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We cannot afford to lose even one more doctor, but the financial reality we face makes situations like hers all too common.

We have all suffered the 33 % reduction in Medicare payment to physicians since 2001. And it’ s not just Medicare – at least in my practice, our Medicaid and private insurance contracts are based upon Medicare rates. This is unsustainable and is pushing physician practices to the brink of financial ruin. This puts us in an impossible position – turn away those patients, somehow further reduce expenses or close our doors for good. And in each of these scenarios, it’ s our patients who suffer.

Last year we were close to getting the reform needed to link future updates to the Medicare Physician Payment to the cost of providing care( the same link that hospitals, ambulatory care centers, long-term care facilities and others have enjoyed for years) but in the end the rule was stripped from the legislation largely because medicine was not united. We did get a 2.5 % increase for 2026, but this is simply a Band-Aid for a wound that continues to bleed. This is why Medicare payment reform has been a top advocacy priority for the AMA, and why it will continue to be until meaningful reforms are achieved.

As physicians, we are all familiar with the administrative burdens thrust upon us that keep us from doing what we all became doctors to do – take care of patients. Daily we face the needless delays and denials from prior authorization and the harm it causes for our patients. We all know that prior authorization denials are rarely – if ever – rooted in science or evidence. When I get on the phone to appeal a denial with a so-called“ peer,” it’ s often clear I’ m not talking to a physician and it’ s almost never an otolaryngologist. Heck, most of them can’ t even pronounce otolaryngology.

In 2024 when we couldn’ t get Congress to pass legislation to reform prior authorization, AMA went straight to CMS, where our advocacy was instrumental in a CMS“ final rule” going into effect in 2026 for government-regulated health plans to reduce the timeframes for prior authorization, to improve transparency and for payers to move beyond fax machines implementing electronic processes.

Now the AMA is pressing for federal legislation to codify these reforms into law and press further on prior authorization reform in Medicare Advantage plans. Recently the AMA spearheaded a letter, cosigned by over 80 specialty societies and every state medical association, to House and Senate leadership in strong support of( H. R. 3514 / S. 1816), the“ Improving Seniors’ Timely Access to Care Act.” This bipartisan legislation would streamline and standardize prior authorization requirements within the Medicare Advantage( MA) program. It would require MA plans to implement an electronic prior authorization system that meets federal interoperability standards.

After years of sustained pressure from the AMA, united with our

Federation partners, more than two dozen prior authorization reform bills have been enacted in states since 2023. In Kentucky we have been close, GLMS and KMA continue our efforts with support from AMA.

Under legislative pressure a group of major insurers announced that they will institute reforms including reducing the volume of prior authorization requirements, improving transparency and automating the process. While this announcement was welcomed, these promises echo commitments health plans previously agreed to in the 2018 Consensus Statement on Improving the Prior Authorization Process, yet were never implemented by many of the plans. The AMA will closely monitor the implementation and impact of these changes as we continue to work with federal and state policymakers on legislative and regulatory solutions to protect patients from obstacles to necessary care.

Meanwhile, we have an administration that is calling into question established medical science and spreading misinformation. Diseases that were thought to be largely eradicated from our shores have returned. Legislation that threatens access for millions of our most vulnerable patients has been passed into law and tax credits that help millions of patients afford health insurance are set to expire. Student loans are limited, creating barriers for talented students who want to become physicians.

In many ways my colleague in the hospital that day was correct – health care in our country is a mess!

So, how do we fix it?

Whether you are passionate about payment reform, reducing administrative burdens, securing access to care for patients, protecting children from preventable disease or the many other battles we fight – the only way to win these battles is with a unified front. I assure you GLMS, KMA and AMA are leading the charge on these and the many other challenges we face as physicians – not divided as primary care or specialists, not as private practice or employed, not liberal or conservative – but as physicians caring for our patients

This work, to advocate for our profession, for our patients, belongs to all of us … to all in our profession.

Make no mistake, this is going to be an uphill battle.

But I believe that with the unified voice of physicians from across the country, from every state and specialty, together, we CAN Fix it.

* This article draws upon Dr. Scott’ s presidential address at the AMA Interim Meeting; it can be viewed at https:// www. youtube. com / watch? v = T- VHS1XepF9k.

Dr. Scott is Immediate Past President of the AMA and President of Kentuckiana ENT.

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