Figure. Members of the urology delegation to the American Medical Association. Left to right: Willie Underwood III, MD, MSc, MPH, American Medical Association Board of Trustees; William Reha, MD, American Association of Clinical Urologists Delegate; Hans Arora, MD, PhD, AUA Delegate; Ruchika Talwar, MD, AUA Resident & Fellow Section Delegate and AUA H. Logan Holtgrewe Legislative Fellow; Richard Pelman, MD, AUA Delegate; Denise Asafu-Adjei, MD, AUA Gallagher Scholar; Jason Jameson, MD, AUA Alternate Delegate.

The 2023 Annual Meeting of the American Medical Association (AMA) House of Delegates—the principle policy-making body of the AMA—was held on June 9-13, 2023 in Chicago, Illinois. Your AUA was represented by Delegates Hans Arora, MD, PhD (Chapel Hill, North Carolina) and Richard Pelman, MD (Bellevue, Washington), Alternate Delegate Jason Jameson, MD (Phoenix, Arizona), and Resident & Fellow Section Delegate Ruchika Talwar, MD (Nashville, Tennessee). For several weeks prior to the meeting, our team, including the incredible staff of the AUA Governance & Policy Division, reviewed several hundred pages of reports and resolutions related to health policy, medical education, medical ethics, and public health, in anticipation of this biannual meeting.

One of the most significant policy points from this year’s meeting was the passage of a resolution introduced by a national sample of state medical societies that establishes fixing the Medicare physician payment system as the explicit primary national legislative priority of the AMA. While this has long been an AMA priority, this new policy puts the issue at the organization’s very forefront. Organized medicine, including the AUA, has been challenged with lobbying for short-term patches that only temporize the problem. When adjusting for inflation, Medicare physician payment has declined by 26% from 2001 to 2023. Additional resolutions called for the physician payment schedule to be appropriately inflation adjusted in keeping with the Medicare Economic Index and annual reporting by the AMA to its membership on the progress of congressional legislative activity on these issues. As urologists, we are no strangers to the challenges associated with a broken Medicare payment system that is clearly unsustainable in the longer term. Further information on this initiative can be found at https://fixmedicarenow.org/.

There were several policies related to public health, science, and technology related to the practice of urology that were passed at this meeting as well. The AUA, in collaboration with the American Association of Clinical Urologists presented and successfully passed a resolution titled “Pharmacists Prescribing for Urinary Tract Infections,” which directed the AMA to take advocacy action against the practice of pharmacists diagnosing and treating urinary tract infections without the oversight of a physician. This is an issue that is currently being faced by the AUA State Advocacy Committee, as there has been proposed legislation that would permit pharmacists to do this (as well as diagnose and treat a number of other health conditions) in several states, including Connecticut, Mississippi, Montana, New Mexico, Oklahoma, and Virginia. As urologists, we know very well how this could result in and further exacerbate issues of overtreatment, over- and underdiagnosis, and misdiagnosis of urinary tract infections without proper physician oversight.

One topic of particular interest to our academic colleagues was related to the proposed National Institutes of Health Public Access Plan. Currently, federally funded research is embargoed by scientific and medical journals for 12 months prior to public release. During this 12-month period, published articles are accessible to individuals with a subscription to a medical journal, as all AUA members have access to The Journal of Urology® as a benefit of membership. The proposed plan would do away with the 12-month embargo, the unintended consequence of which would be a substantial disruption of the financial structure of many major medical journals which rely heavily on subscription revenue to support the publication and dissemination of high-quality scholarly activities. The AUA, along with many other national medical specialty societies, introduced and successfully passed policy asking the AMA to work with Congress to raise awareness of the potential adverse consequences of this plan and work to mitigate these issues while ensuring continued equitable access to clinical research.

Telemedicine and artificial intelligence continue to be topics of interest at the AMA, and policy was introduced asking the AMA to advocate for the preservation of the physician telemedicine waiver and reimbursement at parity with in-person visits beyond December 31, 2024, as well as encourage research to determine how telehealth can improve health outcomes particularly for patients who are underserved and seniors with chronic health conditions.

Gender-affirming care was another topic of discussion. A resolution introduced by the Endocrine Society and supported by the AUA titled “Protecting Access to Gender Affirming Care” called on the AMA to advocate for opposition at the national and state levels to any and all criminal and legal penalties levied against physicians, institutions, patients, and their families who provide, seek, or receive gender-affirming care. Our AUA Transgender Working Group has been heavily involved in tracking legislation state by state on restrictions related to the provision of gender-affirming care, as urologists are one of the major medical specialties involved in gender affirmation surgeries.

Finally, several elections took place as part of the Annual Meeting business. Jesse Ehrenfeld, MD, MPH, an anesthesiologist from Milwaukee, Wisconsin, was elected President of the AMA, and Bruce Scott, MD, an otolaryngologist from Louisville, Kentucky, was elected President-elect. Most excitingly for the field of urology, this year we saw the reelection of fellow urologist Willie Underwood III, MD, MSc, MPH (Buffalo, New York), to the AMA Board of Trustees. Dr Underwood will be serving as Chair of the AMA Board of Trustees this year and is only the second urologist to have served on the AMA Board of Trustees. Please join us in congratulating Dr Underwood!