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March 29, 2022

Scope of Practice Talking Points

The following talking points were developed to support members in the creation of any materials crafted to address the overarching issue of Scope of Practice. Please feel free to utilize and further customize these points for use in social media posts, interviews with news media, industry speaking engagements or thought leadership activations.

ACEP has launched a public campaign "Who Takes Care of You in an Emergency?" to raise awareness of the importance of physician-led care teams. View the campaign page and our educational videos here. Our recent poll found that nearly three in four adults (72%) would be concerned about the quality of their care if a physician was unavailable during their medical emergency. 

High Level P.O.V.

  • An emergency physician should be leading every emergency care team in the country. Emergency physicians are the most highly trained and qualified health care professionals able to make medical decisions in an emergency.
  • Emergency physicians will continue to do everything necessary to treat patients, but it will take a collaborative effort with legislators, policymakers and health system leaders to strengthen care teams, improve access and address capacity concerns.
  • Successful initiatives will respect the practical limits of the scope of non-physician expertise while taking steps to empower care teams to save lives right now and in the future.

Supporting Points

The value of Emergency Care

Access to emergency physician-led medical care is critical and more people rely on emergency physicians than ever before.

  • One in three Americans visit the emergency department each year, for a total of more than 150 million visits.
  • Nine in ten adults say it is an “essential” or “high” priority for people to have 24/7 access to the ER, the highest of any utility or service that communities provide, according to an ACEP/Morning Consult poll.

For many patients, the emergency department is the first and best source for timely medical care.

  • More than half of adults who sought immediate medical care chose to go to an emergency department because urgent care was unavailable, or they were referred by a medical provider.
  • Another 40% went because their injury or ailment appeared too severe for urgent care, according to an ACEP/Morning Consult poll.

Emergency physicians provide incredible value to their patients and broader health care system. They deliver lifesaving treatment to anyone who needs it, and they help contain health care costs. 

A study in JAMA Network Open shows that as the number of people visiting the emergency department increases, patients who receive timely emergency care often avoid more costly hospital stays.

Who are Emergency Physicians?

Despite a growing reliance on emergency medicine, many people do not get a chance to get to know the professionals who take care of them during some of life’s scariest moments.

Emergency physicians are the doctors in charge of the care teams on duty 24/7 in thousands of emergency departments across the country.

  • Emergency physicians make a promise to treat anyone, anytime they believe they are having a medical emergency.
  • No appointments are necessary, and no one will be turned away from an emergency department when they need medical attention—that’s the law. (EMTALA)
  • Emergency physicians are ms or ability to pay.
  • While nearly 70% of emergency medical professionals who are dedicated to saving lives and providing the highest quality of care to all their patients—regardless of their insurance status care services goes uncompensated or under compensated, emergency physicians are committed to providing this care because otherwise many patients would go without treatment.

People often think of emergency physicians working in hospitals, but patients rely on them in all sorts of settings, from cruise ships to spaceships, sporting events, and anywhere that immediate care is necessary.

  • Emergency physicians answer a call to serve whenever and wherever emergencies occur, whether it is a bustling city or a rural community where resources are limited.
  • Emergency physicians respond to the scene of car accidents and plane crashes, and are there to save lives in remote locations in the middle of the wilderness, at the top of a mountain, or even as part of the military, leading medical missions or treating soldiers wounded in battle.
  • Emergency physicians are on the frontlines for all types of emergencies, ready to do whatever is necessary, every day of the year, to care for patients during all manner of medical emergencies in the hospital; in the event of public health crises, natural disasters, terrorist attacks; and in many other scenarios.

Patients prefer emergency physician-led care-teams

When it matters most, patients want the most qualified health care professionals in the room. There is no substitute for a licensed, trained, and board-certified emergency physician.

Patients deserve access to the most highly trained experts available.

  • Shifts in the emergency department are exhilarating and unpredictable, but a licensed and board-certified emergency physician completes thousands of hours of training, and more than a decade of expert-level education, so that they are prepared in a moment’s notice for any challenge that comes their way.
  • An emergency physician is required to complete 11 or more years of training and is the only member of a care team that completes a medical residency. In comparison:
    • Registered nurse: two-four years of training
    • Nurse practitioner: two-eight years of training
    • Physician assistant: seven years of training
  • Emergency physicians also have significantly more hands-on training with real patients than the other professionals on their team.
    • A nurse practitioner is required to clock at least 500 clinical hours. For a physician that requirement is at least 12,000 hours.

Emergency nurses are incredible. Each nurse is a highly trained professional who has a vital role on any care team. But their level of training and education is nowhere close to the requirements that physicians must meet.

  • Emergency physicians have deep respect for nurses. As the leader of a care team, emergency physicians work closely together with nurses, nurse practitioners, physician assistants and others. Each team member has unique skills and training that allows them to make important contributions to the team.
  • Nurses are indispensable partners, but there are meaningful differences in the training that each member of the care team receives so that they can do their jobs.
  • With fewer nurses available due to a severe nationwide shortage, each member of the emergency team will clock extra hours, care for more patients, and stretch to take on additional clinical and nonclinical duties. Meanwhile, emergency physicians are leading efforts at the facility, regional and federal levels to address workforce issues that include staffing concerns and resource shortages that cut across job roles.
  • While a nurse completes 4-8 years of training, an emergency physician is required to complete 11 or more years of training and is the only member of a care team that completes medical residency. This allows them to confidently perform difficult procedures and make complex diagnoses on their own.

People have difficulty identifying who leads their care while they are in the emergency department. While they prefer to be treated by an emergency physician, they are often not clear about the roles of each team member or who is leading their care.  

  • Patients will use a variety of unreliable criteria to make assumptions about whether they are being treated by a physician. According to the ACEP/Morning Consult poll, 20% of younger adults (ages 18-34) would use the color of a health care provider’s scrubs to determine if they are a physician. However, different facilities have different rules about scrub colors, which makes that an unreliable indicator of a person’s role.
  • One quarter of adults (ages 35-44) make assumptions about job roles based on how colleagues interact with each other, which may not account for leadership styles, personality traits or individual biases.  

There should be less ambiguity about the distinctions between different members of a care team, especially in an emergency.

The laws that determine who can practice medicine without supervision vary across the country, so it is understandable that a patient can get confused about who manages their care.

  • But hospitals are increasingly having non-physicians—like physician assistants and nurse practitioners—perform complex medical procedures.
  • Allowing non-physicians to perform surgeries, administer diagnostic tests, prescribe medicines, or give medical advice that they are not trained for can have consequences.

There is evidence that granting too much independence to non-physicians can lead to overprescribing and overutilization of diagnostic imaging, or other services.

  • Nurse practitioners prescribed more opioids than physicians, according to one analysis. In states that allow independent prescribing, nurse practitioners were 20 times more likely to overprescribe opioids than those in prescription-restricted states.
  • Non-physicians ordered more imaging over a 12-year period, according to another study. Scans increased more than 400% by non-physicians, primarily nurse practitioners and physician assistants.
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