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January 2024Bruce A. Scott, MD, the new president-elect of the American Medical Association (AMA), has spent much of his professional career volunteering with the association. He served as a leader in the AMA’s resident and young physician sections, as a delegate for Kentucky in the AMA House of Delegates, and as a young physician on the association’s Board of Trustees. After completing terms as vice speaker and speaker of the House of Delegates, Dr. Scott was elected in 2023 as the first otolaryngologist to become AMA president.
ENTtoday was able to spend some time with Dr. Scott to discuss his beginnings in otolaryngology, the challenges that face physicians today, and his hopes for the future.
Time in the AMA
ENTtoday: Congratulations on becoming the president-elect of the American Medical Association (AMA) When do you step up as president?
Bruce Scott, MD: I’m currently a spokesperson for the AMA as president-elect. I’ll take office as president on June 11, 2024. That’s a one-year term, followed by a one-year term as immediate past president. In effect, the three “presidents” become the three key spokespersons for the association.
ENTT: This is quite a commitment for you.
BS: It is, but I’ve been committed to the AMA since I was a medical student. I first became involved when I was a senior medical student. I went to my very first AMA meeting and saw physicians from all over the country, from every walk of life, and from every specialty coming together to craft policies for our profession and for our patients. I’ve been back to 72 consecutive meetings since that, and I’ve served in a variety of roles over those years, so I’d say I’ve been pretty committed to it. It’s quite an honor to be selected as the person who will carry forward the message of our AMA.
ENTT: What is it about the AMA that has made you so dedicated throughout the years?
BS: The AMA is the single organization that represents all physicians across all specialties and is really focused on patients as well. We aren’t just a union for physicians. We really, truly do care about the betterment of public health, improvement in our profession, and taking care of patients.
I’m still an actively practicing physician—I saw 13 patients this morning. But on the AMA level, I can have an impact on a community, on the entire nation, and on the healthcare delivery system as a whole. That’s why I got involved. I truly believe that the AMA can and does make a difference for our patients and for our profession.
ENTT: What do you hope will be the next steps for you during this three-year commitment? What are you hoping personally to accomplish, for physicians in general and otolaryngologists in particular, during your term?
BS: I live the issues every day that our physician members and their patients face, and I intend for my presidency to be focused on those administrative burdens that get in the way of our delivery of care. They make it more and more challenging for physicians to sustain their practices, particularly those of us who have chosen to stay in independent private practice. It’s the fact that we’re surrounded by pressures from insurance companies, from the government, and from the public to expand the scope of practice of non-physicians into care that ought to be delivered by physicians. All of this comes together to create physician burnout.
I recently read that 60% of physicians coming out of COVID are experiencing the signs and symptoms of burnout, and, perhaps even more disturbing, one in five physicians, according to a recent study, are looking to either retire or significantly slow down and change their practice in the next two years, all worsening the workforce challenge of taking care of our increasingly aging population. I’m going to keep those issues front and center.
Ongoing Challenges
ENTT: What do you think are the most pressing issues that are affecting physicians today?
BS: The American Medical Association has identified what we think are the five most pressing issues that are impacting all physicians, and so we’ve created what we call the Recovery Plan for America’s Physicians. Coming out of COVID, physician practices were challenged. We did everything we could to take care of this nation, and now it’s time for the nation to take care of our physicians.
Sometimes physicians shy away from discussing finances, but we’re in a system where Medicare hasn’t increased what they pay physicians since 2001. When adjusted to inflation, physicians have actually faced a 26% cut in our pay over the last 22 years. And now there’s another cut as we enter 2024 with another pay cut of over 3%. Making it even worse, is that insurance companies have jumped onto the opportunity, tying their reimbursement to the Medicare system. And as a result, we’re also getting paid less by insurance companies today than we were years ago. Physicians are the only group in healthcare that doesn’t get an inflation adjustment.
This is a time when expenses are increasing—rarely does a week go by that one of my staff doesn’t come to me and ask for a salary increase because gas and food have gotten more expensive, or that they’re offered a different job, oftentimes out of healthcare, that pays more than I can afford to pay.
But it isn’t just about finances. There are also administrative burdens that take us away from taking care of our patients. An AMA data study showed that physicians spent two hours in administrative tasks for every one hour spent taking care of patients. Imagine if we could return even half of that time back to physicians to take care of our patients? We all became physicians to take care of patients. We didn’t become physicians to enter things into electronic medical record, or, even worse, deal with prior authorization.
ENTT: How much do prior authorizations affect physician work?
BS: Consider this: I sit down with a patient and their family, and I listen to their story. I take a thorough physical examination. I review the diagnostic studies, and then we have a discussion using my expertise and come up with a plan. At that point I need to get on the telephone and talk to an insurance representative about what’s going on and get approval about what we want to do.
Unfortunately, most of the time they haven’t gone to medical school; some of the time, they can’t even pronounce “otolaryngology,” much less tell me what I ought to be doing for my patient. It’s incredibly frustrating for physicians. All of this comes together to create that burnout factor.
ENTT: I would imagine that this can take a big toll on physicians in private practice.
BS: I think that it impacts physicians of all stripes, but I agree that it does hit private practice physicians really hard. As a result, over the last few years many private practice physicians have decided that they just can’t do it anymore. They sold their practice, either to venture capital firms, large conglomerates, or hospitals. Otolaryngologists as a group have been able to sustain private practice better than some others. That’s been good for our profession, but I can see it slipping away in my own community. The largest group in our city recently got acquired by a venture capital firm.
But AMA has had an impact—telehealth has been expanded through 2024 largely because of AMA activities. Legislation has been introduced to link Medicare payments to adjusted inflation. We’ve convinced the federal government to add rules to make Medicare Advantage plans more open in terms of prior authorization.
Choosing Otolaryngology
ENTT: What made you choose otolaryngology as your specialty?
BS: I’ve always been a person who enjoys fixing things. My office staff thinks it’s kind of funny—I’m the guy who winds up hanging up the things that fall off the wall or fixing the instruments that get broken. So, when I went to medical school, I loved the idea of taking care of patients. I knew I wanted to be a surgeon, but I also enjoy taking care of patients in the office clinical setting. That’s what drew me to otolaryngology.
I realized that the beauty about otolaryngology, although it’s considered a niche specialty, is that we have such a diverse opportunity to care for patients. Today, I saw a two-year-old patient who needed tympanostomy tubes and an older patient who I performed cancer surgery on to restore his voice. I saw a patient who just wanted to breathe better through their nose, and another patient who has an acute infection. All of that was just in this morning’s clinic. When I can go to the operating room and do something as simple as a tympanostomy tube placement and as complex as a head and neck cancer resection, that’s the variety that drew me to otolaryngology.
I think that variety also makes otolaryngologists important leaders in healthcare and the AMA. One of the challenges that AMA has is that it represents physicians of all specialties, and sometimes there may be friction between the specialist, the surgeons, the primary care doctors. Otolaryngologists can relate to everyone.
I think one of the key things that has helped me be successful through my AMA career has been the fact that as an otolaryngologist, I go to the operating room, work with the anesthesiologist, see my fellow surgeons in the surgeons’ lounge, and then I rotate to the hospital and walk the hallways with the internist, hospitalist, and cardiologist, and in my office, I’m using E&M coding for billing. Otolaryngology bridges those gaps.
The Academy of Otolaryngology–Head and Neck Surgery does a great job in representing otolaryngologists, while the AMA has a broader approach that helps to take care of the entire profession. I’m proud to say that the academy has a long history of working closely with the AMA, and one of the things that I’d like to try to do during my time as AMA president is to make sure we continue to embrace that relationship and work more closely with our specialty society.
ENTT: Although the medical environment is difficult for all physicians, what advice would you give other otolaryngologists to more successfully navigate the current U.S. healthcare climate?
BS: Get involved. Physicians are looked to as leaders within our community. Get involved in your neighborhood—join the school board, the Rotary Club, your specialty’s society, your state or county medical association, and the AMA, because we’re looking for leaders. The AAO–HNS and the Triological Society have representation within the AMA. If we don’t step up to protect our practice, our profession, and our patients, who will?
And once you get involved, stay involved. It’s awfully tempting to just take care of your own area and not work toward broader advocacy opportunities. But at some point, the broader wave of things happening in medicine will affect every practice and every physician. There are a lot of challenges to overcome to reach all our goals, but at the same time, we’re chipping away at them, and we need the physician voice. If you can’t get involved in person, that’s okay. Go online—we’ve created the website www.fixmedicarenow.org where practicing physicians can let their Congressional representatives and senators know their concerns. I encourage my fellow otolaryngologists to get involved at whatever level they can. The rewards really do come back to you.
Amy E. Hamaker is the editor of ENTtoday.