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Ruchika Talwar: Hi, everyone. Hello from San Antonio, Texas, at the AUA's 2024 annual meeting. I'm here joined by Dr. Hans Arora, who's an assistant professor of urology at UNC Chapel Hill. Thanks, Dr. Arora, for spending some time chatting with us today.

Hans Arora: Thank you, Dr. Talwar, for having me.

Ruchika Talwar: I'm very excited that our UroToday audience gets to hear about your expertise. Obviously, clinically, your background is in pediatric urology, but I brought you here today to lean on your AUA and AMA advocacy expertise. And so, for those of you who don't know, the AMA is the American Medical Association, and Dr. Arora has been rising through the ranks of the AMA leadership since he was a medical student. And so, I brought him here today to tell us a bit about organized medicine. Now, the AMA is just one entity of organized medicine, but we'll talk about that organization specifically and why it's important to get involved more broadly. So let's back up, Dr. Arora, tell me a bit about your journey.

Hans Arora: Yeah, absolutely. When I started medical school, I was like a bright-eyed, bushy-tailed engineering undergrad, an MD-PhD student. I thought I was going to invent a new drug, invent a new device. And as I was about halfway through my first year of medical school, I started to learn more about all these things that were deciding how we were going to practice it, that nobody was really teaching us. And so I turned to a good friend of mine, someone who, over 15, 19 years later, I would still consider a good friend. And I said to him, I said, "Arjun, what is all this? What are all these things that I keep hearing about? What is the sustainable growth rate? What does that mean?" And he said, "Why don't you come to a meeting?" And so about February of my first year of medical school, I went to my very first meeting. It happened to be a meeting actually in Washington, DC.

Ruchika Talwar: And what meeting was this?

Hans Arora: This was the American Medical Association, back then they called it the National Lobby Day. So you'd actually go down to Capitol Hill and meet with legislators, meet with our elected officials and their staff to talk about issues that mattered to us and our patients. And from there, I was hooked because I found there were all these neat things about medicine that I didn't know about. And I've just run with it since then.

Ruchika Talwar: Yeah. And why does organized medicine matter? Why does the American Medical Association have any relevance for urologists when the majority of the things that the AMA does or advocates for or talks about may not necessarily affect the average urologist?

Hans Arora: Yeah, no, I think Dr. Talwar, you bring up a really interesting point, and it's a question I get from a lot of our colleagues. There's so much about medicine that may not deal with urology, but a lot of the issues that affect urologists, a lot of the legislative priorities for the American Urological Association overlap directly with legislative priorities within the American Medical Association. Things like Medicare payment reform, expanding Medicaid funding, graduate medical education, access to care, telemedicine. These are things that are touched on no matter which specialty you're in. So even if we are spending time talking about these things at the AMA or the AUA, it all comes together.

Ruchika Talwar: Yeah. And I would imagine the AUA is a small organization, and there are lots of small subspecialty organizations like the AUA. So it probably makes sense to align ourselves with something larger, right?

Hans Arora: Yes. No, you're absolutely right. In order for us to be able to get anything done or advance the priorities for urologists and urologic patients, we can't do it by ourselves. We have to work together, right? Medicine is a team sport, something we learn in medical school. So we collaborate with groups like the American Medical Association, the American College of Surgeons, the Alliance for Specialty Medicine, and other groups where people can come together from different specialties to talk about the things that really matter, not just to us but to our patients.

Ruchika Talwar: Yeah. So how does the AMA work? How is the organization structured? How do they actually do anything for us?

Hans Arora: Yeah. So the AMA has a lot of parts. From a policy perspective, the AMA makes policy through what's called the House of Delegates. So the House of Delegates consists of over 500 physicians who represent every single state and specialty medical society across the country that wants to be represented there. And what they do is they talk about issues brought forward by the members. So every state, every specialty, every delegate has the opportunity to bring ideas forward. So if things are happening to their patients, things are happening to them in their hospitals, covering topics such as medical ethics or medical education. Payment issues are a common topic, or other legislative things coming down the pipeline. Drug pricing is a hot one right now.

And then we hear about things coming through in Congress and through our states, and that's where it really all comes together. And those issues are debated in that forum and discussed and revised, and then we vote on them. And if they pass, they become part of the AMA policy. And that policy is what drives the AMA's lobbying efforts, outreach efforts, public health efforts. And so by working through the AMA, that's one way in which the American Urological Association and urologists can advance policy that's important for us and our patients.

Ruchika Talwar: Yeah. And it sounds like anyone, including urologists, can bring forth a policy statement or a resolution for consideration. And I was just wondering if you could maybe talk me through a scenario in which urology has leaned on this pathway to drive forward some of our priorities.

Hans Arora: Yeah. So we collaborate closely with other urology organizations, including the American Association of Clinical Urologists. One of the things, particularly for me as a pediatric urologist, that has been particularly important is access to decision-making ability for parents of children born with urologic conditions. And so that was something that we have worked closely on, and it's not an issue that was necessarily brought forward by us, but it's one where we really had the opportunity to educate people about the work that we do and how it may be something that we don't talk about a lot because it involves a lot of taboo topics for a lot of folks, like a lot of urology.

But it's an opportunity to really bring that to light, collaborate with other stakeholders, and bring other voices in who may not be as well represented to talk about what we do. I mean, other issues that have come forward in the past, prostate cancer screening, when the US Preventive Services Task Force came forward with a recommendation with a poor grade for prostate cancer screening, we had to work with other groups, the family physicians, the other primary care folks, to really talk about why the data behind that recommendation may not have been analyzed in the way that we thought was appropriate. And to maybe think about how we accept the recommendations that the USPSTF makes, and maybe look if the way that the decisions are made at USPSTF should be revised.

Ruchika Talwar: Okay. That makes a lot of sense. What is your role specifically right now within, how does it intersect between the AUA and the AMA, and are there any others that do this work with you?

Hans Arora: Yeah. So everything is a team effort. We have a team of delegates, yourself included, Dr. Talwar.

Ruchika Talwar: Yeah, it's an unfair question, but just so our audience knows.

Hans Arora: Another of our colleagues, Dr. Jason Jameson from Arizona, and other notable members of the urology community who've been part of this include Dr. Willie Underwood from New York, Dr. Aaron Spitz from California, Dr. Peter Breton from California, and Richard Pelman from the State of Washington. A lot of folks have been very involved for a long time. Former AUA President Dr. Bill Gee held this role several years ago as well. And so we work together with an incredible group of staff, mainly from our Washington DC office. What a lot of people don't realize is actually that the AUA has a presence in Washington DC and that's how a lot of this work gets done. It's a small group, but they really staff an incredible array of topics, from legislative priorities, to state advocacy priorities, to coding and reimbursement.

So my role specifically, I am the lead delegate or delegation chair for urology in the American Urological Association at the AMA House of Delegates. So I'm kind of like a go-to person for any urology-related issue or urology viewpoint in the AMA. Concurrent with that, I also sit on the AUA's Public Policy Council, which is the major policy-making body or policy decision-making body within the AUA. And so that's where we see overlap. I get to see the different things that are happening in the Public Policy Council and see where there's overlap in the work with the AMA.

Ruchika Talwar: Got it. Got it. Now, there are a lot of people out there who perhaps think the AMA doesn't really align with my viewpoints, whether it's related to urology, whether it's related to the practice of medicine, or maybe even more broadly. What do you have to say to those folks? Why is it important, even despite the fact that they may not align fully with the AMA on all things, to stay involved and engaged?

Hans Arora: I'm a big proponent of the belief that if I'm in a room and everybody agrees with me, I'm in the wrong room.

Ruchika Talwar: Yeah.

Hans Arora: And that's one of the really cool things about the AMA or really any big organization, is that you get different viewpoints. You have people coming from so many different aspects of medicine, different life backgrounds, and they're coming together to talk about issues from different perspectives. And I have to tell you, it's one of the best learning opportunities for me and for so many folks who keep coming back. I don’t agree with everything that happens in the country; I still pay my taxes, and I still love being an American. But it's the same thing in a lot of ways to me, because this is how we learn and this is how we grow. And being part of the conversation is so incredibly important if we ever hope to shift it in a way that we think is going to be good for medicine in the future.

Ruchika Talwar: Yeah, that makes sense. And not everyone is going to have the amount of time or resources or the ability to devote part of their career to doing this work. So what is your advice to members of the urologic community who perhaps care about these issues but may not be able to be at every AMA meeting or make their voice heard in every granular way?

Hans Arora: Yeah. So there are so many ways to be involved and to make your voice heard, and I wouldn't expect anybody to spend as much time as I do thinking about these things. But for those who want to, I'm happy to help them figure that out. But there are opportunities to advance policy issues at so many levels. We talked about the American Urological Association; going to the Urology Advocacy Summit that's held every year is an incredible opportunity to learn more about urology-specific issues. The American Medical Association, being a member alone is a really big deal. Being part of your state medical society or your state urologic societies. A lot of state urologic societies are not really engaged in advocacy currently. Some are, but a lot aren't. And there's a lot of opportunity there to be able to grow that part of urology and understand how we can work at the state level, because so much of medicine is really regulated at the state level.

Other colleagues have chosen to take the route of other organizations such as the American College of Surgeons or the American Academy of Pediatrics. But honestly, in order to do advocacy, you don't have to be doing it through an organization. It's important to be a member because it's important to show that you care about the issues and that your voice is in that room. But you can also meet with your legislator, particularly in their home office; you don't have to travel to Washington DC, you don't have to travel to your state capitol. You can pick up the phone and call their office. You can write a letter, you can talk to your colleagues. Advocacy comes in so many forms. It's not always political advocacy, it's not always legislative advocacy. Sometimes it's advocacy where you work.

Ruchika Talwar: So any parting words for our audience today?

Hans Arora: Gosh, always the heaviest question of any interview. So the one thing I would tell people is not to be dissuaded by what you hear other people say. It's to go out and look at the opportunities available for yourself and to make your own decision about, is this something that I think is important, and if so, what am I going to do about it? And I think that's the best thing I can tell folks, is to be open-minded and decide for yourself what you think matters and what it's important to be a part of.

Ruchika Talwar: Yeah, absolutely. Really, really important words there. Well, Dr. Arora, thank you so much for sharing a bit of your expertise with us today, but also more importantly, for all the work that you do representing urology in the sphere of organized medicine.

Hans Arora: Thank you. Thank you for having me.