New AMA President: 'It is Such an Honor to be a Doctor'

A practicing family medicine physician from South Carolina becomes 176^th president of the American Medical Association.

The new president of the American Medical Association says physicians have a key role to play in the lives of their patients.

Gerald Harmon, MD, is a practicing family medicine physician based in South Carolina. He has been a member of the AMA board since 2013 and served as board chair from 2017 to 2018. Before his election to the AMA board, Harmon served on the AMA Council on Medical Service.

Harmon is a clinical professor at two South Carolina medical schools. He also is a member of the clinical faculty at the Tidelands Health MUSC Family Medicine residency program.

Harmon was inaugurated as the 176^th president of the AMA in June, succeeding Susan Bailey, MD. He recently talked with HealthLeaders about a range of healthcare topics, including the pandemic, health equity, and physician burnout. The following is a lightly edited transcript of that conversation.

HealthLeaders: At this stage of the stage of the coronavirus pandemic, what is the primary pandemic-related challenge facing physicians?

Gerald Harmon: Physicians have always been shown to be one of the most trusted sources of information for patients. The patients get direct advice and recommendations from their physicians. Now, physicians need to encourage vaccine confidence and encourage improved access to vaccines.

Vaccine administration has slowed because it is not quite top of mind for a lot of folks. So now, it is critical for physicians to have the vaccines available to vaccinate their patients. We know physicians have been eager to vaccinate patients, and we are still trying to make sure that physician offices across the country have a vaccine supply.

So, it is important for physicians to serve as a source of vaccine information and encourage their patients to receive the vaccine, but it is also important for vaccine suppliers to get vaccines into physician offices and practices so they can give those vaccines to patients and reduce the spread of COVID.

HL: What can physicians say to their patients to increase confidence in the vaccines?

Harmon: There is some misinformation in the media and social media. I try to offer to my patients that there are proper vaccine protocols. I say these vaccines were developed rapidly but not by missing any scientific hurdles.

The messenger RNA and adenovirus technology was taken off the shelf. We did not have to go through funding hoops because the federal government applied funding upfront. The absolute rigor of the scientific process was followed, and these vaccines are among the safest and most effective ever developed. Patients should have every confidence that these vaccines are safe.

HL: How can physicians help to advance health equity?

Harmon: One of the things I get to be is the spokesperson for the AMA's health equity accelerator. Part of our mission statement is advancing the art and science of medicine and the betterment of public health. It is hard to do that without advancing health equity and addressing healthcare disparities. So, health equity is critical to our mission statement.

We released a plan in May with different actions on health equity. We want to promote equity and racial justice in the AMA itself. We want to expand the capacity to understand and implement anti-racism and equity strategies. We want to build alliances with other stakeholders. We want to look upstream to social determinants of health and root causes of inequities. We want to ensure there are equitable structures for providing healthcare such as broadband expansion into underserved and rural communities. Finally, we want to foster some pathways for truth, education, reconciliation, and transformation for AMA's past racial inequities.

It is a big deal. We have had policies established by the AMA House of Delegates establishing that race is a social determinant of health.

HL: Assess the impact of the coronavirus pandemic on physician burnout.

Physician burnout has worsened. Physicians and others absolutely stepped up during the pandemic. They had taken an oath to take care of people. They risked their lives and even the lives of their families by taking care of COVID patients.

A factor that has limited burnout during the pandemic is a renewed sense of purpose. We have done some surveys at the AMA during the pandemic that found that as many as 48% of doctors felt a renewed sense of purpose. They realized that the practice of medicine was a calling. We have had some psychological, emotional, and physical burnout, but we have had a renewed sense of purpose.

Now that the adrenaline is pulling back and we are getting into a post-pandemic steady state where we do not have the overwhelming burden of COVID disease, we still have barriers to physician satisfaction.

We have the barrier of electronic records not talking with each other. We have statistics that physicians spend many hours per year just waiting to log on to an electronic record. We also know that for every hour of direct patient care, physicians spend up to two hours documenting what they did—so it is a very inefficient system. Then we have the barrier of prior authorization, whether it is a prescription drug, a referral to a specialist, or an imaging procedure. We know that the average doctor has almost 40 prior authorizations to process every week. We consider prior authorizations to be barriers to care. We have a lot of disincentives for physician morale to stay high.

HL: What are some of the primary solutions for physician burnout?

The AMA has some prescriptions for physician burnout. If you have an energized and engaged workforce of physicians that is resilient, it is essential for achieving national health goals. We also know that burnout it is not only a physician workforce issue—a healthcare organization must become resilient itself.

For example, if I work for a large health system, I want the organization to develop a resiliency policy. The health system cannot just say that doctors need to be more resilient and work harder. Healthcare organizations can take a more systemic approach. They can focus on staffing and scheduling. They can focus on giving physicians the right tools. They can focus on getting better vendor support for electronic records. They can work with physicians to reduce the burden of credentialling. These irritators can be reduced without reducing quality of care.

HL: What advice would you offer to new physicians who are just beginning to practice medicine?

Harmon: Remember your opportunity to be a doctor. If you are a new doctor now, you have been given a gift. You can treat your fellow human with a level of trust that you have never had before.

To get to be a practicing doctor today, you have climbed a steep hill. You have gone through education in the twelve grades, then you qualified for a college-based degree, then you qualified for medical school. You have met all kinds of successful standards—you can take data, analyze it, and come up with a meaningful application to benefit humankind. You are an extraordinarily gifted person if you are a young doctor. Take that to heart without getting an artificial sense of self-importance. Apply your gift.

Whether it is me as a family medicine physician, an emergency room physician, a researcher, a pathologist, and all manner of physicians in practice, it is such an honor to be a doctor. I recommend to every doctor—take advantage of that honor and be proud of being a physician.

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