Jack Resneck Jr. shares the agenda for his American Medical Association presidency and prescriptions for some of the biggest challenges facing physicians.
A top priority for the new president of the American Medical Association is a recovery plan for the nation's physicians.
Jack Resneck Jr., MD, was recently inaugurated as the 177th president of the AMA. He is a practicing dermatologist in the San Francisco Bay Area and is the first dermatologist to serve as AMA president since 1925.
Resneck was elected to the AMA Board of Trustees in 2014, and he was board chair from 2018 to 2019. Before being elected to the AMA Board of Trustees, he served as chair of the AMA Council on Legislation and as a delegate to the AMA House of Delegates. Resneck has held several other leadership positions, including serving as the president of the California Society for Dermatology and Dermatologic Surgery.
HealthLeaders recently talked with Resneck about issues related to his AMA presidency, including his agenda, physicians and the coronavirus pandemic, and how physicians can address health equity. The following transcript of that conversation has been edited for brevity and clarity.
HealthLeaders: Physicians have been on the frontline of the pandemic for more than two years. What concerns should we have for physicians at this point in the pandemic?
Jack Resneck Jr.: First, I have never been prouder to be a physician as I look at my colleagues across the country and watch what they have endured and what they have done to support the country the past couple of years. They have put their lives on the line. Early in the pandemic, doctors were sleeping in their garages or tents to protect their families.
In terms of concerns, physicians have been holding together a health system that has been stretched too thin and tested by the pandemic. I have an enormous amount of concern about physician attrition and retirements. The AMA led a study that showed about one-in-five of physicians and about two-in-five of nurses intend to leave their professions in the next two years. On the physician side, we know that replacement costs are substantial. For organizations that employ physicians, the replacement costs are between $250,000 to $1 million per physician. The aggregate costs of physicians reducing their work time due to burnout alone is estimated to be $4.6 billion a year in the United States.
At the AMA, we are focused on what we are calling a Recovery Plan for America's Physicians.
HL: What are the top agenda items for your AMA presidency?
Resneck: We have already talked about COVID stretching the healthcare system to the brink and furthering burnout among physicians. I feel strongly that our nation must renew its commitment to physicians and the patients they serve.
The Recovery Plan for America's Physicians has several points. One of them is addressing burnout and destigmatizing mental health issues for physicians. Another point is removing dysfunction from the healthcare system, which goes hand-in-hand with addressing burnout because dysfunction is a major driver of burnout. Prior authorization is a good example—it has grown out of control in the past few years. I have been a practicing physician for about two decades, and I remember a time when prior authorization was focused on a few expensive medications or tests. I now have to do prior authorizations for generic topical creams that have been around since the 1960s.
A third pillar of the Recovery Plan is stabilizing Medicare payments. We have seen two decades of nearly frozen payments as practice costs have gone up and inflation is now accelerating. Whether you are a large health system or a small physician practice, that is just unsustainable. In order for health systems and physicians to be able to invest in the future of healthcare, Medicare payments have to get fixed.
Fourth, the AMA is also focused on team-based care and making sure physicians are recognized for their expertise at the top of those teams. And fifth, we are focused on innovation and continuing to further telehealth and other innovations that help physicians move forward.
In terms of other top agenda items, I want to focus on a couple of other things. One is innovation more broadly. It has been a priority of mine for several years that when we have seen innovation go wrong in healthcare—such as lousy electronic health record products—it has been because physicians were not in the room in the early stages when the building blocks were being created. So now, with digital health and artificial intelligence, the AMA is working hard to bring physician values to the table.
Second, I want to keep politicians out of exam rooms. In reproductive health, transgender care, and other areas, we have seen states inserting politicians into the decision-making process that should be between doctors and patients.
Finally, I want to advance health equity. There are shameful inequities in our healthcare system for Black, Brown, Indigenous, and other marginalized patient populations.
HL: What can physicians do to address health equity?
Resneck: At the AMA, we created a Center for Health Equity a few years ago. In 2021, we released a plan to embed racial justice and advance health equity at the AMA and in healthcare. We are committed to eliminating longstanding health inequities and improving outcomes for historically marginalized populations.
There are many pieces to this work. One piece that is very important is reckoning with our own history at the AMA. We have been around for a long time and have done things in the past that have exacerbated inequities. Ultimately, addressing health equity is about embedding this work across the entirety of our organization, whether it's in how we think about chronic disease, whether it's thinking about medical education and having a pipeline of future physicians that looks like the patients we serve, whether it's in advocacy, litigation, or innovation. The effort needs to be on all fronts—it is not siloed work.
As physicians inside the AMA and nationally as a profession, we have an important role to play. This is part of our medical ethics and important to do for the patients we serve.
As individuals and groups, there are several steps physicians can take to address health equity. First is just being committed to doing the work. You must call it out and make it clear that this is something that you are committed to.
We have to have the education and training to shift our norms and practices. We need to be working in medical education to make sure we are producing physicians who are prepared to do this work. We must do the reading of the research so that we know the steps that we need to take.
Within our practices and organizations, we must analyze data to understand where inequities exist and are emerging. We need to develop a clear vision and goals within our practices and our communities. We need to do the work by launching targeted improvement efforts and measuring our progress as we go.
HL: How can healthcare organizations address physician burnout?
Resneck: We know that burnout can be reduced or even prevented with intentional organizational initiatives. The return on investment for organizations that address burnout can be substantial.
Since 2012, the AMA has been a leader in the national conversation on the physician burnout crisis. We have approached burnout in a data-driven way—both in terms of identifying what the problems are and what the solutions are.
Burnout manifests in individuals, but we think it originates in systems, and physicians cannot solve this crisis on their own. Addressing burnout requires a comprehensive strategy and investment to target barriers and burdens. Addressing burnout is not about yoga classes, dinners with leadership, and resiliency training, which are all lovely add-ons, but they are not at the core of what is going to solve burnout. If anything, they send the wrong message, which is the problem is with the physician as opposed to being with the system.
There are three things that systems must do to address burnout. First, measure burnout with validated tools such as the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index. Knowing where you are starting is important. Second, for healthcare organizations, addressing burnout must be an organizational value. It must be on the leadership dashboard and resourced. Third, the changes must be real. Physicians need real help with tasks that do not need to be done by physicians. For example, the in-basket in electronic medical records requires a team-based approach.
HL: What advice do you have to offer to new physicians entering the field?
Resneck: Given the challenges of the past two years, it would be easy for new physicians to be hesitant about the field. But I love my job—whether it is the part of my job that involves going into an exam room and working one-on-one with a patient or whether it is getting involved in policy and advocating on behalf of physicians.
I love what I do. So, I hope young physicians can be optimistic about the future that is ahead because we still have one of the coolest jobs possible. Physicians are incredibly lucky and privileged to do our work.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Jack Resneck Jr. is the first dermatologist to serve as president of the American Medical Association since 1925.
Resneck believes the physician burnout crisis is a systemic challenge that physicians cannot solve on their own.
He says physicians have an important role to play in addressing health equity, adding it is a matter of medical ethics.