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Jennifer Miles-Thomas, MD, URPS, MBA, discusses the AUA's legislative priorities along with issues in medicine related to artificial intelligence.
The American Urological Association (AUA) conducted its Annual Advocacy Summit March 3-5, 2025. The organization came to the gathering with 4 key priorities:
1. Medicare payment reform. The current Medicare payment system has been identified as a significant concern. Reforming this system is a top priority for the AUA to ensure fair and sustainable reimbursement for urological care.
2. Workforce expansion and preventing burnout: Recognizing the strain on the health care workforce, particularly exacerbated post-COVID, the AUA aims to address the shortage of urologists and prevent burnout among practitioners. This involves raising awareness of the issue, understanding the supply-demand gap, and advocating for policies that support workforce growth and retention.
3. Reining in prior authorization requirements: The AUA is strongly advocating for the streamlining and reduction of prior authorization requirements. These requirements are seen as a significant impediment to timely patient access to necessary therapies and procedures, often causing delays and frustration for both patients and clinicians.
Jennifer Miles-Thomas, MD, URPS, MBA
4. Drug shortages and policy solutions: Addressing the recurring issue of drug shortages is another critical advocacy priority.
In this interview, Jennifer Miles-Thomas, MD, URPS, MBA, discusses these priorities along with issues in medicine related to artificial intelligence (AI). Miles-Thomas is an assistant professor of urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois.
Miles-Thomas: For 2025, there were 4 main issues that we wanted to address with all our representatives and our congresspeople. The first one is Medicare payment reform. We know the health care system is not working. It's not working for patients, it's not working for clinicians, it's not working for the government. That was one of our main priorities.
This year, Medicare payment reform was the priority closest to my heart. At a time when reimbursement rates have effectively declined by 33% since 2001—when adjusted for inflation—our ability to deliver sustainable, high‑quality care is under threat. Listening to fellow urologists and patients, I felt deeply that reform is not just a policy debate; it’s about preserving the very foundation of patient access and clinician well‑being. The proposed HR 879, which would eliminate the 2.83% cut and include a 2% inflation adjustment through the end of this year, offers a tangible step forward. Yet its passage hinges on our collective voice making clear that without meaningful change, our health system cannot endure.
Workforce expansion and burnout prevention follow closely behind. We’re facing a striking imbalance: 62% of U.S. counties lack a practicing urologist, and nearly 40% of those in practice report feeling burned out. I reflected on the ripple effects—families traveling long distances for routine care, family practice and medicine colleagues stretched beyond capacity, and medical students questioning whether they can enter a system that seems to offer impossible odds. Advocating for additional GME slots and supporting initiatives like the Dr. Lorna Breen Health Care Provider Protection Act. It is not simply about numbers; it is about people—those who care for us and those who will lead the next generation of medicine.
In addition, we also wanted to focus on reining in prior authorization requirements. Every delay caused by cumbersome prior authorization steps chips away at the trust between clinician and patient. If the therapy I recommend isn’t covered, we must navigate five additional steps to secure approval—which only delays patient care. I often find myself explaining to families why a straightforward surgical procedure or a necessary medication requires multiple rounds of administrative review—and the frustration is palpable. Reducing these hurdles isn’t just bureaucracy; it’s restoring humanity to care.
An additional priority is drug shortages policy solutions. Whenever there is a drug shortage there is a clinical impact. There are no aligned incentives right now to encourage a vulnerable medications list and encourage pharma to actually produce those drugs. When there are supply chain issues, we need to have alternatives. We saw that with the fluid shortage. Many times, the only options are to ration, skip or delay doses of therapies or utilize a less effective or safe alternative treatment- if there is one. Drug shortages strike at the core of patient safety. When essential generics disappear due to supply‑and‑demand imbalances, we’re forced into improvisation, risking outcomes. We need policy incentives that align profitability with reliability, ensuring that vulnerable medications remain accessible.
Miles-Thomas: I was honored to speak on how artificial intelligence is transforming the field of health care, unpacking the fundamentals of what AI truly is and examining its real‑world applications in our specialty. It's interesting, because AI has created a lot of change throughout many industries, and it's definitely affecting health care. We considered its global impact, recognizing that AI governance and safety mechanisms extend far beyond U.S. borders. Unlike in some other industries, patient data in medicine demands rigorous security and confidentiality, supported by laws that protect individual health records. During the session, we reviewed recent AI legislation and FDA policies designed to promote transparency, limit bias, and ensure equitable access to these tools. No longer can we accept algorithms as “black boxes”—every AI system must be held accountable. While some clinical AI devices follow the FDA’s clearance or approval pathways, countless consumer apps bypass any formal oversight. This gap highlights the importance of questioning how each tool arrives at its recommendations. I urged my colleagues to think critically about the AI solutions they integrate into practice, weighing potential risks alongside benefits. Beyond technical details, I shared my personal sense of responsibility to advocate for appropriate FDA oversight whenever necessary. Ultimately, my goal was to empower our community to embrace AI thoughtfully, ensuring it enhances patient care and upholds the highest standards of safety and ethics.
Miles-Thomas: What stood out most was the sight of many medical students and residents in the audience. I was honestly very surprised at the number of medical students and residents who attended this year. Their presence reminded me that change is driven by curious, passionate individuals willing to step beyond clinic walls into the halls of policy and advocacy. This was very inspiring, because they understand; they get it. They took time off and made a big effort to make it to DC to really understand what is going on outside of the clinic walls, outside of the hospital. Many times, we assume someone else will advocate for us and our patients; someone else will have that conversation. I was inspired by the next generation—eager, committed, and unwavering in their determination to turn advocacy into meaningful change for our patients.