AMA President Dr. Bobby Mukkamala on Fixing American Healthcare

In this episode, Dr. Mamun Alrashid sits down with Dr. Bobby Mukkamala, the 180th president of the American Medical Association, for a wide-ranging conversation that moves between the exam room, the boardroom, and the operating table.

Dr. Mukkamala traces his path from Flint, Michigan, where his immigrant physician parents settled almost by accident, to the head of the nation's largest physician organization, sharing candid stories about growing up the son of Indian immigrants in a Catholic school system, never intending to go into medicine, and eventually finding his calling in organized medicine after running headfirst into the bureaucratic barriers facing both doctors and patients.

The conversation digs into the AMA's top priorities under his leadership: fixing a Medicare payment system that hasn't kept pace with inflation in 25 years, right-sizing prior authorization requirements that delay routine care, addressing the physician shortage by expanding residency positions rather than just medical schools, and recognizing the critical role international medical graduates play in keeping rural and underserved communities staffed. He also discusses how the AMA is working to ensure physicians, not just tech companies help shape how artificial intelligence and electronic health records are built, so they actually serve patient care instead of creating new barriers like the lack of interoperability between systems.

Perhaps most striking is Dr. Mukkamala's account of his own brain cancer diagnosis 18 months ago, mid-speech, and how navigating prior authorizations, NIH-funded treatment, and a high-stakes craniotomy as a patient, rather than a physician reshaped his perspective on the system he's spent his career trying to fix. He speaks openly about the role his Catholic and Hindu upbringing played in helping him face the diagnosis with equanimity rather than fear.

The episode closes on a note of cautious optimism: a call for unity within the "House of Medicine," reflections on what success looks like for his AMA tenure, and a message to the next generation of physicians about picking up the baton and getting involved in shaping healthcare policy, at any level, from a local hospital committee to the halls of Congress.

Topics covered:

00:00 Introduction to Dr. Bobby Mukamala

01:28 Early Life and Influences

05:33 Balancing Clinical Practice and Leadership

10:05 Diversity in Healthcare Leadership

12:29 Challenges in Medicare and Administrative Burdens

19:24 The Physician Shortage Crisis

24:21 Innovative Solutions for Workforce Sustainability

29:57 The Role of Immigration in Healthcare

30:50 Technology's Impact on Medicine

36:03 Addressing the Overdose Epidemic

42:13 Personal Experience as a Patient

49:16 Future Opportunities in Patient Care

55:05 Unity in the Medical Profession

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Transcript

Dr. Mamun AlRashid (00:01.4)
Okay.

Today we have the distinct honor of welcoming Dr. Bobby Mukamala, the 180th president of the American Medical Association, the nation's largest and most influential physician organization. A board-certified ear, nose, and throat surgeon practicing in Flint, Michigan, Dr. Mukamala brings a remarkable blend of clinical expertise, community leadership, and personal resilience to this role. A longtime AMA leader.

Having served on the Council of Science and Public Health, the Board of Trustees, and as Chair of the Substance Use and Pain Care Task Force, Dr. Mukkamala has been a tireless advocate for evidence-based policies to combat the overdose epidemic, address health inequities, and strengthen the physician workforce. His deep roots in Flint, where he led efforts during the water crisis, combined with his recent courageous

Personal journey as a brain cancer patient have onely deepened his commitment to fixing a healthcare system that too often can create unnecessary barriers for both patients and physicians. Dr. Mukkamala, thank you so much for joining us today. Your leadership, grounded in both professional excellence and profound personal insight, is truly inspiring. Welcome.

Bobby Mukkamala (01:31.819)
Thank you very much. I need you to talk to my mom and dad more so that they think the same way about me as you.

Dr. Mamun AlRashid (01:37.07)
Thank you so much. I know you'd like me to refer to you as Bobby, so we'll we'll start there. Tell us give us a glimpse of your early journey as the young Bobby Mukamala, some of the key people in your life, experiences that have shaped you to be the leader you are today.

Bobby Mukkamala (01:41.835)
Sure thing. So

Bobby Mukkamala (01:57.855)
Yeah, you know, I guess thinking back to the early, early days, you know, I was I was born in Pittsburgh, Pennsylvania. my parents are both immigrant physicians, IMGs, from India. And my dad, when he first came, he thought he wanted to be a general surgeon. So he started his residency in Pittsburgh. And it took about, he says about a month. I think it probably took about an hour for him to realize that this was not his calling in life.

So then he ended up changing and went into radiology. My mom went into pediatrics and they ended up at Hurley Hospital in downtown Flint, Michigan. And what was interesting about that is that my dad he took, he had two job offerings. One was to Hurley and the other was someplace else. And he took Hurley because it paid $400 more per year than the other place, which was called Johns Hopkins University Hospital, that he never even heard of.

and so that was the that's how they all started here in this country. And being raised here, you know, the son of immigrant parents who knew everything about growing up in India, but nothing about growing up in this country was a very interesting experience. my my parents, you know, I joke and I don't think it's really that funny. They thought that they gave birth to a genius. And when the school system didn't agree with them, they switched me from one school to another school. I mean, I went to five.

different school systems between kindergarten and twelfth grade. And at some point, I think right around seventh or eighth grade, they said, okay, fine. Maybe he's not a genius. We're just gonna stick with the school that's in town instead of getting on a bus to travel an hour and a half.

so I went to Catholic school my whole life, which is also interesting because they're Hindu and they raised me as Hindu and I would go to Balavihar classes on Sunday and then I would go to Catholic Mass Monday through Friday. So I was just a happily confused kid. But I guess the point of all this is that I never really had a perspective on the world around us like a lot of young people do nowadays. I was just trying to keep my parents happy the whole time I was growing up. If I got good grades, they stayed off my back.

Bobby Mukkamala (04:03.362)
and so then when I got into med school, they were happy. It's not exactly it wasn't my first choice. I thought I wanted to be a journalist, but when I told them that, they basically grounded me. They didn't let me go to any high school events after three o'clock. I got on the bus, I came home, and no social life until I changed my mind and told them fine, I'll go to medical school. This is when they had one of those seven-year programs at the University of Michigan where you get into medical school from high school.

And so when I started that program, they were happy. And again, I just did it to keep them happy. Then when I started my my practice, even not through residency, you know, residency is just tough. And it's all focused on the hours you put in. And this was before the reform of the resident on-call hours and all that. I mean, I remember taking call every other night. and I wasn't even thinking about the world around me until I became an attending physician, starting my own practice. My wife and I are in private practice in Flint, realizing all of

The barriers to being able to do what we needed to do with our patients and for our patients, from insurance companies to pharmaceutical companies to the big industries, for-profit or nonprofit involved in healthcare and those challenges. That's when I said, this is not right. And that's when I started to get involved in organized medicine. And as they say, that was 26 years ago when I started my practice. At some point along the way,

the within the the American Medical Association, those that elect their president liked what they saw and and made me president elect back in twenty twenty four and here I am.

Dr. Mamun AlRashid (05:36.655)
What an what an awesome journey and and having great role models as your parents are in the medical field definitely does kind of give you that exposure from an early age. So y you're a practicing surgeon and but you're also a healthcare leader who has a place at the table that can help shape this country's healthcare policy. How do you reconcile those two challenging roles?

Bobby Mukkamala (06:01.738)
You know, it I think one informs the other, right? I mean the fact that just this morning, so this morning I gave grand rounds at at what used to be Beaumont Hospital in in southeast Michigan. Now it's called Corwell.

And so I did grand rounds there and then I came home and I saw patients in my office. And now I have the privilege of and honor of doing this call with you. And then later this evening I do another dinner presentation to all the ophthalmologists in the southeast Michigan area.

And I think that were it not for the middle part of my day, right, seeing, you know, a dozen patients in my office, knowing what it's like to, you know, see people that needed prior authorization for the CT of the sinuses that I need to be able to tell them whether or not there's actual sinusitis. And if so, what does it look like? And is it something we need to do, something medical or surgical?

Just the barriers to be able to provide that care. I scheduled two surgeries today. And I know that one of those insurance companies in particular, it's gonna take a long time to get prior authorization to get that done.

And then in the morning speech, in the evening speech, one of the main topics is dealing with insurance companies about prior authorization. And so instead of doing it from the 10,000-foot perspective of the president of the American Medical Association talking about this, but then in the middle of those two talks, dealing with exactly that issue in my office is fantastic. And so I would say that intersection is important. It's amazing to have that perspective, and I would say it's essential.

Dr. Mamun AlRashid (07:40.578)
That's that's really illuminating. I think those of us in the front line who can act who actually experience healthcare every day, if you s if you are also on the policy side, I think definitely helps inform you. Do you wish that more of our health care policy leaders had that clinical insight?

Bobby Mukkamala (07:58.603)
I would say that yes, the the even if they don't as individuals, right? Like if the next president of the American Medical Association happens to not have a clinical focus to their life. I mean, next one does. Willie Underwood is a urologist and he's working. But it's not inconceivable. In fact, you know, sometimes this is something that

That has it's the part of a career that's near the end of clinical medicine, somebody that's retiring, you know, in their 60s, upper 60s, that then they take this time to become president of the American Medical Association. They know exactly what it's like. but just like with anything, I think being in the flame versus having felt that flame are two different things.

One tends to be a very factual, somewhat emotional delivery of this information. And I think other ones tend to be much more emotional. And that's good and bad, right? When I when I get invigorated talking about what I dislike about healthcare from my own perspective, having dealt with it that morning or dealing with it now for a long time, dealing with Medicare, for example, and they've decreased reimbursement, and yet my

Office costs continue to go up. When I have fire in my belly, it tends to not be a like who's that guy? Spock, right? Like Spock from Star Trek. Not that intellectual, non-emotional, but more like Kirk, where it's like, ugh, you know, so that frustration. And I think it's just different styles, both of which are valuable. but I like being a hybrid between Spock and Kirk.

Dr. Mamun AlRashid (09:44.921)
That's a great point, great analogy to put it. So, Bobby, let's go a little bit more into the meats of leadership and the American Medical Association's priorities under your leadership. How do you see the American Medical Association evolving to better represent the diversity of America's physicians and patients under your leadership?

Bobby Mukkamala (10:09.415)
I think that this has been a trend even before I got the title of being president-elect of the American Medical Association. When I think about the AMA in my parents' generation, my dad was a alternate delegate from Michigan to the American Medical Association starting, I think, in the nineties, and then became a delegate and was involved in that delegation. but

At that time, when you look at the Board of Trustees of the American Medical Association, it was a relatively homogenous group. There were men and women, they were, you know, they were black and white and and that sort of diversity. But now it's much more than that.

Right, the extent of that diversity is something that I've never seen before. When I look at pictures of the AMA and photographs from decades ago, it's not the same. Right? I would say that we've evolved. because the more diversity and the voices that we have at the board table about the healthcare system, the more perspective we have. And I think that's wonderful. Right. And there's, you know, there's there's never been in president of the AMA of Indian descent.

And yet there's you know almost 10% of the country are IMGs of Indian origin are from India itself. And so I think it's another sort of glass ceiling that technically I'm not an IMG from India. I went, I was born in Pittsburgh and went to University of Michigan, but I wouldn't be here were it not for IMGs. And so I say I I put a big crack in that glass ceiling, but haven't broke through. But there will be somebody because of this trend, because of the change in leadership and the philosophy of.

of the American Medical Association's House of Delegates about valuing the diversity in mind and background and experience that helps our board to function at a higher level.

Dr. Mamun AlRashid (12:03.65)
That's that's wonderful to hear. So let's let's focus in a little bit on on your policy stances. you've been an advocate for reforming Medicare payments and reducing administrative burdens. I mean, particularly this whole issue that you already alluded to prior authorizations that is the bane of a lot of physicians' lives and patients too. Why are these issues so critical right now for preventing both physician burnout?

And access to patient care.

Bobby Mukkamala (12:35.499)
Yeah.

I mean, I think these are, you know, when you look at AMA policy, every year, c every twice a year, the House of Delegates gets together and thinks about what do we need to do to improve the health of our of our country, of our planet. And you can see that that there's going to be so many resolutions that are passed, like this is our policy, or we should actually do this. And every year it goes up by a hundred or so. but of all of those things, we need to have some priority.

Items, right? Instead of working on 200 things to the same extent, some are more critical, some are more urgent, some are more timely. And so, based on that, that's where we have our recovery plan, is what we call that. So, what is it going to take to bring joy back into the practice of medicine? And you mentioned a couple of them. So, so Medicare, right? What Medicare reimburses us for taking care of patients? And I wouldn't make the assumption that, well, that's Medicare, I'm a pediatrician.

I don't see any people on Medicare. They're mostly, you know, young adults, kids, but there's a lot of Medicaid, and we'll get to that in moment. But what you're doing for Medicare isn't going to help us. That I disagree with because all the insurance companies tend to look at what Medicare compensates us for for a given service, right? Whether that's a 99203 code or a procedure. And then they decide based on what Medicare pays, we'll pay 110% of that, 120% of that, sometimes even 9%.

90% of that, not even what Medicare pays, and that's where they set their compensation. And where Medicare goes, all these insurance companies follow. And Medicare hasn't been going in a good direction at all. When we look at a graph that I use in all my speeches about Medicare compensation to physicians keeping up with inflation over the course of the past 25 years, pretty much exactly how long I've been in practice.

Bobby Mukkamala (14:28.447)
You look at our practice costs, just the cost of what we pay our staff, pay for equipment, pay for what we use in the office, that has gone up by 60-some percent. Right? And then our compensation from Medicare for the whatever code it is, right? The you know, the stuff that I do, cleaning out of earwax, you know, that's gone up by six percent.

So such a huge gap, not even keeping up with inflation. So a net loss of about 30 some percent that gap.

And so this is something that is devastating. And that's why it's a priority of the American Medical Association to do a simple fix. It's not a calculation that has to be done every year. Every year we beg Congress, please don't cut us. And in an amazing year, we'll have zero cut or maybe a one or two percent increase. But then the very next year it could go down by three percent. Right? This is that constant begging that we do. And we're the only unique entity that gets paid that way for the care that we provide.

If it's a hospital, it's an automatic adjustment for what inflation does. If the costs go up by 1%, payment goes up by 1%. That's what we want for physicians. If the cost, right, there's a medical, medical economic index that basically looks at what the cost has done. And we're just asking to follow that index. If it goes up by half a percent, please increase our payment by one by a half a percent. And this so this is one of our main priorities. The other one I talked about already, and you mentioned prior authorization.

Just, you know, make it right-sized. I understand why there's prior authorization. There are some things that are just super expensive. We see these things advertised on TV all the time. You know, there's a particular medicine I'm very familiar with with my own history that costs $900 per day.

Bobby Mukkamala (16:16.5)
And so that's something that I totally understand why an insurance company would say, you know what, before we give you a year's supply, let's just double-check that you still need it after 30 days. So that's the kind of justifiable prior authorization. But for the CT scan that I ordered today on a sinus patient, right? Sinusitus patient.

That gets approved 100% of the time for me. Because I know exactly the indications to do it. It goes through this process. My office staff sits and clicks on a particular icon for this insurance company or a different icon for that insurance company, just to figure out, okay, how do we get this permitted to get approved 100% of the time is a waste of time.

That my office staff have to deal with this and delay the patient care. If they're in discomfort to the point of getting severe headaches, and their employer isn't getting them back at work, and they're waiting an extra two weeks just to figure out, do they need a neurologist, do they need an otolaryngologist, that's a waste of time from a moral perspective, but also from a financial perspective.

And so that's why the AMA is very focused on that, right? And there's, I think there's a little bit of a game that insurance companies play. When 70% of patients themselves say, you know what, it's not worth the prior authorization. I'm just going to use the second choice medication for my treatment, just so I don't have to deal with this. They're going away from what we recommend just so they don't have to wait. And what happens?

The insurance company doesn't spend as much. Patient doesn't get the best treatment, they get the second best treatment, but it costs less. That's a problem. And so there's a lot of data we have. And sometimes this causes very much a dangerous healthcare outcome, right? So severe risk due to the delays of prior authorization. I myself, when Michigan was dealing with prior authorization, we had a bill called Health Can't Wait.

Bobby Mukkamala (18:10.366)
And I took a patient with me. This was a patient that had a tonsil cancer while waiting for a PET scan, developed a lymph node. So went from stage one to stage two just because of prior authorization for a PET scan. And then there's you know who's practicing medicine. We want it to be physicians, we want it to be a physician-led team, as opposed to you know being a non-physician, whether that's a physician assistant.

Whether that's a nurse practitioner, people with less education, less exposure to the science behind patient care, they should work on the team led by physicians as opposed to replacing physicians with less training. So those are again, there's there's more. But those are the three that that I think would just totally get nodding from all physicians in this country.

Dr. Mamun AlRashid (18:59.466)
Absolutely. I think you w you've just expressed and really explained what a lot of folks who may not necessarily be in healthcare don't really see or understand behind the scenes and you've kind of broken that down and and you re you know, your your your words resonate with with what people you know at the forefront providing care face on an everyday challenge. And do you worry that as you expressed that this sort of this

You know, this slow compression of reimbursement while complexity increases, where overhead increases, where the administrative burden continues to rise, in an inflationary economy, everything is sort of in a deflationary trend. Is there a point at which you feel the threshold may come where really begins to limit access to patient care from physicians?

Bobby Mukkamala (19:54.605)
For sure, for sure. Even if everything was perfect and you and I loved what we do, right, and everybody made it easy for us, we are still short of physicians in this country. Within the next 10 years, we're gonna be 86,000 physicians short, particularly in rural and underserved areas, to primary care physicians, to specialists, and and everybody. And that's if everything was great, but it's not great, as we just talked about.

So what happens? People tend to want to retire early or reduce the size of their practice. Right. And so these are these are having consequences, not just for the headwind that we face, but the internal suffering that we have as physicians. Because when you have to deal with things that are

Based on the adversity on the outside, as opposed to the biologic adversity of trying to prevent cancer, cure cancer, but instead now having to deal with prior authorization to deal with cancer. That causes us to burn out. Right. And so that's what we suffer from when we say, you know what, I just can't do this anymore.

Right. And and some people call it burnout because that makes total sense. But it's also referred to as moral injury, right? Knowing the right thing to do, but having such a hard time taking care of patients in the way that the science supports, because somebody on the other end of the phone that's not an otolaryngologist, that's never even seen tonsil cancer, is telling me that my PET scan is not approved.

That's it, it affects me morally, right? How can I take care of this patient in the best way possible when that is the headwind that we face together?

Bobby Mukkamala (21:35.969)
And so this is something that has a patient consequence for sure. Right. And you know, one of the slides I use in all my in all my presentations, I just used it this morning, I'll use it again tonight. Is when we look at what the US spends on healthcare relative to every other developed country, we're not comparing it to a third world country. We're comparing it to France, Germany, the UK, right, New Zealand. When you look at what we spend, we spend almost twice as much as anybody else. Not dollar amount, but percent of GDP. Right? So

It peaked at about 18%, it's a little lower than that now. Other people are at other countries are at like 9 or 10%, twice as much. But then when you look at the output of our healthcare system, just measuring how good we are at preventing disease, right? And doing the preventative medicine and that approach, the public health aspect of it, we are ranked at the bottom. So we're outliers in both graphs. Outlier for spending so much and an outlier for our performance.

Right. And so these are the kind of things that will cause poor patient outcomes. To spend more than anybody and get the worst grade is not justifiable. And so that's why the AMA is very passionate about focusing on what is our role as physicians. Yes, we will take care of cancer when it happens, but we also want to spend the time, spend the resources at preventing that cancer. Whether that's the the food that we eat, right, the new dietary guidelines.

Whether that's exercise, right, and having a safe place to do it. I live in Flint, Michigan. When it's wintertime and it gets dark at five o'clock, and after dinner you just want to go for a walk in the park, if you're in certain neighborhoods, you'll hear gunshots. Right? There's not enough lighting. There's not enough security. And what does that do? That affects the health of my community. And so these are also the kind of things that we have to deal with to improve the health of our country and improve the quality of a patient's life. We are

Great at treating chronic disease. We can keep people alive with stage four cancer now that we couldn't even think of doing that a generation ago. But how about prevention of that cancer? You know, based on our lifestyle, based on what we eat, how much sleep we get, our exposure to things like smoke and drinking. Those things take conversation, right, to prevent that disease. And that's what we need to invest in as a country.

Dr. Mamun AlRashid (23:58.211)
That's that's awesome. I mean you you touched on very, very key issues, prevention, nutritional sciences, and I know you're also working on medical curriculum on the on the medical education side so that physicians get more awareness on those issues. Just to kind of hone in on some of the points that you mentioned, physician shortage, and you mentioned particularly in the primary care and the rural areas, where there's a growing crisis.

what innovative solutions is the AMA championing to build and retain a sustainable workforce?

Bobby Mukkamala (24:32.672)
Yeah, yeah. It's you know, when when people first look at this problem, the gut reaction is we need more medical schools, right? We need more people to go into medicine.

That's not really where the narrow part of that funnel is. Because, like in Michigan, where I live, when I went to medical school, University of Michigan, we had three medical schools total. Now we have double that. And yet we still have a shortage of physicians. So the narrow part of the funnel isn't the number of medical schools, it's the number of residency positions. That really hasn't changed since the 1990s. In the 90s, we thought, you know what, maybe we'll have a surplus of physicians and we should freeze the number of residency physicians.

Well, we had no idea that we were going to be able to live life longer despite disease.

Right, living with chronic disease, not passing away because of that disease. And what does that mean? We need more physicians. And so now we're short, like I said, of almost 80-some thousand physicians in the next decade. And so because of that, we need to widen that narrow part of the funnel, more residency positions. And this is something that the majority are funded by the federal government.

And that's what we are working on. And every year there's a bill to consider to be able to do that. Even right now, we have we have a couple of bills, right? There's some spots that haven't even been used yet that can get us up to 14,000 more healthcare workers, not just physicians, but everybody, 2,000 per year for the next seven years. That would be amazing to get that passed. Right? Even things like debt forgiveness for practicing public health in a rural area is an amazing.

Bobby Mukkamala (26:15.272)
Way to not just improve the health of our country, but to improve the economics of a ridiculously expensive medical education by having loan forgiveness for that. So there are a lot of ideas on how to deal with our physician shortage. There are some ideas that didn't work out so well, right? When private industry sponsors a residency program. And then at some point, after a few years, they say, you know what, we're not really interested in that anymore. And next thing you know, you got a PGY3 resident that all of a sudden

doesn't know where to finish. And we as the AMA.

In the graduate medical education programs are scrambling to not leave these amazing people behind. So we have to be careful when it goes outside the federal government that usually funds this. Who are we hoping can help? States. Some states do that. And so that's a more reasonable thing. But the risk of having something brand new that needs to be really kind of refined and tuned up to at least do something like if we decide not to do this anymore, those that are

already enrolled will go all the way until they're done and they graduate, but we just won't have a new PGY1 class. That's the decent way to do it. Still not ideal, not great, but it's better than leaving a PGY3 resident just out in the d in the in the valley.

Dr. Mamun AlRashid (27:37.015)
Right, absolutely. And and it s seems that there's systemic changes and there's long term commitments involved in terms of addressing the gap. And I think in the past you did mention and you've acknowledged the role of IMGs that they play in the in the healthcare workforce today in our country. what do you how do you find that and do you feel that that there this would could help as we kind of look at those systemic approaches to solve the wider problem?

Bobby Mukkamala (28:04.16)
Yeah, 100%, right? So, like, you know, my parents' generation, when they came, we were short of physicians in the 19 late 60s and 70s, where IMGs were welcome to help communities like Flint, Michigan. Even now, right? 50 years later, most of the residents at our city hospital are international medical graduates. Why? Flint, Michigan isn't the top of anybody's list to come for residency.

Were it not for IMGs, these residencies would be empty, for the most part.

Right, the the primary care residencies, pediatrics, family practice, internal medicine. And so IMGs played a critical role 50 years ago and still play a critical role if we want to maintain and improve the health of our country, especially in rural and underserved areas. Right? That's where the majority of them went, and that's where the majority of them go. And so it has a critical role, if that is the goal, to improve the health of our country. There's a lot of misunderstanding of this, right? When a resident goes unmatched.

A US graduate, and they look and they say, Well, look at all these places just take a bunch of IMGs. Well, it's because they don't tend to rank Flint, Michigan on the list. So matched and unmatched, and thinking that one is cause and effect without looking at the actual details. Right? I mean, if somebody applies to a competitive residency and ranks half a dozen places and doesn't make it, and then they say, look at all the IMGs taking these positions. No.

If it's a competitive residency, the IMG is at the bottom of the list, right? To be able to get that residency. And so it's a conclusion that isn't based on the facts that cause a lot of this push against IMGs. But in a place like Flint that depends on IMGs, yeah, that would be the wrong direction to go to have a $100,000 bill for the H1B visa.

Bobby Mukkamala (30:01.344)
That used to be something that welcomed people into the community, right? Like the, you know, the surgery that I had, the surgeon that did that is an H1B visa holder from Canada that saved my life, basically. And so we're not for that openness to help us with the healthcare system we have in our country, then it's a you know, it's a step in the wrong direction.

Dr. Mamun AlRashid (30:27.202)
Thank you, Bobby. Let's turn to technology in in medicine. It's rapidly evolving. Robotic surgery, we're constantly hearing about AI. The EMR system has been pervasive in in most health systems across the country. But integration and modernization in a complex, multi-mode, different geography is is a challenge.

Where do you see the biggest opportunities or risk for technology to truly support physicians and also enhance access to patient care or support patient care?

Bobby Mukkamala (31:07.456)
Yeah, I mean I think there's a right way to bring in technology to help us take care of our patients, right? Some people look at AI and they call it artificial intelligence, right? Almost everybody does. When the AMA refers to AI, we call it augmented intelligence. It should help me to take care of my patients. And that's where the AMA is very involved, right? So we have a we have a council that that looks into digital health.

And AI.

And how to make sure we're part of the conversation about how to evolve this so it helps us to take care of our patients. You know, when I when I think about the electronic health record, right? It's something that Nita and I in our office, we got our our we still use it. The original EMR that we got was in 2007, so almost 20 years ago. And it works. It takes care of people in my office. I just used it today. We actually have an AI module on that now where I just hit a button, it just listens to what I say to my patients.

And it comes up with a pretty darn good note, right? And so I'm not a typist anymore. That is a wonderful evolution of the role of AI.

Right, it augments my ability so I can be looking at my patient. That was an amazing transition. You know, since 2007, I'm not the best typist, right? So I'm kind of, you know, I'm typing and I'm looking at my patient, and then I'm back to typing, so I'm not making typos. Now I just hit the button, I turn on the AI listener, and I'm looking at my patient the entire time. That's a wonderful product to help us take care of our patients. But if that's something that's developed without us,

Bobby Mukkamala (32:45.674)
Because somebody figures, well, this is gonna help doctors. And they wrap it up in a beautiful gift wrap with a price tag and they say, here you go. We can easily be disappointed by that. Right? That EHR that I have, the fact that there's no interoperability of that now. Where if, you know, in Michigan, we have a lot of patients that spend their winters in Florida.

And when they go to Florida and they have some issue, and then when they come back in the spring and I see them for that issue or follow up on that issue, I have no idea what those people saw, what they did, except for what the patient tells me and what they fax on the fax machine to my office. That is prehistoric. And it's also the same era that we have.

robotic surgery and all this amazing technology. And so for those people in our generation, I tell people it's like Fred Flintstone and George Jetson living at the same time, right? Prehistoric and then in the future at the same time, doing robotic surgery and faxing the operative note.

Dr. Mamun AlRashid (33:42.926)
Yeah. Right.

Bobby Mukkamala (33:50.897)
So these are the things that it's important for physicians to be involved. Yes, electronic health records are great. They could be a whole lot better if we were involved. If we were involved at the beginning, we would demand interoperability. Do not give them permission to create and sell this product if it doesn't interact with the other one. If I have to fax an op note that I did in Epic to somebody that's on Cerner.

That's ridiculous. Yes, there are third parties that are created, but I don't have a third-party app on my Verizon phone just to be able to call your ATT phone, right? Those things have to be compatible without a special app to do that. To have one app to call an ATT phone and another app to call a Sprint phone. That's exactly what's happening with electronic health records. That is stupid. And we don't want that to happen with AI. We made that mistake once. So that's why we want to be involved.

Dr. Mamun AlRashid (34:46.626)
And I think that makes sense. I think clinicians being involved, not just in direct patient care, but in shaping these technologies that support patient care, I think is is very involved is very important, as you say, to to really be meaningful so that it you know, these are not designed without the perspective of somebody who's actually dealing with the issues head on every day. That's that's

Bobby Mukkamala (35:10.444)
Yeah, and I would say that you know, to get that involvement, if I have a passion for computers, and that was my major in my Ivy League school, and I'm a genius about that, and I say, you know what, I want to be involved. Almost zero chance of that happening if I'm just some guy in Flint, Michigan. So how do we make that happen? We have now a council at the American Medical Association that takes that genius.

Brings them to the table to create the policies of the AMA that then we would talk to lawmakers, we would talk to the technology developers about saying, look, all of these brilliant people, this is what we ask for. That's how we get involved through organized medicine, not just the individual trying to do it on their own. That's the importance of organizations like the American Medical Association to give us a voice with our brilliance to improve healthcare.

Dr. Mamun AlRashid (36:06.946)
Let's touch on another topic that I know is close to your heart and you've, you know, personally been involved, the overdose epidemic and substance use disorders that continue to devastate communities in our country. So, as a former chair of the American Medical Association Substance Use and Pain Care Task Force.

What progress have we made and what more needs to be done on evidence based policy making?

Bobby Mukkamala (36:37.354)
Yeah, so first thing, not former, current, right? So I still do that.

started almost 10 years ago now to be the chair of the task force. So the first thing I answer is: why is there an ENT guy that's chairing the task force on substance use disorder? Some people call it addiction, and then adequate treatment of those that actually have pain. Well, how is an ENT do it? Well, this is something that I guess my personality is such that I I tend to be a little curious, and I don't like getting to the microphone, talking to crowds of

hundreds, if not thousands, of people saying you should do this without having done it myself. And so that's why I got my X waiver to prescribe bupinoorphan, just to understand what it's like to be getting over addiction.

And so when I did that, the AMA took interest and they said, that's interesting. Why don't we have you chair this task force so we can broaden the responsibility for this epidemic in our country to not just those that specialize in this, but all physicians, all of those involved in the care of our entire country. And so that's when I started doing that work. But why? Why do we have that group? Well, when you look at the mortality from overdose.

We were losing more than 110,000 people per year. And that's something that is just not acceptable. And so that's why we got our task force together. And at the same time, when we realized quickly that the reflex in that situation is to not prescribe any potentially dangerous opioids to anybody, what's the consequence of that? When you have somebody whose pain is adequately managed.

Bobby Mukkamala (38:25.96)
And may include an opioid. And now all of a sudden there's a hesitancy to prescribe anything, like, my gosh, right, we're doing too much. Sorry, I'm not going to give you any more. The pain doesn't go away the next day. And so what does that patient do? Sometimes they go to something illicit instead of prescription. And so there's a consequence, right? It's like the pendulum.

It was too far this way, too many people were dying. And then all of a sudden the pendulum swings this way, where yes, we may be helping this problem, but we're creating a different problem. And so that's why those two task forces merged. And that's when I became involved in doing that. And we've done pretty well. Right. And so this is a table of 20-some physicians from all the expected specialties, right? Everything from pain management to anesthesia to psychiatry and everybody that's involved in helping patients with a substance use disorder.

Right. And we've made progress. We went from 110,000 deaths back then to about 70,000 now. Massive improvement. That's still a super high number. But we're working on that. And so we have a lot of goals and we want to make sure.

That insurance companies do what they should do, right? There's this whole concept of what we call mental health parity. It's something that's always just kind of been part of an insurance policy. That when you take care of somebody with a broken hip and you take care of somebody with a broken mind, right? With psychiatric diagnosis, for example, they should both have the access to care, the parity in that care. That doesn't exist in so many places, so many insurance companies.

So this is something that we're working on as the AMA to make sure that insurance companies support everything from a substance use disorder to depression to everything. It relates to mental health. And so those are the things that our task force on substance use disorder and pain care is working on.

Dr. Mamun AlRashid (40:25.678)
I mean it's a complex issue and s it seems needs a multi pronged approach. Obviously education is key, but are are you seeing any legislative efforts that you feel would help prevent that pendulum swung too far the other way?

Bobby Mukkamala (40:41.376)
Yeah, f for sure. And so, you know, we we talk about a lot of states that have

resolutions and and laws that support patients in this. And so we have, I think a couple years ago, we did a state-by-state analysis and we talked about each of these states that is doing something amazing. That we should, you know, if you're in a different state, you should look and see, hey, what's Colorado doing? Right? That's getting so much attention for good reason so it can be replicated. And so that's exactly what we did. Right. There's I'm not a big fan, you remember the saying about reinventing the wheel.

We shouldn't be reinventing this wheel. We should learn from what other communities have done. And sometimes it's something that one community will do and another one would never do. Like, for example, needle exchange. The consequence of using illicit drugs that are injected is potentially getting hepatitis and HIV. Preventable with needle exchange.

Where we might have a group or a state that basically says, look, if you come in, we're gonna do harm reduction. We will help you to do what you're addicted to doing, but not at risk of further disease like HIV. And while you're there, let's talk to you. You know, tell us about what you're going through. Give them the resources.

So they're not just doing it in their basement with no interaction with we as the providers of healthcare in this country. So these are ideas that we that we share with the rest of the country so that we doesn't have to be reinvented.

Dr. Mamun AlRashid (42:17.304)
Thank thank you, Bobby. So this takes us to our segue about your personal leadership approach. And you've had a personal journey, it seems that it's been out in the public. I believe you were diagnosed with brain tumor d recently and from what I heard

read that you were in the mid speech of a giving a a speech and then you found that your words just was not being deliverable and then you had to go through this whole journey of as a brain crancer patient while in the midst of pursuing your leadership process. Take us through how it was you as the patient navigating the same system and and kind of getting a sense of what everyday patients and families go through.

Bobby Mukkamala (43:07.34)
Yeah, it was it was an amazing experience. And and just anybody that thinks back to when they got diagnosed with brain tumor, right? A malignancy that shortens their life expectancy, you would think that that was the most tragic moment in their life. And technically, it is. It was, right? This was 18 months ago, giving a speech, words didn't come out right, everyone thought I had a stroke, got an MRI scan, showed an eighth century.

Centimeter medial temporal lobe tumor that ended up again. My surgeon, the H1B visa holder from Canada, did an awake craniotomy that took all day and got 90% of it out, and that last 10% trying to avoid radiation and chemo by getting a newly approved medicine, possible only because of NIH funding, which is now at risk. So all of these things, right? International medical graduate, not enough physicians to be able to do this anywhere close to home.

Instead having to fly to the Mayo Clinic to do it, taking a medicine to avoid radiation and chemo that costs $900 per day that wouldn't be here without NIH funding. When I think about each little chapter of the story of my brain tumor and how it is an example of exactly many of the things we just talked about and so much more we haven't talked about.

I just think that this wasn't by accident. This wasn't something that's a tragedy, it's an opportunity. It gives me a different perspective. Nobody's closer to patients than their physicians. But when a physician becomes a patient and you take that giant leap dealing with a healthcare system, like prior authorization, this pill that I take at the beginning, I needed prior authorization every 10 days. As the AMA president-elect, I was traveling the world sometimes.

And I'm going on a 10-day trip, I only have three days left of this medicine, I go a week without taking my brain tumor suppression medicine because I didn't have it.

Bobby Mukkamala (45:10.57)
That is a failure in our healthcare system. And so experiencing that, not just the knowledge of it because I'm taking care of a patient that's dealing with it, but being that patient myself has been amazing preparation to hit the road and spend 200 days this year on the road talking about healthcare from the perspective of a patient. I put all those slides of the picture of the brain tumor, which is funny because having an eight-centimeter tumor that lights up.

The last science class you might have taken would have been in high school, but even that person takes one look and sees immediately what doesn't belong here.

Dr. Mamun AlRashid (45:46.531)
I mean, what an amazing and exceptional approach to thinking of with adversity. I mean, very few people can take that and like how you're describing it, as an opportunity to learn and better. And so share with us in our audience and perhaps the next generation who want to follow such inspirational wisdom and approach to to life in general. How do you

Face adversity and challenge and yet find the courage to continue to lead and serve? What are the qualities?

Bobby Mukkamala (46:22.176)
No, I guess I can't help but think that something I learned in Catholic school Monday through Friday or in Balavihar Hinduism classes on Sunday, something stuck in my mind. But I just think about one is this Eastern religious concept of lack of attachment.

Right, that we do everything we should do without being attached to the consequences. We do the best we can do, but don't be attached to the consequences in a way that if it's not a great consequence, that we should it should hurt us mentally. Right. And so I lived the healthiest life I could, and I got a brain tumor.

Right. And so to be to have the sadness about what happens to my brain, despite me doing everything I could, you know, I don't smoke, I don't drink, I eat reasonably well, I exercise, I did everything I could. When they told me to get a colonoscopy, I got a colonoscopy. When I got vaccinated for COVID, I did what I was what what the science told me I should do, I got a brain tumor. Right. So that's not something that should create sadness in me if those are just the things that happen. and then the other part of it that's also interesting is.

is that when you're when you're Hindu, you believe in reincarnation. So it's not the body, it's the spirit. Whatever happens to the body is irrelevant. You come back reincarnated until you reach nirvana and then you don't have to come back anymore.

And so it's funny because my parents, they forced me to go to this class on Sunday because I got a Catholic influence Monday through Friday. They needed to give me something different on Sundays to neutralize that, was their perspective. And so here I am learning about reincarnation. And so then my when my parents are with me, crying about my brain tumor.

Bobby Mukkamala (48:10.28)
I tell them, look, mom and dad, you forced me to go to class every Sunday to learn about reincarnation. I'm not attached to my body. You taught me to not be attached to my body. I'll preserve it, I'll take care of it. So it lasts as long as it can last. But I'm not attached to it. And so why are you crying when I am totally happy believing in what you asked me to believe? And so they gave me this funny look. They were like, Yeah, you're right, but.

you know, we're gonna miss you. So totally understandable. But I think that that has helped me navigate this phase of my life that some people would look at as tragedy and I look at it as opportunity.

Dr. Mamun AlRashid (48:50.542)
I mean that's so inspirational in so many levels, so many ways. And it I think the message is one of a a connectivity with your spiritual sense and one of a higher purpose that that keeps you going. That's wonderful. Thank you, Bobby. And and kind of t you know, leading this into the next segue, which is the future. Where do you see the greatest opportunities for improving patient care?

In the next few years.

Bobby Mukkamala (49:22.188)
Yeah, I think that that needs to come from having a louder physician voice to accomplish that. Right? When I think about all the voices that have an influence on healthcare, whether that's pharmaceutical companies, whether that is big healthcare centers, right? That used to be the hospital for the acute care, but now is the hospital for every aspect of that care. And sometimes.

The north on that institution's compass is the right north, right, to improve the health of our country. And sometimes it's not the right north. It's about market share. It's where billboards go up about, do you need your hernia replaced? Come to our hospital. Do you need your hip replaced? Come to ours, right? That's not the direction that we should go. It should be focused on where the best care is for a patient in the acute setting and in the preventative outpatient.

Setting. And that's where physicians need to be unified. We know what North on the compass should be. This is what we do every day. And to have our voice heard by those that are in charge of policy, to put pressure on those that aren't in charge of policy but have big influence, like an insurance company, it takes unity. But we don't tend to have that sometimes, right? I was just talking to somebody the other day about how the AMA,

Wanted everybody to have access to insurance. And one option was the Affordable Care Act. Far from perfect, but accomplished at least one thing, which is dramatically reducing those uninsured. And so that was something that the AMA, because that lined up with our goal, we said, yes, this is something that could be good. And immediately the House of Medicine divided.

Because some people thought it was terrible and some people said, well, it's not perfect, but it helps. That difference of opinion, which you and I might have over dinner tonight if we went out for dinner, just a difference of opinion. It doesn't mean I'm gonna be angry with you, stand up and walk out.

Bobby Mukkamala (51:34.943)
It just means, you know what, I disagree. I try to convince you, you try to convince me. But then tomorrow, if I called you and said, hey, you want to go play tennis? You wouldn't say, No, you said yes to this plan and I hated it. I'm not going to ever play tennis with you. That would never happen on a one-on-one conversation. So within the House of Medicine, our family, our profession, we all went through that system. We all deal with the outside forces in that system. For that to divide us is tragedy.

We want this book to have a happy ending. We want to improve healthcare in our lifetimes. And when we're divided within that house of medicine, we have zero chance of doing it. And I think that has a lot to do with why we're suffering so much, facing these headwinds. We don't have the voice we need. And so unified within organized medicine. And the largest voice within organized medicine in this country happens to be the American Medical Association. And yet, when we succeed,

In reforming Medicare to compensate us in a way that keeps up with inflation, 20% of the physicians in this country will be members of the AMA. 100% of the physicians in this country will benefit from the work of the AMA. That's where I think we need to change. We need to be unified in our singular goal of improving the role of physicians in improving the health of our country and taking care of our patients.

Dr. Mamun AlRashid (53:00.866)
That's a great message. Thank you. And staying on that, what what gives you optimism about the future of medicine right now?

Bobby Mukkamala (53:10.58)
fact that you and I are having this conversation, right? If we were so frustrated that we were just gonna give up, what's the point of having this conversation and trying to reach your entire audience? Right? We wouldn't be doing that. We would just be like, you know what? It's like on the Titanic. Remember when that I don't know how real it was, but the movie, there are just some people that prayed, knowing that this was the end. That's not where we are.

Dr. Mamun AlRashid (53:32.077)
Yes.

Bobby Mukkamala (53:39.257)
That's not at all where we have to be. So what I see is the happy ending, or it's not even gonna be an ending because this is something that we're always gonna be challenged by, but moving in the right direction is because of this involvement. Because the people that watch what we're talking about right now, it'll put a little fire in their belly instead of giving them more to be frustrated by and just give up. That's not what we want. Right. And at a minimum.

At a minimum, it's to join this work just by adding your name to the list of people that are working on these issues, and at a maximum, change your entire career path and be involved as a lawmaker.

In Washington, DC, and everything in between, whether that's a committee at your county, whether that's a hospital committee, whether that's the state medical society, whether that's the AMA. So it can start with just being on the team passively but importantly as a member, to being incredibly active, where that is the call of your life now to do that. There's so many opportunities.

Dr. Mamun AlRashid (54:46.828)
That's such an optimistic message. And it seems to be a core ethos of yours. You you mentioned, you know, one of your motto is leave things better than you found them. And looking back on your tenure at AMA, what does personal success to you look like and for your organization?

Bobby Mukkamala (55:09.26)
Well, I don't know. I I I don't tend to, I don't like taking credit for anything. Right. Maybe this was again, whether that's the Catholic school of blessed are the meek, for they shall inherit the earth. I did what all of our presidents in the past and all of our future presidents and people that are involved in healthcare leadership in general do, right? We sacrifice our time to improve health care. If I had to sort of, if if I make it 20 years.

And I'm talking about my time at the AMA. What would my theme be? What would I be happy about? I would be happy about this whole thing that we talked about about unity of the profession to improve health care and physician leadership and getting us in that direction. And what is the evidence of that? Not just something I say, but we have now the biggest spike in membership at the AMA since I started my practice. Right? So now we're at above 300,000 members.

And it used to be about 200,000. There's a million doctors in this country, so we got a long way to go. But a big first step in the right direction to get to that unity. So if I had to brag, I would say that I happened to be the person with the president badge on when we took that first big step in that direction.

Dr. Mamun AlRashid (56:27.318)
Wonderful. And finally, Bobby, what message would you like to share for the next generation of physicians who aspire to follow in your footsteps, who may want to consider leadership role in organized medicine, or at even at a local level? What what message would you give them?

Bobby Mukkamala (56:46.284)
I would say that this is an amazing profession, right? To have this responsibility, this opportunity, where when we do what we love and things go so well that we sleep well every night because of satisfaction with our choice, that's that's our goal.

Right. And that's what we're working on. You know, I'm in that generation that's probably past the halfway point in my career, but we're working on this. So when that generation starts, there's enthusiasm instead of fear. And there's something that they should do, right? It's I kind of like a like a like a baton raised Right? We're gonna do well on this. We're gonna do our best. And we're gonna hand that baton to you. And it's your responsibility.

to preserve that and improve that. And how does that happen? Right? Being involved in those external factors that affect the healthcare in our country, as opposed to just making that lap without focusing on what is it going to take to get ahead.

Dr. Mamun AlRashid (57:52.14)
And what a positive way to end this conversation, Bobby. I mean, this has truly been an illuminating conversation. I mean, your leadership, your thoughtful perspectives, you know, are are really I think something that our audience and the general public, not only those affiliated with healthcare, would I think really benefit from. There's so much of educational

points that you've shared. And I thank you again for really giving us the time to share your insights and your expertise and your wisdom. And we wish you continued success in everything that you do and I hope that you'll come back again.

Bobby Mukkamala (58:32.328)
Absolutely. No, thank you so much for this opportunity to share just what we think about with whoever watches. And I and the more the merrier. I hope this is a record audience for you to listen to this conversation, to improve healthcare. So love this opportunity. Thank you so much.

Dr. Mamun AlRashid (58:48.057)
Thank you, Bobby. Thank you so much. Awesome. So I think we're gonna end the recording there.