Physician Group Rails Against AMA, Price Nomination

In the days and months following the election of Donald Trump, many people have felt a "call to action," whether it's through contacting their local representatives, setting up marches and protests, donating to various non-profit organizations, or in the case of some, starting their own advocacy groups.

That was the case for Jane Zhu and a few other clinicians, who started the Clinician Action Network. Zhu, an internist at the University of Pennsylvania Pearlman School of Medicine, and a group of other physicians came together immediately after the election, concerned with what might happen to health policy under President Trump and how that would affect patients.

"A number of us sat around, shared our concerns and expertise and experiences. We really became galvanized to take action to find ways to not only get our colleagues' voices heard, but to speak up on behalf of [patients]. Very often, lots of traditional physician organizations do a good job for physicians and health systems, but sometimes the patients' voices get lost in that," Zhu tells Physicians Practice.

Interest around the group took on a new life when Zhu and others in the Clinician Action Network called out the AMA for their endorsement of Rep. Tom Price, a Georgia-based orthopedic surgeon nominated to be the next Health and Human Services (HHS) Secretary. The group then collected nearly 7,000 signatures from physicians, nurses, physician assistants, and other clinicians on its open letter to the AMA expressing concerns about their endorsement.

Physicians Practice spoke to Zhu about the goals of the Clinician Action Network, their objection to Price, and how they've responded to critics who say they are taking an anti-Trump stance. Below are excerpts from that interview.

What are your main goals with the Clinician Action Network?

Because we're such a new organization, some of the long-term goals are being defined. In the short term … we want to help support evidence-based policy that puts patients first. Secondly, we'd like to take the energy from clinicians that have joined our ranks and act as a clearinghouse and put them in touch with organizations already doing great work. [We want to mobilize] physicians who may have been dormant before, who care about these issues, but haven't found an outlet to voice their opinions about issues. To find a way [for those physicians] to be more vocal [and] public, in terms of their advocacy work.

We're not trying to be partisan. We're not trying to oppose a specific individual or party. We align with patient interests. Now that there is so much potential for health system change, we want to advocate for policies that will benefit our patients in the end.  

Why are you taking aim at the AMA?

We're not trying to target or attack the AMA. They actually do a lot of great work. They were very focused on moving the health system forward and supporting the ACA in 2010. Part of the letter focusing on the AMA was because we were so surprised by the strength of their stance in supporting someone [Price] who has opposed the work they've been promoting over the years. The second thing is while the AMA doesn't represent all physicians, they are a very strong and vocal voice. Our concern with their endorsement of Price is we didn't want the public to view an endorsement by AMA as an endorsement by all physicians. Like the general public, there is a lot of disagreement and difference of opinion between doctors and other clinicians in terms of what they see as the health system vision. We wanted to publicize that physicians have different viewpoints, there's not an insignificant number physicians who disagree with Dr. Price's policies, who want to work hard to ensure patients [receive] more coverage. We're not all represented by the AMA.

Was it just the AMA endorsing Dr. Price or was this just the straw that broke the camel's back?

It's hard for me to say why others signed that letter, whether they [disagreed] with the AMA for other issues. For me and for our letter writers, we were surprised by the strength of that endorsement. We have real concerns over Dr. Price's policies. It doesn't go much beyond that.

Did you expect the response you got?

Yes and no. We didn't expect to go viral in the way that we did. The letter was passed along through social media and it went around the country and back to us, with an urgency that I hadn't seen before in this space. That was a really surprising element to it. It was a reflection of broader sentiments we've been seeing in the past few weeks and years. As clinicians, we've been struggling to provide care for Americans amidst all these debates about policy and reform. The sentiment has been there; these are conversations that clinicians having a long time. I think we were able to capture a particular moment within that debate.

Some criticism I've seen of your group and its actions is that you are taking on more of an anti-Trump stance than having an issue the AMA. What do you say to that?

Our issue is not with the AMA. The AMA was just an audience to hear our concerns about Price's polices. I can't emphasize enough it's about policy and what that means for patients. The specific policies that Rep. Price have promoted, while he was [House Budget Committee Chair], proposing to reduce               funding for Medicaid while trying to change Medicaid into a block grant program, voting no against [the Children's Health Insurance Program] consistently, trying to repeal the ACA.

Those types of policies are concerning to us because we have patients who rely on those programs for everyday care who are still struggling. It's not about Trump. We don't mention him at all in the letter. We focus on policy. If Rep. Price were to listen to his physician colleagues, be open to different ideas, to listen to everyday Americans who are trying to seek accessible, affordable quality healthcare, and if he were to propose policies that move patients forward … there's nothing we'd oppose. It's not about ownership or authorship of policies. It's about what those policies mean at the end of the day.

What would you say to the physicians who like Price and think he will better represent their interests?

That may very well be true. He may better represent physician interests. In the end, as a calling and a profession, I got into this job to serve patients. Our efforts here and our attempts to bring a voice to patients revolves around the idea that we're here to serve Americans who are trying to obtain good care. He may very well serve physician interests. We're speaking out on behalf of patient interests. On the front, we have real concerns based on his history.  

The fact he is a physician could be a great thing, but like any leadership position, we feel strongly that someone should be judged based on the substance of their proposals, not because he is a physician. We're taking what he says at face value. … Just because he's a physician with experience, doesn’t make his proposals good for patients.