AMA President Says N.Y. Needs More Primary Care Physicians


The president of the American Medical Association, Dr. Nancy Nielsen, was already quite busy before taking on her new role: The Buffalo, N.Y., native is a mother of five, a practicing physician, and a medical school dean.

The second woman to be elected president of the country’s largest physician membership organization began her medical career late by most standards. Dr. Nielsen, 65, entered medical school at 29 after giving birth to her children. A graduate of the Catholic University of America, where she earned a doctorate in microbiology, Dr. Nielsen received a medical degree in 1976 from the University at Buffalo School of Medicine and Biomedical Sciences, where she currently serves as a senior associate dean for medical education.

Elected president last month, Dr. Nielsen is charged with articulating the positions of the AMA, which has more than 240,000 physician members. Among the association’s most recent efforts was a successful battle to urge Congress to halt a 10.6% reduction in Medicare fees for physicians.

In an interview with The New York Sun a day after the vote, Dr. Nielsen reflected on the state of the country’s health care system, and the system in New York, where the price tag for Medicaid is nearly $47 billion and where doctors face some of the most expensive medical malpractice insurance costs nationwide.

She spoke with the Sun by telephone from an airport in Washington, D.C., during a layover upon returning from England.

Q: You’re just returning from a British Medical Association’s conference. What was on the agenda there?

A: There was a lot of talk about the national health system, to which they are very committed. There was a lot of concern about privatizing and letting their citizens “top off” the care they get through the national health service, by going private and supplementing it with private services. The United Kingdom is trying to reduce waiting times to 18 weeks. I don’t believe Americans would tolerate 18 weeks for an appointment, but care in that country is free and it’s supported by tax dollars. It was an interesting way to learn more about their problems and some of their solutions, because frankly, if we are to craft an American solution to the problem of the uninsured, we really must learn from other countries.

Do you think this country is moving in the direction of a national health system?

I actually don’t — for a lot of reasons. First of all, we have an employment-based system. Americans won’t want to give it up. It will probably be a blend of the employer-based system and a variety of other approaches. Let the debate begin, that’s the important thing.

Is this country moving toward some kind of universal health coverage?

I want to be careful about the terms. People think they mean a single-payer, government-run system, and our answer is no. We think that would be a terrible mistake. We have government involved in health care now both through Medicaid and Medicare. But there’s an important role in America for the private health plans. We believe that all Americans should have heath insurance, and it should be affordable health insurance.

What’s your priority as president of the AMA?

The role of the president is to be the voice for America’s physicians and to make sure that we articulate the policy passed by the AMA House of Delegates. So it’s not my independent vision. Our priority is to ensure that all Americans have timely access to quality health care.

How would you rate New York’s health care system?

One of the big problems is not unique to New York. We have a tremendous need for primary care physicians. It’s because of the way that reimbursement is structured, because primary care is not reimbursed adequately for what is being done. In my own location of Buffalo, we’ve just been through a wrenching situation because of the hospital closings and mergers that were ordered. It has not been easy, but the right things have been done.

Is Governor Paterson committed to changing New York’s health care system?

I think the jury’s out on that. We are hopeful. There is one issue that New York physicians are facing, which is liability premium increases. That is a serious problem. We’ve had a medical liability crisis in New York for a long, long time, and when I say crisis, it has led people to leave their practice before they otherwise would have.

Is there a solution?

What doesn’t work is what our state has, which is jackpot justice. There are many alternative approaches that have been suggested, such as medical courts, because people who are injured deserve to be compensated. It’s when it becomes a lottery that that’s not so good.

What does it mean to you to become the second woman to be elected president of the AMA?

I think the most important thing when a woman does something for the first time and breaks that glass ceiling, it’s actually more important for the organization than it is for the individual. I’ve been the first woman to do a lot of things. I don’t spend a lot of time thinking about it.

Why did you wait until you were 29 to start medical school?

I wanted to be a physician from the time I was 8 years old but I didn’t have any money. I grew up in West Virginia and we really had no money. My dad was a plumber. So for me it was a lifelong dream. It was a dream deferred but it was very sweet.

How did you balance the needs of your children with your studies?

It really was hard, as you might expect. We were pretty poor, but happy. I’m very grateful to the University of Buffalo School of Medicine. At that time they had an experimental program where they picked six people, most with advanced degrees, which I already had, and let them go through in three years instead of four.

The AMA has been called out of touch with a younger generation of doctors — what do you think?

I think there’s some truth to that. I think the younger people are not joiners. I teach medical students and they’re very, very committed to serving others. I think what all medical societies have to do is to connect with younger people in a way that is meaningful and that is on their terms.

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