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AUA ADVOCACY The Role of the American Medical Association in Physician Advocacy
By: Hans Arora, MD, PhD, University of North Carolina at Chapel Hill; Willie Underwood III, MD, MSc, MPH, Board of Trustees, American Medical Association; Ruchika Talwar, MD, Vanderbilt University Medical Center, Nashville, Tennessee | Posted on: 09 Jun 2023
This article represents a recap of our presentation at the recent 2023 AUA Annual Urology Advocacy Summit held in Washington, DC, on February 28, 2023.
The American Medical Association (AMA) is one of the oldest and broadest national medical societies in the country. Throughout its history, it has played a part in major policy changes in American health care, including the development of the Flexner Report, leading the charge on banning smoking on airplanes, fighting medical quackery prior to the founding of the Food & Drug Administration, and shepherding major changes to health care legislation. The AMA continues to lead and innovate in areas of medical education, public health, medical ethics, diversity, equity and inclusion, and of course legislative advocacy.
Often criticized for the positions it has taken on certain issues, the advocacy and legislative priorities which the AMA chooses to support are rooted firmly in its internal policies, which are developed through a purely democratic process within its House of Delegates (HOD)—the principal policy-making body of the AMA. Over 500 delegates (and an equal number of alternate delegates) representing over 190 state and specialty medical societies come together twice per year to discuss and debate issues related to health care policy, medical education, ethics, public health, and internal governance through a process governed by parliamentary procedure in order to ensure fairness. Ideas are presented by individual delegates or societies as “resolutions,” which are discussed at the HOD, and, if passed, are forwarded on to the Board of Trustees for execution; subsequently the AMA works to enact the changes or act on the priorities determined by its members (see Figure).
Voting delegate seats in the HOD are apportioned to a society according to the number of dues-paying AMA members it has. The AUA maintains 2 full physician seats within the HOD, as well as a resident/fellow seat. We are also incredibly fortunate to have as a member of the Board of Trustees, in a major leadership role, a fellow urologist and AMA member, Dr Willie Underwood III. In addition to this small cadre of urologists representing the AUA, our voice is amplified by 14 additional urologists representing other state and specialty societies.
The AUA is a relatively small specialty society representing a relatively small medical specialty (take for instance, the American Academy of Pediatrics or the American College of Surgeons as counterexamples). As a result, we are often asked, what is the value in our participation in such a large policy-making body? Over the years, we have both participated in and led items of both direct and indirect impact on the practice of urology, including issues of fertility preservation, urological trauma, parity in military reproductive health insurance coverage for all service members and veterans, surrogate decision-making for pediatric care in the case of differences of sexual development, preserving the independence of the Urology Match, access to PSA screening, USPSTF (United States Preventive Services Task Force) reform, and telehealth. When we consider issues of alignment, a cursory review of AMA policies (https://policysearch.ama-assn.org/policyfinder) reveals multiple relevant AMA policies for each of the AUA’s Federal Legislative Priorities (see Table)—in fact, the AMA has had policy in support of access to prostate cancer screening since 2000!
Table. AUA Legislative Priorities and the Number of relevant American Medical Association Policies
| AUA federal legislative priority | Example of relevant search terms | No. AMA policies |
|---|---|---|
| Promote permanent reforms for Medicare physician payment and reimbursement that provide stability for all practice models. | Medicare physician payment | 248 |
| Reduce administrative burdens (prior authorization and step therapy, medical malpractice) that negatively impact the practice of medicine and patient care. | Reduce administrative burdens Prior authorization Step therapy Medical malpractice |
112 |
| Advocate to ensure access to telehealth services as an alternative health care delivery model in urology to address access to care and health care equity. | Telehealth/telemedicine | 33 |
| Improve health care outcomes through the preservation of access for all treatment options for urological disease states. | Access for all urological treatments | 1 |
| Advocate for the full spectrum of prostate cancer care including, research, USPSTF reforms, PSA screenings, and treatments for all patients. | Prostate cancer care (USPSTF, screening) | 11 |
| Address the needs of the urological workforce to maintain the longevity of and expand the profession while strengthening patient access and health equity. | Workforce issues | 137 |
| Promote and protect funding for urological research including disparities in urological care and patient access. | Research funding | 764 (21 cancer) |
| Preserve the appropriate use of the IOASE to the Stark Law. | IOASE | 6 |
| Support policies to protect physician interests in the utilization of electronic health records systems that may otherwise inhibit the practice of urology. | Electronic medical records | 70 |
| Encourage drug pricing implementation and negotiations that do not hinder urologists’ ability to provide patient access to all pharmaceuticals or therapies. | Drug pricing | 36 |
| Abbreviations: AMA, American Medical Association; IOASE, in-office ancillary services exception; PSA, prostate-specific antigen; USPSTF, United States Preventive Services Task Force. | ||
My colleagues and even mentors not infrequently lament that the AMA “doesn’t represent us” or that the AMA membership is overall dwindling and no longer represents the majority of physicians. But through your membership in the AUA, we are your voice in the AMA as your AUA representatives in the AMA HOD, whether or not you maintain your AMA membership. However, the number of seats we hold (and the volume and effectiveness of our voice) is likewise limited by holding such a small number of seats. Many years ago, I listened to a talk by Dr Matthew Wynia, former Director of the AMA Institute on Ethics, about AMA membership and “tipping.” Much like a seesaw, as we forgo our AMA membership, we leave the conversation on health care, and the balance tips in favor of those who stay. Within the organization, that may mean that the voice will tip in favor of other specialties or societies or other political viewpoints. But on a broader scale, leaving behind our AMA membership amplifies the voice of nonphysicians and nonhealth-care providers, the special interest groups who may differ significantly in their opinion of the way American health care should move. But when we join the AMA–when we stand up and say what we believe is important—we increase our collective voice. And the people who win are not just urologists. It’s not just physicians. It’s our patients.
To quote a famous fictional president, Jed Barlett from the popular TV show The West Wing, “Decisions are made by those who show up.” But to quote another famous, not-so-fictional president, Dr Bill Gee, former President of the AUA and former AUA representative to the AMA HOD, “The AMA is our shield.”
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