Thousands of Medical Students Voice Opposition to Trump Health Czar

Friday, December 16, 2016

Thousands of medical students are voicing opposition to President-elect Donald Trump’s choice to head of the Department of Health and Human Services, with many threatening to leave the American Medical Association for its quick endorsement of the choice.

On Nov. 29, Trump picked Dr. Tom Price, Republican congressman from Georgia, to lead the HHS. Price is controversial for actively working to repeal the Affordable Care Act (ACA), taking hard-line positions on defunding Planned Parenthood, decrying the recent Supreme Court decision legalizing same-sex marriage, and pushing privatization of Medicare.

Nonetheless, hours after Trump’s announcement, the American Medical Association (AMA), the largest association of physicians in the country, released an enthusiastic endorsement of Price:

“Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs.”

Notably, the press release did not mention the ACA, President Obama’s landmark healthcare legislation.

This discrepancy did not go unnoticed. Almost immediately, an open letter entitled “The AMA Does Not Speak For Us,” by a group called Clinician Action Network began to be shared on social media; the letter now has over 5,700 physician signatures. Here at UCSF, opposition to the AMA’s position and Price’s appointment was voiced on social media and in person.

Second-year medical student Sarah Koser was part of a working group that drafted a similar open letter to express the dismay of many future doctors at the endorsements by groups like the AMA.

“I think it serves the AMA well politically to respond in this way,” Koser said.

As communications chair of UCSF’s AMA chapter, she sees the pragmatism in the endorsement, but was dismayed at the release’s message, and felt as though the AMA was too quick to act without first consulting their members.

Koser’s letter quickly garnered support; as of this writing, it has been signed by more than 2,300 medical students. Some students have even advocated leaving the AMA in protest.

Despite Koser’s opposition to the endorsement, she remains committed to staying in the AMA and working from the inside.

“People are able to be active in the chapter that we have on campus. I think it would be counterproductive to drop out of the AMA and lose the voice that we have.”

Responding to mounting pressure from these letters and AMA members, the organization released a second press release on Dec. 1.

The longer statement acknowledges that there are areas of disagreement with the new HHS nominee, most notably on the ACA, which the AMA currently still supports.

Though continuing to laud Price for his leadership, “our support for Dr. Price to lead HHS should not be taken as an endorsement of every policy position he has advocated.”

UCSF AMA chapter co-president and second-year medical student Prihatha Narasimmaraj is glad of this clarifying message, despite not personally agreeing with the AMA endorsement.

Having worked with the national AMA organization and with the Medical Student Section, she is aware, she says, of the heterogeneity of the sprawling organization, and thinks that the endorsement shouldn’t be seen as the unequivocal views of all AMA members.

“I think there’s a lot of dialogue lately around do people actually feel like they’re being represented by their leaders, and how do people gain leadership… It’s an issue at every single level.”

UCSF’s AMA chapter works with many groups, including the San Francisco Medical Society, the California Medical Association, and the AMA Medical Student Section, not all of which are in accord with the endorsement.

Narasimmaraj thinks it is important for medical students to have a voice at all of these organizations, and points out that, many times, it has been medical students that have changed the conversation.

“It’s really interesting to see what the priorities of the medical students are, because often I feel like the students are the ones bringing up ethical, patient-centered issues.”

Narasimmaraj reflected on the recent AMA House of Delegates meeting in Orlando, FL in early November, where a push to rescind support for the ACA was met by steep resistance, much of which was from medical students.

Third-year medical student and former UCSF AMA chapter president Rachel Ekaireb agrees that a more nuanced view of the AMA is needed, and also perhaps a more hard-nosed approach to political reality.

“I think this knee-jerk response… the expectation to denounce this choice immediately is really naïve, because you have to take into consideration the political world that we’re living in right now.”

Both Narasimmaraj and Ekaireb mentioned the experience of feeling like they live in a progressive “bubble” here at UCSF.

Going to AMA meetings elsewhere has shown them that not everyone has a similar view of medicine and what’s good for patients.

“I would love to see more of this discourse on campus. I think it’s events like this that pull us out of our bubble. I feel very fortunate to live in this city and this state, both of which have released many statements this last month that reinforce the values that I hold dear. I think if we want to make change on a national level, these are the tough conversations that we have to have,” said Ekaireb.

To those thinking about leaving the AMA over this endorsement, Narasimmaraj and Ekaireb extended an invitation to come talk to them, share their views, and get involved in the chapter.

“We are still engaged and active because we know that there are still good things that happen because of a direct response to our involvement, but a lot of people don’t know that, and all they see are these big public statements.”