When Jesse Ehrenfeld, MD, attended his first American Medical Association meeting in 2001 as a medical student, he couldn't shake the feeling that as a gay man in medicine his options in the profession might be limited.
"I was an outsider who might never be accepted for who I was," he said. "The policy debates I heard were jarring to me. To hear the arguments against inclusivity, to hear arguments that flew in the face of science because of homophobia and ignorance. I knew who I was, but I wasn't sure there would ever be a place for me in our AMA."
There is a place — at the head of the table.
Dr. Ehrenfeld was sworn in on June 13 as the 178th president of the American Medical Association, succeeding Jack Resneck Jr., MD. The organization elected Bruce Scott, MD, an otolaryngologist from Kentucky, as president-elect. He will take over the position from Dr. Ehrenfeld in June 2024.
The new AMA president, a practicing Wisconsin anesthesiologist, knows he is taking the helm of the organization at a pivotal time in healthcare — and he told Becker's that he is ready to take on the challenges physicians are currently facing as well as the ones yet unknown.
During his presidency, he intends to advocate for the AMA Recovery Plan for America's Physicians and will "take a stand against discriminatory practices in medicine, to stand on the side of justice and equity, and to partner with allies who are committed to advancing the rights of all patients to receive equitable care."
In addition to his active practice and many philanthropic pursuits, Dr. Ehrenfeld is a senior associate dean and tenured professor of anesthesiology at the Milwaukee-based Medical College of Wisconsin, an adjunct professor of anesthesiology and health policy at Nashville, Tenn.-based Vanderbilt University and an adjunct professor of surgery at the Uniformed Services University of the Health Sciences in Bethesda, Md. He is also the co-author of 22 clinical textbooks and the editor-in-chief of the Journal of Medical Systems.
He is married with two sons and is a combat veteran who served in Afghanistan during Operation Enduring Freedom and Resolute Support Mission. He is also an Emmy-nominated photographer and 2015 recipient of a White House News Photographers Association award for his work in capturing and advocating for the lives of LGBTQ+ people.
"I've always believed that I was put on this earth to leave it a little bit better than I found it. In the places that I've been able to have influence and be a part of making a difference, I've always tried to try to do that," Dr. Ehrenfeld told Becker's, noting that while he is proud of the AMA's successes, "we have a lot of work to do ahead of us."
Editor's note: Responses have been edited for clarity and brevity.
Question: The topic of diversity, equity and inclusion is one you take very personally. As the new AMA president, how will you work to fight against discrimination and champion equity and inclusion in healthcare?
Dr. Jesse Ehrenberg: The AMA has recognized that to have meaningful change to elevate health equity requires a strategic approach. Our Center for Health Equity is an important driver in all of our work. In 2021, we launched the Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity. It's a strategic plan that calls for embedding racial justice and health equity in everything we do. This plan really is foundational in organizing all of the AMA's activities. It is a three-year roadmap that lays out how we will embed health equity in all we do — and I believe we're making some headway.
Is it all done? No. But I think that we've got the right people on board to execute this plan with a coordinated approach. We are bringing the right people to the table and building the right alliances to get this work done. This is going to be a big focus of my work over the next 12 months.
Q. You have said that medicine is at a crossroads. What do you mean by that?
JE: We see amazing things happening — there's so much excitement around artificial intelligence, large language models in digital health, telemedicine and so many new therapeutics. We are seeing a change in the way patients experience medicine and how we practice medicine.
A dear friend's wife was diagnosed with metastatic melanoma, and she has been through an unbelievable journey over the last five years. She is having tremendous success in beating this disease because of amazing advances in science and in the therapeutics she's been able to receive. She can now have a life she would not have had otherwise.
On the other side of the coin, we have a system that's at the breaking point. We have physicians who are burned out, and our survey data tells us that nearly two-thirds of physicians say they are suffering from burnout. We have 1 in 5 doctors saying that they're going to leave the practice of medicine in the next two years because they're just exhausted.
Why is there burnout? Administrative hassles. Prior authorization. And there's also the attack on science going on right now. Physicians have a lot of backseat drivers in medicine right now. It used to just be the insurance companies telling us what to do and denying patients necessary care. Now, we've also got the government in many states interfering in the practice of medicine through legislative overreach.
All of that is just incredibly exhausting and draining and frustrating to so many physicians. We have just been stretched in so many ways.
So there's the crossroads. We've got all this innovation and technology, but we just struggle to make sure that we have the people, systems and support to be successful.
Q: Why is the AMA so adamant about what it calls "scope creep" — offering patients anything other than physician-led care?
JE: Studies have shown over and over that when you expand the scope of practice, you do not expand access to care. Why? Because it turns out that the advanced practice nurses don't go to the rural areas that they say they're going to. Expanding practice won't solve rural healthcare challenges.
I think we are selling our rural communities, our Native American communities, our underserved communities short by telling them that "it's okay to have second best, non-physician led care by expanding scope of practice." Shouldn't the aspiration be that everybody gets the best? In my opinion, this is physician-led, team-based care. We shouldn't be siloing care, fragmenting care; we need to bring people together to leverage technology and make sure that patients get what they need.
Q: When it comes to the AMA's Recovery Plan for Physicians, where will you focus your efforts?
JE: There are two things I want to focus on. First, we need to help physicians get care for their burnout by removing the stigma attached to behavioral health. We have done a lot on this, but there is more to do.
Additionally, there's a whole bundle of work that we're doing to try to reduce administrative hassles around prior authorization. We have a bill that would require Medicare Advantage plans to implement prior authorization reforms at the federal level. Unfortunately, the Medicare Advantage plans have been some of the worst offenders in terms of the cat and mouse game that we play with insurance companies to give patients' access to the things that they need. We've seen movement already through rulemaking at CMS that we think is going to bring some real regulatory relief.
Q: What are your thoughts on what you call the "criminalization of healthcare?"
JE: There have been hundreds of bills attacking transgender healthcare and LGBTQ health all over the country in just this past year alone. And unfortunately, the worst of these bills criminalizes care and threatens criminal penalties against physicians. Some state medical boards want to sanction physicians' licenses.
Unfortunately, all this does is prevent patients from getting the care that is evidence-based. These decisions should be between them and their physician. So, in a moment where there is an orchestrated, coordinated attack on evidence-based care for LGBTQ people, as well as in many circumstances, transgender people, we have to stand up. We have to call it out for what it is — an attack on science. We cannot allow that to take root across the nation.