New AMA President Urges More Action on Substance Use Disorder, Mental Illness

CHICAGO — The American Medical Association (AMA) must continue the fight against substance use disorder, firearm violence, and other problems affecting patients and those who care for them, Jesse Ehrenfeld, MD, MPH, said here Tuesday evening after being sworn in as the association’s 178th president.

“The profession of medicine is at a crossroads,” Ehrenfeld said in a speech at the Crystal Ballroom of the Hyatt Regency Hotel at the conclusion of the AMA’s annual House of Delegates meeting. “On one hand, we’re witness to incredible new technologies and breakthrough scientific discoveries — remarkable treatments, amazing new medicines that make it easier to diagnose and cure common diseases and prolong life.”

“At the same time, life expectancy in the U.S. is lower than it was when I was in residency,” he continued. “Maternal mortality is surging — more than doubling the rate of other well-resourced countries. And we continue to face daily shortages of critical, life-saving medications.”

And although COVID-19 “may not be the threat it once was,” the nation is still dealing with the epidemics of substance use disorders and firearm violence, Ehrenfeld said. He noted that another crisis — mental illness — is getting worse and has hit the physician community especially hard.

“A dear medical school classmate of mine, who went into emergency medicine, worked tirelessly on the frontlines throughout COVID, [and] struggled,” he said. “I knew he struggled, but I didn’t know how to help him, and he didn’t know how to ask for help. And 2 years ago, I lost that friend to suicide. He was an energetic and loving soul, and I am haunted by his loss.”

‘We Must Do Better’

That friend “is yet one example of why I know our AMA must continue to advocate for the mental health needs of all physicians and of our patients,” said Ehrenfeld. “Our profession — and our society — can do better. We must do better.”

Outgoing AMA president Jack Resneck Jr., MD, noted in his farewell remarks that Ehrenfeld was the AMA’s first openly gay president, adding that Ehrenfeld recently said that he “‘didn’t run as a gay man; that’s not my platform, but it’s part of my identity.’ And representation and visibility are indeed important.”

As a gay man, Resneck said, Ehrenfeld “brings lived experience — experience like navigating the healthcare system with his husband, as gay parents. And that positions him to continue building alliances to advance health equity.”

Ehrenfeld also spoke about his perspective on health equity, telling a story of when his son Ethan — born 10 weeks early and weighing a scant 2 lb 7 oz — needed a blood transfusion. “As an anesthesiologist, I have given thousands of units of blood to hundreds of patients,” he said. “But at this moment, watching my son cling to life, I was struck by the painful reality that, even though I was a physician and now, a father … Neither I, nor my husband, could donate blood — simply because we are gay. Discriminatory policies — policies rooted in stigma, not science — barred us from doing the most humane of acts, donating our blood.”

Progress Made, but Further to Go

“Thankfully, Ethan got the blood he needed,” Ehrenfeld added. “But that feeling of helplessness lingered with me for some time.” He discussed inequities in medicine faced by other minority groups, noting that Black women in the U.S. are at least three times as likely to die during pregnancy as white women, Black men are 50% more likely to die following elective surgery, and LGBTQ teens and young adults suffer higher rates of mental health challenges, “both diagnosed and, far too often, undiagnosed.”

There is some good news, however. “Just recently, the FDA, thanks in large part to a decade of advocacy by our AMA and others, rescinded some of these discriminatory [blood donation] practices, making it possible for my husband and I to give someone else’s child a much-needed blood transfusion,” said Ehrenfeld. “This kind of advocacy is why I am so proud to lead our AMA at this moment.”

But “as far as we have come, we have even further to go,” he continued. “And as I stand here tonight, I can’t help but to be awed by the willingness of our AMA to make difficult and necessary change.”

Ehrenfeld said he had mixed feelings when he walked into his first AMA House of Delegates meeting in Chicago in 2001, having just finished his first year in medical school. “I was in awe of the open and deliberative process. Here were physicians from all over the country, and from every specialty, debating health policy in minute detail. Here were medical experts establishing the policies, guidelines, and directives I would one day follow.” On the other hand, he said. “I had an unshakable feeling of insecurity, knowing that as a gay man in medicine I was an outsider who might never be accepted for who I was, limiting my choices.”

Helping Medicine Evolve

A few years after that meeting, Ehrenfeld, who was doing a residency in Boston, became active in the Massachusetts medical society and helped write and pass a resolution ordering the state society to form an LGBTQ committee “to elevate the concerns of our community, not only as patients but as physicians and healthcare professionals,” he said. However, not everyone was enthused about the formation of the committee. “I was pulled aside by a colleague and told that while creating an LGBTQ committee was all fine and good, continuing on this path would bring a swift end to my career in organized medicine.”

“I realized at that moment that my choices were to continue to hide who I am, or to help organized medicine evolve into a place that welcomed people like me,” said Ehrenfeld. “Standing on this stage tonight and accepting the honor of the AMA presidency is proof that our organization can evolve. This is why visibility matters. And this is why, when you have a platform like this one, you have a responsibility to use it for the greater good.”

For instance, “our AMA has a duty to call out politically appointed judges who would upend 80 years of FDA precedent and threaten access to critical drugs long proven to be safe and effective,” he said, referring to the federal court case in Texas challenging the legitimacy of mifepristone (Mifeprex), an FDA-approved abortifacient. “We have a duty to push back against legislative interference in the practice of medicine that is leading to the criminalization of care.” Ehrenfeld was referring to recently passed state laws that impose jail time, fines, or loss of licensure on physicians who provide abortions or who help a pregnant person obtain one, as well as laws that ban gender-affirming care for transgender patients.

“We have a duty to fight for the recovery of America’s physicians in the aftermath of the pandemic, pushing to fix our broken Medicare payment system, reform prior authorization, and end the stigma around physician burnout,” said Ehrenfeld. “We have a duty to make sure that the human connection that is so essential in medicine remains at the center of our increasingly digitized world … And as president, I pledge to do all that I can to ensure that your voices — and your priorities — are heard.”

“Let us move forward with confidence and purpose,” he concluded. “Let us speak with conviction. Let us hold firm to science and the ethics of our profession. Let us serve with honor, courage, and commitment. And let us always fight for a more inclusive, and more equitable, tomorrow.”