December 3, 2018

Letter from the Chair - Amicus quo vadis

ACEP had a very successful Council meeting and Scientific Assembly in sunny San Diego as the members celebrated the 50th anniversary of the founding of the specialty of Emergency Medicine. I wish everyone had attended. However, for those members of our section who for one reason or another were unable to attend or have never attended these proceedings before, our section secretary, Thom Mitchel, MD, FACEP, has given an excellent summary of the proceedings and a good introduction to what the ACEP Council does. Please read his article in this newsletter.

By now everyone is familiar with the story of John Rogers, MD, FACEP, elected ACEP President-elect at the 2017 Council in Washington, DC. He resigned shortly before assuming the highest elected office of the College when his lack of emergency medicine residency training and Board certification became a raucous distraction in some circles. John has practiced emergency medicine for more than thirty years. His service record to our college is second to none. He will always be respected for his invaluable contributions, wisdom and mentorship to many. Read Dr. Rogers’s letter of resignation to the ACEP 18 Council here.

John was one of those leaders arising from our predecessor section; the Certification and Emergency Medicine Workforce Section. Remember that section? There were many leaders from that time and era including Ted Switzer, MD, FACEP; John Newcomb, MD, FACEP: Sandy Herman, MD, FACEP; Rick Blum, MD, FACEP; Tony Gerard, MD, FACEP; and others who worked tirelessly for recognition of career emergency medicine doctors who were members of the College but happened for one reason or another not to have been fortunate enough to be residency trained in emergency medicine or missed the cutoff time for grandfathering into the College. Out of their work came the College time-limited offer of “legacy emergency physicians.” That particular ACEP policy directly addressed the hospital credentialing of this type of emergency physician.

"ACEP believes that the quality of care delivered by legacy emergency physicians should be a primary determinant of their hospital privileges and credentialing. Legacy emergency physicians should be subject to the same quality standards as ABEM/AOBEM certified emergency physicians. Legacy emergency physicians should not be forced out of the workforce solely on the basis of their board certification status."

The outpouring of support for Dr. Rogers from the depth and breadth of the College Council is a well-earned accolade and lasting testament to who John is as a man. The Council passed a unanimous resolution of commendation co-sponsored by a diversity and plurality of ACEP state chapters and sections, as well as non-ACEP organizations such as the Emergency Medicine Residents’ Association (EMRA) and Council of Emergency Medicine Residency Directors (CORD). His selfless love of colleagues and his dedication to the advancement of our beloved specialty, beyond any personal gain or ambition, resonated and reverberated to higher confines of the College. 

Recently, the EM Workforce section has been blessed by the fact that our ACEP Board liaison has been the immediate past ACEP President. Last year it was Rebecca Parker, MD, FACEP. This year we have Paul Kivela, MD, FACEP, an indefatigable and perceptive leader who has obviously given a lot of thought to emergency medicine workforce issues. Paul came to our section meeting and gave an impromptu speech about where he sees the emergency medicine workforce headed. He is clearly thinking outside the proverbial box.

Traditionally, most pundits who cared to think about emergency medicine workforce projections approached it as a linear project of zero-sum game of supply and demand. Will there be enough doctors to fill a certain number of anticipated open slots in a projected number of Emergency Departments at a future given point in time? How many active bodies would be needed, and would those numbers meet the anticipated demand?

The increasing use of scribes and Advanced Practice Practitioners (APPs), the preferred and politically correct nomenclature for Nurse Practitioners (NPs) and Physician Assistants (PAs), in the Emergency Department (ED) is greatly influencing this workforce dynamic. In some areas, the ever-increasing perennial surge in ED volume is levelling off, not because the sick population is levelling off, but due to the fact that some hospitals are building Out-patient Clinics and Urgent Care Centers that are siphoning off some of the traditional ED volume. These Mac-Health Care Centers are utilizing a mixture of different types of AAPs other than emergency physicians to provide care in these settings. The future of emergency medicine workforce is beginning to take shape before their eyes. To be sure equitable care coverage in certain geographic areas will continue to remain a challenge for the foreseeable future.

Formulating and projecting the future needs of emergency medicine workforce has become quite challenging but stimulating in very unanticipated ways. If you are interested; and you should be, come join the party. Join the ACEP Emergency Medicine Workforce Section. If you are already a member get more involved and contribute!

Gratia vobis et Pax

Leslie Mukau, MD, FAAEP, FACEP