On June 14, 2016, Andrew W. Gurman, M.D., an orthopedic hand surgeon, was sworn in as the 171th president of the American Medical Association (AMA). Dr. Gurman brings a notable history of service to the medical profession, serving as vice speaker and then speaker of the Pennsylvania Medical Society House of Delegates, and as a two-time chair of the Pennsylvania Medical Society’s Political Action Committee.
Dr. Gurman received his medical degree from the State University of New York Upstate Medical University, Syracuse, in 1980. He then completed a surgical internship and residency in orthopedic surgery at the combined Montefiore Hospital/Albert Einstein program in New York City, followed by a fellowship in hand surgery at the Hospital for Joint Diseases Orthopaedic Institute. Dr. Gurman has maintained a practice in Altoona, Pennsylvania, for 30 years.
Dr. Gurman served as AMA president-elect this past year, and was formerly speaker and vice speaker of the House of Delegates for eight years. He has served as board liaison to the AMA Foundation and represented the AMA at the Physician Consortium for Performance Improvement and the National Association of Boards of Pharmacy Stakeholders Group on Opioid Prescribing and Dispensing.
Andrew W. Gurman, M.D.
OTW: You have said that physician burnout will be one of your priorities. What are your thoughts on this topic?
Dr. Gurman: “Burnout, which affects more than half of U.S. physicians, is a multifactorial issue. There is not one cause nor is there one answer. Doctors need to be involved in the advocacy process, and should participate in making the rules that affect them. To start, we need to determine what exactly are the problem areas with regard to burnout.”
“Like everyone else, physicians want their lives to be rewarding. A study by the RAND Corporation found that what gives doctors the most satisfaction is taking good care of patients. For orthopedic surgeons, that means performing great surgeries and having positive interactions with their patients. And this is a far cry from the paperwork or electronic documentation that they are burdened with each day.”
OTW: Which leads to another issue that you have identified as a priority…paperwork!
Dr. Gurman: “Unnecessary paperwork is a real albatross for physicians, and it is not connected to the quality of care they provide. We need dedicated doctors who will devote time to helping us find solutions.”
OTW: Some orthopedic surgeons have complained that the AMA does not represent their interests. How would you answer those doctors?
Dr. Gurman: “My guess is people who think this are out of touch with the organization. The policy governing what the AMA does emanates from the AMA House of Delegates, which contains 192 entities and numerous orthopedic surgery entities (this includes all of the orthopedic societies). Actually, we represent everyone whether they want us to or not.”
“The fact is that when Congress wants to know what physicians are thinking, they turn to the AMA. The AMA of today is not the AMA of 5 or 20 years ago. We are committed to three strategic focus areas. The first item is advancing initiatives that enhance practice efficiency, professional satisfaction and improve delivery of care. AMA’s goal is to provide tools and support so physicians can reclaim the joy in practicing medicine and have more time with patients. To that end we have greatly expanded the physician resources available on our website, and now have 35 educational modules addressing practice improvement strategies. Physicians can even get continuing medical education credits for these sessions.”
“The second point in the plan is to transform medical education to create the medical school of the future. The AMA realized several years ago that in the 21st century we are still training medical students in methods that we utilized in the late 19th century. We have acquired $10 million as seed money to invest in this program; to date we have received interest from 146 out of 184 medical schools. There were 30 finalists and we selected 11 to begin the program. In addition we have created a consortium for cross-fertilization and will be expanding to another 21 schools. These schools are preparing physicians for a lifetime of learning and exciting new curricula content that includes a shift towards team-based care, the growing challenge of managing chronic disease, and using data and technology to improve and coordinate care.”
“And third, the AMA is working to prevent and treat common, chronic diseases that place a heavy toll on the lives of millions of Americans and shorten lifespans. Our ambitious goal is to prevent type 2 diabetes and heart disease by identifying and addressing their precursors: prediabetes and hypertension.”
OTW: There are those who are under the impression that the AMA contributes more to Democrats than Republicans. What can you tell us?
Dr. Gurman: “The AMA doesn’t contribute to political parties at all. The AMA’s political action committee makes contributions to candidates who are running for U.S. House and Senate, and it does so on a bipartisan basis. These decisions are made on a case-by-case basis in close consultation with state medical society PACs. The partisan breakdown varies in each election cycle.”
OTW: Do you have any thoughts on the fact that the AMA supported the Affordable Care Act (ACA) while the specialty societies did not?
Dr. Gurman: “Most people who had the information we had at the time would have decided to support the ACA. We gave it our qualified support because the data were incontrovertible that people without insurance lived sicker and died younger. The promise of the ACA was that some of them would be helped with insurance. We were given the opportunity to support a program that might give them insurance in concert with both AMA policy and, frankly, humanity.”
“It’s also important to remember that Medicare is 51 years old and we are still tinkering with it. So the notion that this huge piece of legislation the size of the ACA was born fully formed and ‘ready to go to medical school’ is unrealistic.”
OTW: What is the AMA’s position on bundling and do you have any tips for orthopedic surgeons facing a bundled future?
Dr. Gurman: “We as orthopedic surgeons need to get involved because we have a tremendous stake in this issue. There is more experience with bundled payments for orthopedic procedures than any other surgery. It is critical that we come to the tables where these payment models are being designed and ensure that they support our continued leadership role in our patients’ care. Designed well, bundled payments can support improvements in patient care that are difficult to achieve when surgeons and hospitals are being paid under separate systems. A joint replacement model on the Jersey shore, for example, was able to provide support for pre-operative patient risk reduction and care coordination throughout surgical episode. Designed poorly without the right payments or risk adjustment, bundled payments will hurt access to high quality care for our most vulnerable patients.”
OTW: Insurance companies are merging and becoming these huge companies. Why is this occurring, what does it mean for orthopedic physicians and what is the AMA’s position on this?
Dr. Gurman: “The AMA is actively opposing this. The organization publishes a comprehensive study of competition in the health insurance industry every year and derives data that is compelling to Congress and regulators. There is evidence indicating that the merger of insurance companies reduces competition, which leads to increases in health insurance premiums for patients and can reduce access to quality care. Several such mergers have taken place and in one case our economic analysis has shown that premiums are up 14% with no increase in network availability or resources. Unfortunately, it is an ongoing problem.”
OTW: How did we get into this situation with opioids and what is the AMA’s position regarding opioids as a component in the treatment of pain?
Dr. Gurman: “The AMA is taking ownership of this, and has convened a task force with 23 members—including a representative from AAOS [American Academy of Orthopaedic Surgeons]. They have formulated several recommendations, one of which is awareness education. This involves destigmatizing chronic pain and destigmatizing the disease of addiction. In addition, we need to rethink our prescribing habits. Jeffrey Rogers, M.D., of Des Moines Orthopaedic Surgeons, P.C., wrote a great study that was published in the Journal of Hand Surgery. Their default prescription for minor hand surgery procedures was Tylenol with Codeine #3, 30 tablets. They called people to find out how many they actually took. They found that the average was 12, and if they wrote for 15, they would cover at least 80% of their patients. So they changed the default to 15 tablets with one refill. In this one, isolated situation, involving four hand surgeons, they estimated that they removed over 3, 000 pills per month from circulation.”
OTW: Thank you for your time and enjoy your tenure as president.
