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NATIONAL HARBOR, Md. -- American Medical Association (AMA) President Jesse Ehrenfeld, MD, MPH, urged his fellow members to continue the good fight against the multifront crises in medicine.

Burnout, mental health issues, political pressures, and financial strains are all taking a toll on physicians. Ehrenfeld, who is an anesthesiologist at the Medical College of Wisconsin in Milwaukee, shared examples of the challenges that he'd seen clinicians contend with, such as a physician who left her community and the LGBTQ clinic where she worked because of "legislative overreach" and a colleague who had a breakdown in the physician's lounge. He also referred back to his inaugural speech and the loss of his friend, an emergency medicine physician, to suicide.

Ehrenfeld shared photos from "" an art exhibit by Jeremy Rosario in Columbus, Ohio. Rosario used medical waste to create portraits of physicians who died by suicide.

"I know the work of advocacy isn't easy ... but the truth is nobody's going to do this difficult work for us. It has to be us, " said Ehrenfeld during a presidential address at the AMA Interim Meeting of the House of Delegates.

"Medicine is not just at a crossroads...it's at a crisis. And we demand action," he stated.

On the financial front, Ehrenfeld emphasized that Medicare's "inadequate" reimbursement rates, particularly for those in private practice, can make it hard to keep afloat. "Adjusted for inflation, physician payment under Medicare has dropped 26% since 2001...with more cuts planned next year," Ehrenfeld said, adding that rising inflation, along with increasing personnel and practice costs, have worsened an already tough situation.

He said that his parents' primary care physician stopped accepting Medicare payments so, like many seniors across the country, they had to find a new physician. That can lead to a "frantic search" for a new doctor and, in some cases, "delays occur and things get missed," he said.

But the AMA is doing its part to battle for better economics, he noted, by urging Congress to block the 2024 Medicare payment cuts, and by championing a that links Medicare physician payment to the Medicare economic index. This would put physicians on the same financial footing as other providers in the program, he said.

"When a system becomes so broken that, year after year, it places greater financial pressure on physicians -- in fact, penalizing them for providing care to Medicare patients -- we cannot simply shrug our shoulders...we must keep the pressure on and we will," he added.

The AMA also has made progress on key pillars of its to stop "," support expanded telehealth, fix the prior authorization process, and eliminate the stigma around physician burnout while prioritizing mental health.

"These are not just words on paper; the AMA is making real progress on each of these pillars," he said. Some examples are:

• New CMS regulation that "right-sizes" prior authorization requirements in Medicare Advantage plans, along with the prior authorization reforms bills that have been introduced in more than 30 states and that have been adopted in roughly 12.
• A voluntary effort by Cigna and UnitedHealthcare to reduce prior authorization hassles.
• Approximately 85 state-level scope-of-practice victories, as a result of the advocacy of the AMA and its federation partners.
• Recognition given to 72 health systems, hospitals, and medical groups for their leadership in developing "a roadmap for reducing burnout" and supporting physician well-being.

"There is no doubt that this is hard work, but our voices, our stories, and our experiences are powerful, and we must amplify them to shine a light on what is truly happening in our healthcare system," Ehrenfeld said, "because despite ongoing efforts to undermine faith in science and medical institutions, people still trust and believe in their physicians."

A previous version of this story stated that this was Ehrenfeld's final address. Ehrenfeld's term ends in June 2024.

If you or anyone you know is in crisis or has thoughts of suicide, please call the

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