July 2016 

Texans Sweep to AMA Office

Texas physicians and medical students enjoyed an outstanding showing in leadership elections at the American Medical Association House of Delegates. Taking home the blue ribbons were the following:    

  • Former TMA President Sue Bailey, MD, of Fort Worth was unanimously reelected to her second term as speaker of the AMA house.
  • Cynthia A. Jumper, MD, a pulmonary specialist and professor at Texas Tech University Health Sciences Center-Lubbock, was elected to the AMA Council on Medical Education. Dr. Jumper joins Lynne M. Kirk, MD, from Dallas as the second Texan on the council. 
  • Laura Faye Gephart, MD, a fellow at Baylor Scott & White in Temple and a resident member of the TMA Board of Trustees, was reelected to the resident position on the AMA Council on Medical Service.
  • Little Elm internist John Flores, MD, won a spot on the AMA Organized Medical Staff Section Governing Council.
  • Theresa Phan, a third-year student at Texas Tech University Health Sciences Center-Lubbock, was reelected vice speaker of the AMA Medical Student Section.
  • Will Estes, a third-year student at the Texas A&M Health Science Center College of Medicine, was elected a student alternate delegate to the AMA House of Delegates.
  • The new chair of the AMA Medical Student Section Region 3 is Robbie Good, a third-year student at The University of Texas Medical Branch at Galveston, and the Region 3 secretary/treasurer is Nazish Malik, a first-year student at Texas A&M.   

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AMA Builds on Efforts to Expand GME Funding

AMA adopted policy at its Annual Meeting in June aimed at ensuring sufficient funding for medical residency positions. The new policy also calls for transparency in the actual costs of residency programs and how graduate medical education (GME) funding is distributed to address physician shortages in undersupplied specialties. 

“The AMA is committed to improving GME funding to ensure we train enough physicians to meet our country’s changing health care needs,” said AMA President Andrew W. Gurman, MD. “We believe that financial transparency will be essential to the sustainable future of GME funding, particularly in making sure that we have enough physicians trained in needed specialties and regions to increase patient access to health care. To help accomplish this, we encourage institutions to publicly report the aggregate value of GME payments they receive, as well as how these payments are used. We will continue to vigorously advocate for the continued and expanded contribution by all health care payers at the federal, state, and local levels, as well as private sources, to adequately fund GME.” 

AMA has been a long-time advocate for modernizing GME. This includes increased funding for medical residency slots, development of innovative practice models, and residency positions that reflect societal needs. Most recently, AMA urged support of two federal bills, the Creating Access to Residency Education (CARE) Act and the Resident Physician Shortage Reduction Act of 2015. These bills would increase funding for GME, improve access to health care for patients in underserved areas, and address physician shortages. 

AMA also supports the maintenance and expansion of GME as part of its SaveGME campaign. This initiative urges Congress to protect federal funding for GME, which supports access to care in undersupplied specialties and underserved areas. AMA’s Accelerating Change in Medical Education initiative also addresses some of these issues by supporting medical school projects aimed at accelerating student progression through medical school, allowing them to enter residency sooner and contribute more rapidly to expanding the physician workforce. 

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AMA Medical Education Policy Highlights

Medical student disapproval of the U.S. Medical Licensing Exam (USMLE), Step 2, Clinical Skills (CS), along with ongoing concerns about graduate medical education (GME) capacity, and maintenance of certification (MOC) policies were the top medical education issues AMA tackled at its Annual Meeting held in Chicago in June.  

Overwhelmingly, the top issue for AMA’s Reference Committee on Medical Education was the USMLE Step 2 CS exam. Dozens of medical students, residents, and physicians testified on the topic. In particular, medical students lamented the lack of benefit from the exam, noting it is essentially the same as the Objective Structured Clinical Exams required by individual medical schools; is expensive (upwards of $2,000, when travel costs are considered), contributing to an already high level of education-related debt; and, as demonstrated by the exceptionally high pass rate, yields extremely limited benefit in assessing a medical student’s readiness for residency training.  

The AMA House of Delegates adopted new policy to work with appropriate stakeholders to pursue the transition from and replacement for the current Step 2 CS exam with a requirement to pass a Liaison Committee for Medical Education- or Commission on Osteopathic College Accreditation-accredited, medical school-administered CS exam. TMA has policy in opposition to the Step 2 CS exam.  

AMA’s House of Delegates also adopted several policies in support of expanding GME capacity in conjunction with increasing medical school enrollments. This remains an area of critical concern at the national level, as well as in Texas. 

MOC requirements were a top area of focus again at this year’s AMA meeting. While there remains considerable dissatisfaction with the process, some member boards of the American Board of Medical Specialties (ABMS) received compliments, such as the American Board of Anesthesiology for its MOCA Minute© interactive learning program. Several other boards are considering similar processes.  

The AMA House of Delegates adopted an extensive new report on MOC and Osteopathic Continuous Certification, and reaffirmed several existing policies regarding MOC and Maintenance of Licensure. AMA will also examine the activities initiated by medical specialty organizations for reviewing alternative pathways for board recertification. AMA will then determine if there is a need to establish criteria and construct a tool to assess the equivalency of these alternative recertification methods with established processes. A similar proposal was presented to the TMA House of Delegates at TexMed 2016. TMA’s house referred the item to the Council on Medical Education for review.  

The AMA house directed AMA to “call for the immediate end of any mandatory, secured recertifying examination by the [ABMS] or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination.” The delegates also reiterated their support for physicians’ lifelong learning through quality, cost-effective continuing medical education. 

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 AMA Resident and Fellow Section 2016 Annual Meeting Highlights

The AMA Resident and Fellow Section (AMA-RFS) Annual Assembly Meeting included three educational sessions: a social media presentation by Kevin Pho, MD (KevinMD.com); a discussion on the U.S. Department of Veterans Affairs by David Shulkin, MD; and a panel on innovation and becoming an entrepreneur.  

AMA-RFS successfully passed many policies that directly affect residents and fellows and that advocate:   

  • Treatment of gender dysphoria,
  • Tax-exempt student loan savings accounts,
  • Expansion of the Public Service Loan Forgiveness program to include residents during training,
  • Protection of graduate medical education funding,
  • Elimination of the redundant U.S. Medical Licensing Exam Step 2 Clinical Skills examination, and
  • Increased funding for Zika virus research.  

In response to a resolution resident physicians pushed through the TMA House of Delegates in 2015, the AMA house adopted new policy stating “resident and fellow trainees should not be financially responsible for their training.” 

AMA-RFS also elected a new 2016-17 Governing Council. In addition, the section is accepting Standing Committee applications. The deadline to apply is Friday, July 1. Email your application materials to rfs@ama-assn.org

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AMA Adopts New Policies

The AMA House of Delegates adopted several new policies that touch on a diverse array of public policy issues. 

Creating a Program to Dispose of Unwanted Medications: With a flood of unused medications already in circulation, AMA called for the pharmaceutical industry to fund a program to dispose of unwanted medications as hazardous waste. Estimates indicate that between 30 and 80 percent of patients do not finish prescriptions for common medication, including pain medication. Many of these drugs are discarded at home. The U.S. Geological Survey sampled rivers and streams and found that up to 80 percent showed traces of drugs, hormones, steroids, and personal care products. 

“Many of these unused medications, most notably opioids, are diverted and used by someone other than the patient,” said AMA President-Elect David O. Barbe, MD. “Manufacturers should be stewards of their products throughout their lifecycle and provide this critical service to patients and our environment.” 

Insurance Parity for Telemedicine: With telemedicine playing an increasingly critical role in patient care, AMA called for parity laws to require private insurers to cover telemedicine-provided services comparable to that of in-person services.

“The AMA has supported state medical societies in developing telemedicine policies, which have provided tremendous benefit to rural communities. But these benefits will continue to be limited if patients must pay out of pocket for the services that should be covered by insurance,” said AMA Board of Trustees member and Houston plastic surgeon Russell W. H. Kridel, MD.

Warnings Urged For Lawyer Ads Targeting Medications: With TV viewers inundated by ads warning about the dangers of pharmaceuticals, AMA recommended such advertisements come with a warning that patients should first consult with a physician before discontinuing medications.

“The onslaught of attorney ads has the potential to frighten patients and place fear between them and their doctor. By emphasizing side effects while ignoring the benefits or the fact that the medication is FDA-approved, these ads jeopardize patient care. For many patients, stopping a prescribed medication is far more dangerous, and we need to be looking out for them,” Dr. Kridel said. 

Supporting Addiction Medicine to Help Address Opioid Epidemic: AMA adopted policy supporting the American Board of Preventive Medicine’s (ABPM’s) establishment of addiction medicine as a multispecialty-sponsored subspecialty. This new subspecialty, approved by the American Board of Medical Specialties (ABMS), will be available to qualified physicians who are diplomates of any of the 24 ABMS member boards. The policy also encourages ABPM to expeditiously offer the first addiction medicine certification examination to physicians. 

“We applaud the American Board of Preventive Medicine for establishing addiction medicine as a new subspecialty because we believe that having more physicians specifically trained to treat addiction will help improve access to care and help combat the nation’s opioid epidemic,” said AMA board member Patrice A. Harris, MD. 

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Governor Appoints Physicians to Statewide Health Coordinating Council

Gov. Greg Abbott appointed Salil Deshpande, MD, and Yasser Zeid, MD, to the Statewide Health Coordinating Council (SHCC). Dr. Deshpande’s term will expire on Aug. 1, 2019, and Dr. Zeid’s on Aug. 1, 2021. The council ensures health care services and facilities are available to all Texans through health planning activities. Based on these planning activities, SHCC makes recommendations to the governor and the legislature through the Texas State Health Plan (TSHP). The council also provides overall guidance in the development of the TSHP and submission of the plan to the governor, and promotes the plan’s implementation. 

Dr. Deshpande, of Houston, is the chief medical officer for UnitedHealthcare’s Community Plan of Texas. He is a member of AMA, the American College of Physicians, and the Harris County Medical Society, and is also a diplomate of the American Board of Internal Medicine. Dr. Deshpande received a bachelor of arts in biological sciences from the University of Southern California, a doctorate in medicine from Baylor College of Medicine, and a master of business administration in finance and health care management from the Wharton School of the University of Pennsylvania. 

Dr. Zeid, of Longview, is the chief executive officer at Zeid Women’s Health Center. Previously, he served as the chief resident of Obstetrics and Gynecology at The Brooklyn Hospital Center in New York. He is a fellow of the American College of Obstetricians and Gynecologists as well as a fellow in the International College of Surgeons. He is a diplomate and board certified by the American Board of Obstetricians and Gynecologists. He is a member of the American College of Obstetricians and Gynecologists, Texas Association of Obstetricians and Gynecologists, and AMA. He is past chair of the TMA Maternal and Perinatal Health Committee and is on the TEXPAC Board of Directors. Dr. Zeid received his diploma of medicine and surgery from Ain Shams University in Cairo, Egypt. 

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 AMA Looks at Specialty Preferences

A June 6 AMA Wire article breaks down the statistics to inform you of how many physicians end up in the field they picked when they began medical school. The article also discusses which specialties students are most likely to stick with and which ones attract students along the way.  

For more information, read AMA Wire posts on specialty selection, including what students often overlook when choosing a specialty, which specialties drew the most students, and which were the most competitive. 

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This Month in Texas Medicine

The July issue of Texas Medicine features a cover story on Medicaid’s Vendor Drug Program, which is under reexamination by the Texas Legislature. TMA’s Physicians Medicaid Congress is seizing the opportunity to call for an administrative overhaul of a drug benefit physicians describe as unnecessarily complicated and confusing. In the issue you’ll also find a profile of TMA Board Trustee Dan McCoy, MD, new president of Blue Cross and Blue Shield of Texas; information about Texas’ right-to-try law, TMA’s new MACRA Resource Center, and proposed Texas Medical Board rules for call coverage agreements.

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It's Academic is for physicians in academic settings. For more information about TMA’s efforts on behalf of medical education and academic physicians, visit the TMA Council on Medical Education’s Subcommittee for Academic Physicians page and Advocacy page on the TMA website.

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