Conversations with... Peter W. Carmel, MD



GEORGE LUNDBERG, MD: Hello, I'm Dr. George Lundberg, Editor-at-Large for MedPage Today, and we're here in Chicago, Ill., at the annual meeting of the American Medical Association. And right now we have the great pleasure to introduce you to Dr. Peter Carmel, the just-now elected president-elect of the AMA. Thank you for being here today.

PETER CARMEL, MD: Thank you, George. It's a pleasure to be here.

LUNDBERG: How does it feel?

CARMEL: Scary. Oh yes, absolutely.

LUNDBERG: Expand on that. What do you mean?

CARMEL: I think that there is a responsibility in representing the AMA nationally, which is essentially what the president-elect does. I want to make sure I get our message out, and our message is going to be a somewhat different than it's been over the last four or five years.

LUNDBERG: Dr. Carmel, I've neglected to say, is a pediatric neurosurgeon who practices in Newark, NJ, while living in NY. You won a tough campaign, a tough race. Tell me about your opponents. Who were they, and how did they do?

CARMEL: Well, they did wonderfully. It was historically unprecedented to have three candidates running for president-elect. All three coming from the board of trustees, all three having informed AMA policy over a number of years. Dr. Haymen is an obstetrician and gynecologist solo practitioner from Massachusetts, and Dr. Langston is a family practice member from a large family practice group in Indiana.

LUNDBERG: Why do you think you won?

CARMEL: I think I won because I was very pro-doctor. Doctors are unhappy.

LUNDBERG: I heard that from other people.

CARMEL: Yes. Because they feel that the new healthcare law, which has great things in it for patients, has very little for doctors, and none of the objectives doctors had in mind got into the bill.

LUNDBERG: And yet, what I heard was that there were no candidates from the board of trustees running on a platform of repeal and replace. Is that correct?

CARMEL: That is correct. I think for a number of reasons repeal and replace is a hard thing to do. The truth of the matter is that it's going to take 67 votes in the Senate to override a presidential veto. I think the president is very tied into what has been gained in this new law. So, I'm not sure repeal and rescind is a realistic political goal.

LUNDBERG: Well, I've felt the same way, but I was interested in recognizing that no one ran on a platform like that, even though I've heard for the last many months from doctors all over the country how unhappy they are about so many things. You're going to put effort into making them less unhappy by trying to get the administration and Congress to treat doctors a little better than they have been.

CARMEL: Getting the administration to treat doctors a little better may not be the right term for it. But the fact is, George, that we have never passed social legislation before in this country, Social Security, Medicare, that wasn't tweaked a number of times in the ensuing years. The tweaks in this particular law are going to continue for some time, probably will be more prominent after the next presidential election in 2013.

LUNDBERG: Right, and more tweaks can occur before this actually comes into law since there's this long fuse between this many things being implemented.

CARMEL: Most of the things good for patients in the law are front-loaded. Patients will see this year and the year following most of the things that will change their relationship to mostly their insurance carriers. Insurers will no longer be able to arbitrarily deny insurance to their carriers based on a prior condition, they will not be able to stop insurance because of a serious expensive illness, and they won't be able to stop insurance based on what is a life of payment. These are incredibly good protections for patients.

LUNDBERG: Long overdue for the country at large, for patients specifically.

CARMEL: And I think when patients, and they are things patients are deathly afraid of, people are afraid of having their insurance cancelled. When those things play out in the early part of the bill's history, they are not going to want to see that go away. Another reason why I don't think repeal and rescind is possible.

LUNDBERG: When I was first interviewed by the AMA for the JAMA job, which was in 1981, I was told by a senior staff person that the most powerful position in the AMA is the president-elect position, because he's on the way up. What do you think? You don't feel the power quite yet?

CARMEL: It's not flowing to me, yet, George. No, I think that the way it is set up, the chairman of the board has the most power. The presidents are set up to articulate and annunciate policies that are established by the House of Delegates of the AMA. So, in a very real way, when they say we are the mouthpiece for the organization, it's important that president elects don't feel like they're making policy.

LUNDBERG: No, I understand that. And, of course, the members come first. And we wish that there were more of them, and I'm hopeful that you can do something to get more doctors to join the AMA.

CARMEL: I would love it.

LUNDBERG: We've been talking to Dr. Peter Carmel. We've been privileged to talk to him, the just-elected president-elect of the American Medical Association. Thank you so much for being with us.

CARMEL: Thank you, George.

LUNDBERG: Best of luck to you as you go forward and let us know if we can help getting the message out. We have a lot of listeners and a lot of readers and viewers. Thank you for being with us. I'm Dr. George Lundberg, Editor-at-Large for MedPage Today. And don't forget to give us your comments after you've listened and watched this program. Thank you.

  • Reviewed by Zalman S. Agus, MD Emeritus Professor
    University of Pennsylvania School of Medicine