AMA President Dr. Bobby Mukkamala on ‘tumor wisdom’ and U.S. health care
When Bobby Mukkamala, M.D., was six months away from becoming president of the American Medical Association, the nation’s largest group of physicians with more than 270,000 members he faced a life-changing diagnosis.
While speaking at an AMA membership meeting in Orlando, Mukkamala became disoriented, his words garbled. “All of a sudden, I lost track of where I was,” he recounted last month while addressing AHCJ members at Health Journalism 2026 in Minneapolis. “I thought it was an iPad malfunction, like I got to the wrong screen.”
The doctors in attendance that day were concerned, he noted. “Somebody stood up and said something like, ‘Bobby, we can’t understand you. You’re not making any sense’.” A few minutes passed before everything went back to normal,” Mukkamala added.
That Saturday in November 2024, Mukkamala went from being a healthy 53-year-old otolaryngologist, head and neck surgeon and the AMA’s president-elect to being a patient with a potentially life-threatening brain tumor. For Mukkamala and his wife and two sons, it was the start of an odyssey of diagnostic tests, family meetings, and surgery one month later at the Mayo Clinic in Rochester, Minn., to remove an 8-centimeter, grade two astrocytoma.
The journey from surgery to recovery led Mukkamala to gain insight about the staggering costs of care and what patients need from physicians: understanding and empathy, which he calls, “tumor wisdom.”
An international radiology consult
But first, he needed to confirm the diagnosis. Three days later, he returned to his home in Flint, Mich., and got an appointment with a neurosurgeon the next evening. Within an hour, he had the magnetic resonance images (MRI) on his home computer.
One showed a small white spot on his brain’s left temporal lobe. “For a second I thought it was something on the monitor. So I literally used my shirt to wipe the screen,” he said. “But then the little spot was getting bigger and bigger, and it ended up [being] a total size of eight centimeters, which is pretty big,” he said. “I didn’t know if it was going to be just fluid or a meningioma.”
Seeking a radiology consult, the patient called his father, Apparao Mukkamala, M.D., a clinical professor of radiology at Michigan State University. Apparao Mukkamala took the call while traveling in India and viewed the image his son shared over the phone. At the time, Bobby Mukkamala didn’t reveal the patient’s name.
“He’s looking at it, and says, ‘Oh, something’s wrong with this patient. He’s got a brain tumor.’ “Then he looked at the name [on the image] and there was just silence,” Bobby Mukkamala said. Then, his father said, “Let me call you back.”
Minutes later, Apparao Mukkamala phoned, and Bobby Mukkamala put his wife, Nita Kulkarni, M.D., an obstetrician and gynecologist; his mother, Sumathi Mukkamala, M.D., a retired pediatrician; and his twin sons, Nikhil and Deven; all on a group call.
The family chose two Mayo Clinic specialists to oversee his case, Bobby Mukkamala said: Ian F. Parney, M.D., Ph.D., a neurosurgeon at the Mayo Clinic and member of the Mayo Clinic Comprehensive Cancer Center; and Ugur T. Sener, M.D., a neuro-oncologist at the Mayo Clinic and chair of Mayo’s neuro-oncology program.
Surgeons’ goal: Remove 90%
Once the family decided Bobby Mukkamala should have neurosurgery at the Mayo Clinic, the surgeons’ goal was to remove 90% of the tumor, Mukkamala said.
“They said it was too dangerous to go after more than that and still make it off the table,” he explained. “That was the consensus of my whole family. I didn’t have any preference. I let my parents, my wife and my kids decide.”
Fortunately, the surgery was successful, but soon they learned that the costs of care and the complications that health insurers impose under prior-authorization rules would be staggering.
The high cost of care
Mukkamala’s neurosurgery at Mayo was out of network, meaning he needed to pay his deductible of $21,000 and out-of-network copayments, the AMA said via email. After his health insurance covered its share, his total cost to Mayo was $36,000, the AMA added. But because his surgery was in December, he had to pay the full annual deductible after surgery and then again in January 2025. Taken together, his total costs over two months were $57,000, the AMA explained.
After surgery, Mukkamala was prescribed vorasidenib to help halt disease progression and delay the need for radiation and chemotherapy, he told attendees. The FDA approved vorasidenib in August 2024, four months before Mukkamala’s surgery, he said.
With this and a similar drug, Mukkamala said he might live much longer than the historical survival estimate. “If you search for grade 2 astrocytoma, which is what it ended up being, life expectancy is 10 years,” he added. “Because of this pill, I might live as long as I’m supposed to live, but that wouldn’t have been possible without funding for the National Institutes of Health.”
Of course, health insurance coverage was an issue. Without insurance, the cost would be $40,000 each month, the AMA said. But after he pays his drug-plan deductible, health insurance covers the remaining costs, the AMA added.
Health insurers, however, require prior authorization for high-cost medications. For the first several months on the drug, prior approval was needed every 14 days but now it’s once each month, the AMA explained.
In that early period post-surgery, Nita Kulkarni spent hours on the phone to ensure the drug costs were covered. A side effect of vorasidenib is that it can cause liver enzyme levels to rise, which it did in Mukkamala’s case, the AMA said. That increase led him switching to ivosidenib, which his insurance covers, the AMA added.
A deeper connection with patients
After surgery, he returned to work at his practice in Flint about a month later, with a new perspective on patient care. “Now I can’t help thinking that I need to connect emotionally, even a little” with patients, he commented. “Since I’ve been back in practice, ….I have a different role as a doctor. I take the time to have – not just the facts – but a connection” with patients.
“They come to this appointment to see somebody like me with nobody to take notes on what to expect, let alone be emotionally connected,” he said. “That patient’s there with both of those duties. That’s impossible, right? We’re not superhuman, which is something I never thought about.”
From cancer surgery to wisdom
In June 2025, Mukkamala was inaugurated as the AMA’s 180th president and said the brain-tumor diagnosis and surgery taught him what patients face. “I stand here tonight incredibly grateful but also changed by this experience,” he said in his inaugural address. “I’ve changed because I have a better understanding of our health care system. After 25 years as a practicing physician, I was at death’s door as a patient.
“As Nita and our sons will tell you, I have found a well of emotion inside me that I had long ago buried,” he added. “I even started a file on my computer that I simply call, ‘tumor wisdom.’ In it, I reflect on how fortunate I am, what insights I have gained about medicine and what our patients need from us. Some of these musings are quite personal …
“But the very first note I wrote when reflecting on my cancer was this: If I lived just one mile away in almost any direction in Flint, if I didn’t have the connections that come with being a prominent physician and now, president of the AMA, I would still be waiting for that MRI scan instead of healing at home. And the outcome could have been much, much different.”
