AMA leader outlines major threats facing U.S. healthcare: Payment cuts, AI denials, immigration bottlenecks and corporate takeovers
American Medical Association (AMA) Board of Trustees member Scott Ferguson, MD, FACR, a diagnostic radiologist in West Memphis, Arkansas, is raising red flags about a range of challenges threatening patient care and physician sustainability in the U.S. healthcare system. Speaking to Health Exec at the AMA House of Delegates meeting, he highlighted urgent concerns including Medicare payment reform, immigration hurdles for foreign-trained physicians, prior authorization burdens, politically motivated cuts to public health research, and the unchecked growth of private equity in medicine.
Medicare payment crisis
"The dominant issue today is Medicare and Medicaid payments. Over the past 20 years we had a 33% decline in payments, and our medical costs continue to rise. We need some type of an inflationary update to cover the cost to our staff, our supplies, all our rents. All of those things continue to escalate and we have nothing to balance them off," Ferguson explained.
HE said that outdated budget neutrality rules and the lack of an inflationary update mechanism are crippling physician practices, especially in rural and underserved areas. The 2.83% across-the-board cut in the 2025 physician fee schedule further tightened the noose.
"It's access for our patients, not just physicians being able to keep their doors open. We're losing. We have a physician shortage and we're continuing to lose people," he explained.
The decline of U.S. private practice
Ferguson, who describes himself as a “solo radiologist, which is either a dinosaur or on the leading edge,” noted fewer and fewer physicians now remain in private practice. The rest have joined health systems or been acquired by private equity companies. Hospitals often receive higher reimbursements for the same services.
"They're being bought out by private equity and then you can just see what has happened with many of those practices. When they're bought out, they've got stockholders, they've got people to make happy, and the cost of medicine goes up for everybody and the results are not as good," Ferguson explained.
He shared an example from AMA President Bruce Scott, MD, whose mother saw the price of her annual echocardiogram triple—despite with no change in location, equipment or provider after her physician’s office was acquired by a hospital. He said the costs went up with no extra value added to healthcare.
Trump's public health policy and research cuts
Ferguson also voiced concern over political interference in science under the Trump administration, including steep funding cuts to key federal agencies like the NIH, CDC and FDA. Massive amounts of federal funding for medical research was also slashed, with the reason being many of these grants were labeled as related to diversity equity and inclusion (DEI), which the administration has labeled as bias against whites.
Ferguson's daughter is a researcher working on diversity and health equity, and all of her grants canceled, he said.
He also noted the numerous threats to large, respected academic centers like Harvard and Columbia
"It is going to hurt education, it's going to hurt science and technology. We need a diverse background and we need the smartest and brightest from wherever they come from," he explained.
Trumps immigration policy is now having a major impact on international medical graduates (IMGs), who are being barred from coming to the U.S. to begin residencies at many of these academic medical centers this summer.
Immigration gridlock threatens incoming physicians
With IMGs making up roughly 25% of the U.S. physician workforce, Ferguson said delays in visa processing are threatening to derail the start of residency programs for many doctors in July.
"Right now, they can't get here. They can't get here because they can't get a visa appointment. They can't come. If they are already here, they have been told don't leave the country because you might not get back in. It tears families apart. It makes decision making difficult, and it's really harmful to the system and to the individuals and their families," Ferguson said.
He said these are highly trained, talented physicians that are being prevented from entering the U.S., which will further complicate the critical and growing physician shortage in the U.S.
Prior authorization and the rise of AI denials
Prior authorization continues to be a major source of frustration in healthcare that requires fixing to help reduce physician administrative burnout and ensure patients have timely access to care.
"Prior authorization is a burden like none other. It affects our patients. People can't get their prescriptions," Ferguson explained.
He added when patients cannot get the preventive care they need, especially in radiology, then end up in emergency rooms just to bypass insurance wait times for diagnostic scans. He said this can cost three times as much.
"It costs the system money. It frustrates patients, it delays care, denies care and harms patients," he said.
The AMA has had some successes, getting legislation to reduce prior authorizations passed in about 14 states, but he said a federal law is really what is needed.
He also took aim at insurance companies’ growing use of artificial intelligence (AI) to issue blanket prior authorization denials.
“AI in prior authorization is a no-go," he said. "AI is going to probably just automatically deny everything. We believe in transparency. We want to know what's inside the black box, what causes a denial."
The AMA is calling for transparency requirements, independent oversight and guardrails to ensure patients are not denied care by opaque, unaccountable AI systems.
Ferguson said the AMA remains focused on driving systemic reform—pushing for legislation to stabilize Medicare, stop abusive prior authorization practices, protect scientific research and fix immigration policies that block access to care.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]