years ago, whereas that was the thing that needed a surgeon general's warning at the time to kind of push it to the forefront of the public's mind. One of the most recent, and I would argue, important Surgeon General pronouncements now is about what Doctor Murthy has called the epidemic of loneliness.
Tyler Johnson: [00:43:55] And by the same token, we have seen as we have. You know, we've been doing this podcast for very nearly three years now. We've had more than 150 hours of pretty probing conversations here that many physicians recognize. This is not exactly the same thing as loneliness, but that there is a sense of a kind of a loss of philosophical sense of mission among many physicians that in the same sense that people seem to have lost connection to other people, all the loneliness that there seems to be in many corners, a loss of connection to what it is that makes being a physician special and meaningful and wonderful, that there is this sense that somehow the philosophical or moral or spiritual core of medicine has kind of been hollowed out for a whole bunch of, you know, complicated reasons over many years. And so I guess while I recognize that that's a, you know, a very sort of big problem to lay out. I am nonetheless genuinely interested. What, if anything, is the AMA doing to try to address this sense of sort of philosophical drift, or of this kind of hollowing out of the deeper part of what it means to be a doctor?
Dr. Bruce Scott: [00:45:17] Well, unfortunately, you know, I think this manifests itself as burnout. And in tragic instances, it manifests itself in suicide, and physician suicide has reached, you know, higher numbers over the last number of years and than ever before. The loneliness factor manifest, I think, in all of our society during, you know, the stay at home isolation and Covid, that a lot of people's response. And I think what the surgeon general was speaking about in the position paper was about largely social media and the Isolationism of people who. They have. I read the quote someplace that says, I have thousands of friends. I've just never met any of them. And that's not the interpersonal relationship. Now for positions. We have the opportunity to have that interpersonal relationship, to touch patients, to hold the hand of a patient, to be there at some of the happiest moments and some of the saddest moments of a patient's life. And we all need to recognize that when we talk about physician burnout, one of the things we recognize we need to do is treat the underlying root cause the frustration. What makes physicians happy? It's really pretty simple. Taking care of patients and what makes us unhappy are things that get in the way. The administrative burdens, the rules, all of the challenges that we face every day. And so the AMA is really working to bring back that joy in medicine, if you will, by getting us back to taking care of patients and using the phrase joy and medicine. One of the things we've done over the last number of years, and it's been very successful and increasingly successful, has been working with large employers, whether it's a hospital system or it's an employment system of doctors, to work with them to survey their doctors.
Dr. Bruce Scott: [00:47:23] What is it that's dragging you down? And are the particular policies of this particular hospital system that we can change and work with the administration and then recognize that administration for the fact that they're trying to restore the joy in medicine and that we recognize these hospitals, and we've recognized over 130 hospitals and hospital systems and employers over the last couple of years by this Joy and Medicine Award. Another factor that I think is just really important to recognize is that society as a whole still has a stigma about mental health problems, and particularly physicians and physicians don't want to admit that weakness, if you will, of those stresses that we talked about earlier that they're finally getting to me and I need help. And one of the reasons for that is physicians fear that when they fill out their next credentialing or licensing form, they're going to answer the question, have you ever had a past diagnosis of a mental health illness? And if you say yes, then that leads to a whole new level of scrutiny. So AMA has worked with a majority of states over 27 states now have changed that wording to say, do you have current impairment? And we've worked with credentialing agencies and hospitals all around the United States to not only remove those questions, but to encourage physicians to get help when they need help before it becomes a crisis. So we want to work at it from a perspective of getting rid of the root cause, but also from a perspective of preventing the crisis and making sure that people are willing and able to get help when they need it.
Henry Bair: [00:49:14] So I'm currently a trainee in ophthalmology. I've been interested in health policy since medical school, but I have to say ophthalmology is a rather insular specialty. Most eye clinics, even when affiliated with a larger hospital, are often in a standalone building. We don't often collaborate with other disciplines, with some exceptions. Ocular plastic surgeons, as you know, work with ENT surgeons a lot. But for the most part, ophthalmologists think of themselves as functioning very independently. And indeed, for some, this is a big part of what drew them to this field. I can't really think of many ophthalmologists who have led the AMA or other similar nationwide medical organizations. What is your advice for someone like me who is interested in policy, but maybe doesn't see an intuitive or direct path to it? How can we get involved?
Dr. Bruce Scott: [00:50:10] Well, Andrea, first of all, let me tell you that for a person who opened the discussion with talking about ENT dealing with delicate, uh, items, uh, you're an ophthalmologist. My goodness. The chair elect of the American Medical Association's board of trustees is an ophthalmologist. The ophthalmologist are a very strong force within our AMA. And talk about, you know, again, I'm just you picked up the biology. We could do this with most any specialty. But issues impacting ophthalmology that are at the top of our priority list. I think the ophthalmologist a lot of times deal with Medicare patients. Uh, if you've ever heard of cataracts and so Medicare payment is very important. Optometrists are pushing all around the United States for increasing scope of practice. And and making sure that patients get care by a qualified physician is one of our top priorities. And the ophthalmologists are all over. That is, we successfully fought optometry practice expansion in multiple states just this last year. So ophthalmology is definitely important to us and definitely a factor. But in terms of generically, I think the key for students and residents and any position is to get involved is to show up.
Dr. Bruce Scott: [00:51:30] I mean, sign up to be a member. Show up for a meeting and you already have put yourself in a rarified group because most physicians unfortunately, this has been our problem for years, like to stay home and complain. They don't like to get involved and we need physicians, particularly young physicians, to get involved. And once you show up for a meeting, volunteer for something that you will be embraced. We all are looking, whether it's the state, the county, the specialty societies are all looking for new and expanded leaders, particularly young leaders. And I think one of the things to drive them is to understand that your voice is important, that we want to hear the voice. One of the largest voting blocs in the AMA is the medical student section. Another is the resident section. Voting is all based upon the number of members that you have. And we have a lot of student members. So students have a strong voice within the AMA to help us determine our policies and help us determine our priorities. So in this organization, your voice really does matter. And that's absolutely true as well in your states and your specialties.
Tyler Johnson: [00:52:47] Great. I want to wrap up with one final question. If you were on the wards or whatever and attending, and you had with you many of the people who listened to the program or medical trainees, from what we gather, if you had with you, let's say, maybe a third year medical student who was just on, you know, their first year on the wards, or maybe an intern who was in the first year of their subspecialty training or what have you, and you had a moment to just say, here's my most important advice. The thing that I wish I had known when I was at your, you know, your spot in my own training. What would you say to them? What is the most important thing, do you think, for them to learn or to remember.
Dr. Bruce Scott: [00:53:27] To always keep the patient as your central focus and to remember that you are a patient yourself as well?
Tyler Johnson: [00:53:34] All right. Well, Doctor Bruce Scott, we are so grateful to have the president of the American Medical Association join us on the program. We know that your time is precious, and you're extraordinarily busy with a lot of people who who want a slice of your time. And so we thank you so much for being here, and we appreciate having had you on the show.
Dr. Bruce Scott: [00:53:52] Well, thank you all for the opportunity.
Henry Bair: [00:53:58] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the doctor's Art. Com. If you enjoyed that episode, please subscribe, rate and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:54:17] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments. I'm Henry Bair and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.