AMA President Bobby Mukkamala, M.D., takes aim at pressures facing physicians

Bobby Mukkamala, M.D. © American Medical Association

As physicians confront mounting pressure from shrinking reimbursements, prior authorization roadblocks, workforce shortages and political upheaval, new American Medical Association President Bobby Mukkamala, M.D., says the profession must stay united — and fight back. A private practice otolaryngologist from Flint, Michigan, Mukkamala brings both clinical and deeply personal insight to the role, including his recent experience as a patient with cancer.

In this interview with Medical Economics, he outlines his priorities for the AMA; defends physician autonomy; and explains why the biggest threats to medicine today, from scope-of-practice battles to equity gaps, demand collective action by the medical profession.

The following interview was edited for length, clarity and style.

Bobby Mukkamala, M.D.

I’m an otolaryngologist, and I practice here in Flint, Michigan. I’ve been in practice for the past 25 years, and I share the office with an OB-GYN, which sounds kind of weird, but the reason I do is that she’s my wife. We met back in college, went to med school together and then moved back to Flint. Flint is my hometown.

My parents immigrated here from India back in 1970 and I dragged my wife here to see what practice would be like in Flint, promising her that if she didn’t like it, we’d move back to Chicago, but we had twins born, and we started our new practice, and we shared the office, and we still do 25 years later. It’s a wonderful town to practice in, because it’s the one that welcomed my parents 50 years ago.

Medical Economics

You’re taking on a big role as president of the AMA. What do you see as the mission of the AMA? And what do you see as your primary goals?

Bobby Mukkamala, M.D.

When I think about what my parents’ practice was like when they started their practices in the early 1970s, and how happy they were taking care of their patients. I mean, my mom’s a pediatrician, she worked until it was dark outside here in Michigan, in Flint, to see all those patients, and yet, she would come home with all her charts, before electronic health records, and just do that work at home.

She loved it.

They only retired when they just couldn’t work anymore. And now I look at all of the hassles that are involved in taking care of patients — not looking at my patient, but instead looking at a computer screen, working on things like prior authorization — and in the cost of health care and access to care for people who can’t afford it. And now with the new uninsured population, if they lose their Medicaid, those sorts of challenges are just extremely frustrating. And so, the mission of the American Medical Association is to put us back facing our patients and improving their care and the public health.

It’s an honor to serve as the president, because we’ve done a lot of work over the past several decades, and there’s still a whole lot of work to do.

Medical Economics

You’ve spoken about some of the health challenges that you’ve dealt with recently. Can you talk about what it’s been like to see medicine from the patient’s perspective?

Bobby Mukkamala, M.D.

It was an amazing experience as I look back on it. It wasn’t even a year ago. It was back in November, I got diagnosed with a brain tumor that ended up being a Grade 2 astrocytoma, which is a cancer, but one that has not the Grade 4 lifespan of about 10 months, but at least 10 years, maybe more.

In the first day or two, I was like, “Oh, crap, how did this happen?” My whole family is in tears, wondering what’s going to be the future of our dad, our husband, our son. But within a day or two of just being exposed to the health care system as a patient for the first time, it was an amazing experience. It was wonderful to have that kind of access. But what I realized immediately, and it was almost with a feeling of guilt, that when I look at any of my neighbors here in Flint, Michigan, in this neighborhood, and the trouble they would have in finding a neurosurgeon, having their insurance allow them to get an MRI scan, let alone schedule surgery.

The shortage of physicians in general in the community, the trouble that they have just trying to get in to be seen, whereas I got taken care of within a month of my diagnosis, and other people a month later are still waiting for the MRI or another follow-up scan or access. That’s immediately when I felt like this was something that happened to me for a reason, as I’m six months before being inaugurated as the president of the AMA, after a 25-year career in medicine, taking care of patients, to become a patient on death’s door, was an amazing preparation. So, after a couple of days of misery, I was like, “You know what? This is amazing.”

The affection from friends and the whole community. Every day, even today, I was in my office, and at least half a dozen patients are seeing me for the first time since then, and they’re just happy to see me alive. And that’s been an amazing experience.

Medical Economics

Many of our physicians in primary care feel under threat from a bunch of different areas. I’m wondering, what is your feeling in terms of the AMA and what the organization is doing to try to center the needs and address the challenges that are facing primary care?

Bobby Mukkamala, M.D.

The AMA is very aware of the demands that are on primary care physicians right now. They are the ones who feel the burdensome regulations, the financial strains, things like prior authorization. They are the captains of the ship. That’s what I tell my patients.

That your primary care sent you to me as a specialist because of x, y, z, and this is the reason that they did that, and this is what they had to do to allow this. And my patients call all the time, and they say, “Hey, can we get an appointment with you?” And I say, “Well, with your insurance, you have to go through your primary care physician, and the primary care physician has to do a prior authorization.” So that’s why the AMA is fighting all of these things that make it difficult to take care of patients, everything from prior authorization to the primary care physician shortage.

We’re going to be 80,000-some physicians short very soon, and it looks like it’s going to be getting worse than that in the decades to come. And so now there are fewer primary care physicians to be the captains of the ship, to take care of a population that is getting older, and older with chronic disease. The older we get, the more we need them, and the less supply there is. What does that do for the people who are the primary care physicians in these communities? They burn out. They say, “I just can’t take this anymore.”

It’s frustrating to them. They love taking care of patients, just like my mom and dad, but now all these hassles are making them burn out, and instead of working until their 70s, like my parents did, like the previous generation of doctors did, when they get to be in their 60s, they’re just looking for that exit door because of this frustration.

Medical Economics

We’ve got to talk about policy and politics a bit. 2025 has been a year of massive change so far. We could start with all of the big restructuring of federal health agencies: There’s been a lot of discussion about what happened with the ACIP committee members getting fired, and what’s going on, in general, with vaccination policy under HSS Secretary RFK Jr. We’ve got the tax law changes and Medicaid cuts. It’s a ton of stuff. How does the AMA approach these policy changes?

Bobby Mukkamala, M.D.

As you mentioned that list, I’m sinking in my chair. When you put it all together, as opposed to what we’re working on today, I feel like David versus Goliath. But what do you do in that situation? You do what David did. You put up a fight. That fight is on behalf of physicians’ ability to take care of patients and the public health of this country. That’s the mission of the AMA.

When you see things like totally taking apart a government task force that deals with things like immunizations, such as the Advisory Committee on Immunization Practices, or the U.S. Preventive Services Task Force? These are people whose core purpose at USPSTF is to figure out why we should test somebody for x or y. And that’s something that now is taken apart or at least delayed. I think about my own health care history.

This pill that I’m taking for the last 10% of the cancer that they couldn’t take out was discovered by scientists and by a pathologist at Duke University, and his whole lab received big funding by the National Institutes of Health, and it got approved just four months before I needed it, after more than a decade of research. When NIH funding gets cut ... it’s making it personal. But what does that do to motivate the AMA? You take a punch in the gut, and you keep on going on behalf of the health of this country, and that’s how I feel. It’s difficult, but I’m proud that the AMA exists with the capacity to deal with everything you mentioned.

Medical Economics

While we’re talking about policy, let’s talk Medicare reimbursement, which has not kept up with inflation for decades. What can physicians and the AMA and other physician groups do to try to stabilize the reimbursement system in this country and to make sure that physicians are paid for their expertise and for the care that they give to patients?

Bobby Mukkamala, M.D.

The authority to fix that is in Washington, D.C., as it relates to Medicare. And there’s a ripple effect of that; when I look and see what private insurance companies pay, it’s always some percentage of Medicare. Sometimes it’s 90% of what Medicare pays, sometimes it’s 110%, but wherever Medicare goes, everybody follows. That’s a problem.

The American Medical Association has spent the past six months talking to as many people as we could talk to about the consequences of a bad decision about Medicare payment to physicians. And we had the start to a good idea: Tie reimbursement to the Medicare Economic Index, which basically says if costs went up by 2%, increase reimbursement by 2%. The solution isn’t perfect. But at least it would be tied to a formula, instead of going up and down from year to year based on what the budget looks like, which is nothing that hospitals have to go through, but something that doctors have to go through. We got a temporary increase, as we usually do in a random year, so a 2.7% this year, and then have to deal with it again next year, and who knows where it’s going to go. That’s exactly what’s happened during the entire time of my practice.

What do we do about that? I think the best way to do that is to have patients knowledgeable about the government’s role in health care and let them know what the consequences are of a bad government decision to not keep up with the cost of care.

Medical Economics

During your inaugural address, you described the health equity gaps that you witnessed in your hometown of Flint, Michigan. What do you believe the AMA and individual physicians can do to start trying to narrow these gaps?

Bobby Mukkamala, M.D.

Like I said, I live in Flint. If I go 10 miles south on I-75 to a suburb of Flint, the life expectancy goes up by 12 years: 10 miles, 12 years. Sixty-eight years of age is the life expectancy here. It’s 80 years of age in a suburb of Flint, just a few freeway exits away. There are some people who just didn’t realize that, just not something that they’re aware of.

So, the AMA has a ton of work ahead to lead to raise the level of understanding about health equity and embedding it not just in the work that we do but within the AMA. This is something that we’ve really grown from as we look back at our own history and then also the consequences of a lack of health equity in our country. And this isn’t something that an individual organization could or should do alone. It comes from raising the level of understanding about this throughout the country.

For example, I remember growing up learning about the pulse oximeter, the thing that you put on your finger to measure oxygen levels, and how the numbers if you have dark skin versus light skin are different. This isn’t a blame game at all, this is just about realizing that that thing that you put on people’s fingers, just so you know, it’s going to give you a wrong number if it was all developed with people with white skin. That’s just basic education that we help people get to, to raise the level of understanding, to close some of these gaps, so that people in Flint, Michigan, get to the point where they’re living as long as the people in the suburbs of Flint, Michigan, and multiply that by coast to coast, that’ll be a wonderful consequence of the AMA’s efforts to improve health equity in this country.

Medical Economics

Prior authorization is something that continues to be extremely frustrating to physicians of all specialties. What are some things that we can do to help fix this?

Bobby Mukkamala, M.D.

My gut reaction to prior auth is that it’s not helping us take better care of our patients. When my patient comes in, say they’ve got a lump in their neck, and I tell them, “We know you used to smoke; there’s a very good chance this is cancer. It feels like that to me.

We need to get a CAT scan to figure out what it looks like underneath, and then we’ll figure out what to do about it.” And they’re freaking out. I mean, that’s just terrible news to get. The minute we walk out of that exam room, I’ve got to tell my medical assistant what we need, a CT neck with contrast, to rule out cancer. Boom, immediately, a prior authorization is required. Best-case scenario, we can get on a computer, we’ve got to answer the questions, sometimes it happens within a day or two. Sometimes it gets denied. And then we’ve got to go and explain ourselves.

These are the things we have to deal with while we’re trying to take care of patients. And that’s exactly what the AMA is trying to reform by putting prior authorization where it belongs. This is my 25th year in practice. I’ve been around the block a few times. I know what to do with my patients, and yet I still have to go through prior authorization. I’m identified by the biggest insurance company in our state as being in the top third of otolaryngologists in the way that I practice, but I still have to go through prior authorization on every single one of those cases.

That is just wrong.

Another example: insulin. It’s been around for how many generations, and yet, every 90 days, they have to get prior authorization to get their insulin. The people who created insulin, who discovered it, gave it away for free, and here we are now dealing with prior authorization for insulin. I understand prior authorization for the pill that I take — the IDH inhibitor for my cancer — because that’s more than $200,000 a year. Okay, that I get. But come on, $60 worth of insulin, getting prior authorization for that? That’s just wrong.

Medical Economics

Let’s discuss the ownership of practices. There’s been this decline of private practice and more corporate ownership by hospitals and private equity. What are your thoughts on private practice, independent medicine and the importance of physician autonomy?

Bobby Mukkamala, M.D.

Physician autonomy is critical for good patient care. My wife and I are in private practice. We are a dying breed. But it’s not because it isn’t cool to be in private practice and it’s cooler to be employed. That’s not at all the logic. It’s like, you know what? This private practice ship is sinking.

We better jump off, right? And so, physicians jump into a situation where they’re employed by some entity, or there’s pressure to be employed. I see hospitals pulling this all the time, that if you’re not employed as one of their doctors, they’re not sending any patients to you. That’s just wrong. And so that’s the consequence of the change in the culture within health care from the previous generation, my parents’ generation, who never had to deal with it. That’s when 70% of doctors were in private practice.

Now it’s 70% that are employed, to get off the sinking ship. And what we’ve got to do is improve the ship, so it stays afloat instead of sinking any further. The AMA has a private practice physician section that looks at all of the hassles of being in private practice and tries to help us to be able to maintain that practice. And what I would love to see, and what we’re starting to see a little bit, is medical students who start to think about it and say, “I never thought about doing private practice, but I see Dr. Mukkamala, and I hear him on shows like this, and I’m interested in that,” and they come by my office, and they love it. If you don’t see private practice, you don’t know what you’re missing. That’s going to be critical, because when somebody acquires a practice for the wrong reason, to generate profit by tinkering with the practice of medicine or to try to capture more market share, it can be a problem.

We had a hospital in my hometown, in the suburbs of Flint, that basically bought every single primary care physician. And the headline, the newsletter, says, we want to improve the standards of care, we want to make sure that we’re sticking to the science. That is absolute nonsense, because what it’s related to is making sure that every patient who gets admitted, every MRI scan that gets done, every lab test that gets done, it happens at their institution. And that’s just the wrong motivation if we’re going to improve the care of our communities and maintain the physician’s ability to do that instead of getting burnt out. Independence shouldn’t be punishment. It should be something that’s allowed to thrive.

Medical Economics

You can’t get through a day without hearing about AI, and there are a lot of promising aspects of where AI can assist physicians with doing their job. What do you feel the role of AI is in medicine?

Bobby Mukkamala, M.D.

It’s pretty cool, right? I think this is a good development, but it just depends on how it evolves. When I looked at EHRs when they first came out, I was also like, “This is pretty cool.” We don’t have to have thousands of paper charts and worry about losing a chart. But now we know about the lack of interoperability, the fact that I still have to use a fax machine to send other doctors the note because the systems aren’t communicating properly, so EHRs were something that had a lot of cool potential but fail in many ways.

And I think that’s the potential for artificial intelligence. We at the AMA refer to it as augmented intelligence. Help me to help my patient. It’s something that I think is going to need a lot of attention, because there’s going to be exponential growth, there’s excitement, but there’s also anxiety from the physician’s perspective. What if this thing gets developed and it isn’t right? We need physicians involved in the development of AI, and we need to know when it’s being used. Because if it’s on my computer and the hospital decided to put it there, and I didn’t even know about it, or the software that we bought as a hospital, and me using it as a doctor, had AI within it and we didn’t even know, that’s a problem. And so, there is a way that we need to be very prudent about getting this in to help me and not hurt me and not hurt my patients. Who’s at fault if this thing screws up?

Is it the doctor who didn’t even know it was there? Is it the institution that put it in there? Is it the person who wrote that program? These are all very important things, and so I’m excited, but we’re paying a lot of attention to make sure that what does evolve from it is helpful and not harmful.

Medical Economics

When we ask our physician audience about the things that tick them off, No. 1 is scope of practice. I think there’s general concern out there among physicians about the blurring of the lines between a physician and a nurse practitioner and other nonphysician providers. I know the AMA has stances on this. How should the profession go forward on this issue?

Bobby Mukkamala, M.D.

North on the compass of this issue is improving the health and maintaining the health of our country. I want the people with the most training to be involved in every aspect of health care, whether that’s putting a kid to sleep for their tonsils or whether that’s managing somebody who comes in with a lump in their neck.

To be a nurse practitioner, for example, you can finish that in less than two years of classes and 600 hours of training, compared with four years of classes after your bachelor’s degree and 10,000 hours of training to be a doctor. What do we want for the future of our country? We want those groups to function as a team, so that this person who comes across something that they’re not quite familiar with, they’re not sure what to do, can express that wide open, because there’s a doctor who’s in the room, down the hall in the building, a phone call away to be able to help, to say, “You know what, that lump is an infection. Maybe we should try this first. They don’t need an antibiotic. Or they need a scan,” right? That’s the wisdom that comes from thousands of hours of training, not 600 hours of training, getting your degree and going to one of the states that allows the independent practice of somebody like that.

We need to stay as a team if we’re going to improve the health of our country. Taking that team apart is not going to do that. It’s going to take us in the wrong direction. And we see that already. There are plenty of data to say that cost goes up. If you’re not sure what’s going on, you’re going to order a bunch of tests to try to figure out what’s going on. And so, the cost goes up, access doesn’t go up. I live in the southern part of Michigan.

The upper part is where we need patients taken care of. And the theory is, if we had more people who take care of those patients, if we let nondoctors go up there to practice, that would be better. But what happens in that situation? People stay where everybody else wants to stay. Nobody’s going with that new authority to take care of patients anywhere else. It doesn’t improve access to care.

These are all the different reasons that we need to function as a team if we’re going to go in the right direction in our country.

Mukkamala's full conversation with Medical Economics can be heard in two parts on Off the Chart: A Business of Medicine Podcast.

• Part one: From patient to president, with AMA President Bobby Mukkamala, M.D.
• Part two: Physician struggles, with AMA President Bobby Mukkamala, M.D.