AI Can Be a Boon to Clinicians -- If Used Correctly, Says AMA President

Artificial intelligence (AI) -- when used for the right purposes -- can help ease the burdens created by the nation's physician shortage, American Medical Association (AMA) president Jesse Ehrenfeld, MD, said Wednesday at the National Press Club in Washington.

"We can provide things to make it easier for people to practice medicine," Ehrenfeld, who is board-certified in both anesthesiology and medical informatics, said during a question-and-answer session. "I'm a big believer in technology, but we have to have technologies that work for doctors and for patients."

The rollout of electronic health records "was a bumpy road," he continued. And the reason it was bumpy was the systems were not usable. They were not designed to meet our workflows. And we had a disconnect between these technologies and what people actually needed ... But there is a way to make these technologies -- AI software, medical devices, digital therapeutics -- an asset, not a burden. It requires the voice of the physician being present throughout the design and the development cycle."

One example of artificial intelligence being put to good use in medicine is the first autonomous AI device approved by the FDA, which was in the area of diabetic retinopathy, Ehrenfeld said. "We do not have enough ophthalmologists to screen every diabetic patient in America ... We will never have enough."

However, "there is a little box that you can put in a retail pharmacy -- you can put it in a primary care office, you can put it anywhere you want," he explained. "Any high school-educated operator can put a patient in front of it, take pictures of the retinas, and the AI is so good and the image recognition is so good that the company carries malpractice insurance on the device."

"Suddenly you can screen millions of patients overnight right with this device, and then the ophthalmologist only has to see the patients with disease," he added. "It changes the workflow, it augments the capabilities, it scales the capacity of the workforce, and those kinds of tools I think are really exciting and where AI is going to make a big difference."

Tools like this will be needed to augment the workforce at a time when the nation is facing a physician shortage, a topic Ehrenfeld addressed in prepared remarks delivered prior to the question-and-answer session. "The physician shortage that we have long feared -- and warned was on the horizon -- is here," he said. "It's an urgent crisis ... hitting every corner of this country – urban and rural – with the most direct impact hitting families with high needs and limited means."

In addition, "while our current physician shortage is already limiting access to care for millions of people, it's about to get much worse," he said. "Consider that roughly two in three doctors admitted to experiencing burnout during the pandemic, according to a survey from the AMA, the Mayo Clinic, and Stanford Medicine. That's the highest level of burnout ever recorded by the AMA."

"Consider that nearly half of all practicing physicians in the U.S. today are over age 55," said Ehrenfeld. "And while medical school applications are up, it can take a decade or more to educate and train a physician ... It's no wonder why the Association of American Medical Colleges projects a national physician shortfall of at least 37,000 – and possibly well over 100,000 – over the next decade."

One way to address the burnout problem is to make it easier for physicians experiencing mental health problems to get the care they need, he said. "We're urging states and physician employers to audit their own licensing and credentialing applications to remove questions that ask about past diagnoses of a mental illness or substance use disorder, or past counseling to help with one."

"Seeking care for burnout, mental illness, or a substance use disorder is a sign of strength -- an act that takes courage and deserves our health system's unconditional support," he added.

Decreasing Medicare reimbursement is another big problem for doctors, he said. "When you adjust for inflation, the payment rate to physicians who care for Medicare patients has dropped 26% since 2001 ... with additional cuts planned next year. I don't know many businesses in any industry that could withstand a 26% drop in revenue and still survive."

To solve that problem, "we need Congress to pass the bipartisan bill that was introduced in the House of Representatives earlier this year, the Strengthening Medicare for Patients and Providers Act, which would do what the AMA has long advocated for ... provide physicians with annual payment updates to account for practice cost inflation," he said. "This would simply put physicians on equal footing as inpatient and outpatient hospitals, skilled nursing facilities, and others who receive payment through Medicare."

To help increase physician supply, "we also strongly support the Healthcare Workforce Resilience Act, which would recapture 15,000 unused employment-based physician immigrant visas," said Ehrenfeld. Another worthy measure in this area is "the Physician Shortage GME Cap Flex Act, which expands residency training programs in primary care or other specialties that are facing shortages," he said.

Ehrenfeld also said that states need "to stop criminalizing healthcare, healthcare that is widely recognized as safe, healthcare that is backed by science and many years of evidence." He noted that the Supreme Court's decision last year to overturn Roe v. Wade "has radically changed the healthcare landscape in America – for both patients and for physicians. Fourteen states have enacted outright bans on abortion, and seven others have enacted partial bans."

"These efforts – fueled by misinformation and a heated attack on science and evidence-based care – have forced government into the most intimate and difficult decisions a person can make," he said. "They have made physicians – and other healthcare workers – the targets of attacks and intimidation. They have caused aspiring young physicians to reconsider where they will attend medical school and where they will ultimately practice. And they have needlessly jeopardized the health of millions of Americans."

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