Effort to Strengthen AMA Anti-Discrimination Policy Encounters Resistance

A new draft policy resolution aimed at promoting best practices to curb racism in healthcare faced opposition from some members of the American Medical Association (AMA) during the House of Delegates special meeting.

The American Academy of Pediatrics (AAP) offered a draft resolution that builds on a policy passed by the AMA House of Delegates in November 2020. The AMA policy calls out racism as a “public health threat” and pledges to develop best practices “to recognize, address and mitigate the effects of racism on patients, providers, international medical graduates, and populations.”

In its version, the AAP called on healthcare institutions to establish policies that define discrimination — including systemic racism, implicit and explicit bias, and microaggressions — and to implement training requirements to educate all healthcare professionals on discrimination. The draft also offers procedures for individuals to follow when they feel they have experienced any form of discrimination, including microaggressions. The procedures specifically maintain privacy and confidentiality for the person reporting an incident.

AAP President Lee Ann Savio Beers, MD, speaking on behalf of her delegation, said the House of Delegates has already had several “thoughtful discussions” on the issue of racism in medicine, and now it is up to the AMA to “set the bar for the house of medicine to prevent and address systemic racism.”

In May, the AMA released a 3-year strategic plan for “dismantling structural racism” that included reflecting on and acknowledging “past harms” that the association and its leaders have inflicted. It was not until the 1950s that the first African-American physician joined the AMA, and it took until 1964 for the AMA to pass policy stating that it was “unalterably opposed to the denial of membership in county medical societies” based on race. Earlier this month, Howard Bauchner, MD, announced his resignation as JAMA editor-in-chief, following the release of a controversial podcast about structural racism in medicine.

But some attendees had concerns about how such a policy would be enforced, and argued that an issue of “such huge impact” should be debated by the full House of Delegates.

Rodney Alford, MD, a delegate for the Illinois State Medical Society and the Great Lakes Coalition, spoke on his own behalf in support of the AAP resolution.

“I have no conflicts, other than being a Black person for over 63 years, and a Black student for 18 years, and a Black physician for 39 years. Growing up in the 1960s, I know a little about racism,” Alford said, noting that he had faced life-threatening situations many times because of his race. “After over 40 years in this organization, I think it’s time to have guidelines to prevent and address systemic racism, implicit bias, and microaggressions in the practice of medicine,” he stated.

Ryan Hall, MD, an alternate delegate from Florida, said his delegation agreed with the “general concepts” in the proposed AAP resolution, but argued for referral, due to the need to include clear definitions of certain terms. Hall asked “exactly what is a microaggression and how do we define bias?”

Floyd Buras Jr., MD, a delegate for Louisiana, called for the resolution to be referred back to the AMA Board of Trustees because it lacks a clear explanation of how the policy would be enforced.

Buras, who is white, stated a conflict of interest in that he works in a large urban practice and over 90% of his patients are Black.

“I would like to know what the penalty phase is. If I don’t comply, is AMA going to kick me out of the association?” he asked. That would jeopardize his license because one of the questions asked on re-licensure forms is whether an individual has been dismissed from a professional society, Buras said.

Harry Kuberg, MD, a delegate from Alabama speaking for the delegation, requested referral of the proposed policy. “We too believe that it is in the right direction, but we’re not sure it’s not a bridge too far,” he said.

But Kasandra Scales, MD, MPH, a delegate for the American College of Obstetricians and Gynecologists who spoke on that society’s behalf, supported the proposal. “Your colleagues are telling you that we need support,” she stressed.

Conversations about equity can “make people uncomfortable,” Scales acknowledged. But the proposed resolution represents an opportunity to have those conversations within healthcare organizations, and “to say that ‘This is something that the house of medicine does not tolerate,'” she said.

As for Buras’ concern regarding enforcement, Scales said it was not the responsibility of the AMA to determine the penalties for noncompliance. The point is for the AMA to say that “this is what we stand for and we must stand strong,” she said.

Still, some delegates argued that such a significant change should be debated by the full House of Delegates on the virtual House “floor.”

Gregory Tarasidis, MD, a delegate for South Carolina, shared a statement on behalf of Claudette Dalton, MD, a Virginia delegate. Dalton, who was unable to deliver her statement because of internet problems, questioned the introduction of the AAP resolution. Dalton was frustrated by the “tyranny of the few, try[ing] to convince the majority of us that we should abdicate our responsibility to debate a topic of such huge impact as the strategic plan and its relative resolution.”

Tarasidis said the South Carolina delegation supported Dalton’s perspective.

However, incoming AMA president Gerald Harmon, MD, emphasized that the strategic plan itself “is not up for debate.”

This and other policies will be debated and decided upon in the next few days of the special meeting.