"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.
The American Medical Association (AMA) is the oldest and largest professional association of physicians in the U.S., comprising more than 270,000 clinicians across all medical specialties. It is involved in all aspects of American medicine, from establishing standards of care, to reforming medical education, to lobbying for healthcare policies at the highest levels of government.
This week's guest is Jack Resneck Jr., MD, chair of the department of dermatology at the University of California San Francisco, and the current president of the AMA. In this conversation, Resneck tells Henry Bair and Tyler Johnson, MD, about his personal journey in medicine, how the AMA is addressing the epidemic of physician burnout and coming to terms with its own complicated history with racism, the ways in which digital health is transforming medicine, how healthcare reimbursement rates are determined, and how doctors can play a more active role in advocating for their own work.
In this episode, you will hear about:
- 2:10 Resneck's early years as a self-described "policy nerd" and growing up in a physician family
- 6:01 How Resneck first became involved with the AMA
- 8:23 A brief review of the history and mission of the AMA
- 12:45 A discussion of the epidemic of burnout and how the AMA is addressing it
- 23:42 A survey of the AMA's current policy priorities
- 29:26 A conversation about the incentive discrepancies around primary care medicine and how the AMA's Relative Value Scale Update Committee is addressing this
- 36:25 How artificial intelligence and other new technologies are shaping the future of medicine, and why physicians must take an active role in their development
- 47:15 Reflections on the history of the AMA's race relations and what the modern medical establishment must do to remedy health discrepancies, including the AMA's strategic plan to embed racial justice and advance health equity
- 55:08 Resneck's optimistic view of the future of the profession
Following is a partial transcript (note errors are possible):
Bair: Can you tell us what drew you to a career in dermatology and how you got involved in health policy?
Resneck: That is a great question and I'm still not 100% sure how I got here, but I did. I grew up in a house where my father happened to be a physician and actually happened to be a dermatologist. So I'm sure that had some impact. But frankly, as a kid, I was a little bit more of a policy nerd. And, you know, it sort of dominated conversations at the dinner table. And my family had a history of a couple of uncles who were very involved in the civil rights movement in Mississippi in the 1950s and 60s. So it was a part of the thread of our family.
And so when I went to college, I actually majored in public policy as an undergrad. I went to D.C. for a little while after that, but I think I recognized during that time in D.C. that I was missing something and that it was that one-on-one face-to-face interaction that you get to have with a patient. And it's really fun at the big national level to get to do things that influence lots of people and improve healthcare for large numbers of people.
But there's something also really special about sitting down with a patient. And I think I craved that. As I said, my dad was a dermatologist, but when I did decide, okay, okay, I'm going to go to medical school and take a little time off of this policy work, I said, I'm going to go to medical school, but I swear I am not going to become a dermatologist. Even though we had a great relationship. Somehow, here I am.
And I think partially that was just the impact of seeing somebody get up every morning in my household as a kid who loved their job, he actually was excited to go to work every day as a physician. He loved taking care of his patients and that had a real impact. And derm has been a wonderful specialty for me. I love the mix of getting to do sort of the more medical cognitive work of solving complex rashes and also getting to do a lot of surgical procedures for skin cancer. So I've really enjoyed it.
Johnson: So I'm struck by the fact that you mentioned that even when you were growing up, I sort of imagined from what you were saying, you seated around the dinner table with your family or whatever, and that even as a teenager, you self-identified as what you called a "policy nerd." I don't think most teenagers probably self-identify as policy nerds.
Resneck: Probably didn't win me a lot of friends and popularity either.
Johnson: Yeah, probably not. But I'm curious. Like, I'm not even sure exactly what that means as a teenager, but like, what was it that sparked your interest early on in policy work or what did that even mean for you, especially when you were young?
Resneck: Yeah, I don't know. I think it's probably genetic, but I, you know, I loved looking at editorial pages and thinking about things from that viewpoint. Mostly in middle school and high school, I would say. And I was seeing things in my own environment. I live in California now, but happened to grow up in Louisiana and seeing the unfairness of racism in my community, which is certainly not unique to that part of the country. But there were just a lot of things that drove me to feel like we need to use systems and levers of power to try to make things better.
And I think some people have more of an outsider orientation and some people largely, if you have the privilege to get to sit at tables and have influence and this is probably not as a kid, but later in life, sort of a more institutionalist, and like to try to change institutions from the inside and find levers of power to make positive change. My parents were pretty nervous when I was growing up in middle school and high school that I was going to end up running for public office and that they would be handing out leaflets in grocery store parking lots, trying to raise money for a congressional run or something. And I think they're relieved that that didn't quite go that path and that I've combined medicine and policy work in the way that I have. But it's it's been really fun to get to wear both of those hats.
Bair: So talk to us more about that journey. How did you go from finishing residency and then now to leading the American Medical Association?
Resneck: That's a good question. When I was a medical student, I actually think I wasn't even a member of the American Medical Association yet. Shame on me. But I really got sent as a resident by my specialty society to represent my specialty in the Resident and Fellows section of the American Medical Association. And I pretty quickly realized that policy is made, whether it's in the AMA or anywhere else, by people who show up. And I looked around at other people who were doing the same thing, and I was pretty impressed by the dedication and the values of other people who were increasingly showing up. And I sort of got romanticized by the whole notion of how that worked.
And the AMA is quite unique in some ways in the way that our policy is set. So as compared to some other just advocacy organizations that have a particular policy goal, the AMA is different in that it represents the profession and that our policy is actually not set by me as president. I don't get to go out and decide I'm going to be for this or against that. It's not set by our board or our management team.
But we gather this really large house of delegates, hundreds, even thousands of people twice a year who come together and basically have open public evidence-based, science-based debate around hundreds of resolutions each time about what the AMA should have as its policy, what we should be doing in the advocacy space or in other arenas, public health arena.
For the full transcript, visit The Doctor's Art.
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