By Ryan A. Stanton, MD, FACEP
President-Elect, American College of Emergency Physicians
One of the questions I hear most often from emergency physicians is, "What does ACEP actually do for me?" While many of our advocacy victories happen quietly and behind the scenes, they have a profound impact on our daily practice. The recent changes to the American College of Surgeons Committee on Trauma (ACS-COT) Level IV trauma center criteria represent one of those victories.
Listen: Surgeons Agree on Trauma Staffing (1 minute)
Challenging a Foundational Principle
This story began more than a year ago when discussions emerged around creating verification criteria for Level IV trauma centers, particularly in rural communities. Improving access to trauma care is a goal we all support. However, early drafts of the proposed standards included language that would have allowed emergency departments to qualify for trauma verification while being staffed solely by nurse practitioners or physician assistants.
That proposal represented more than a trauma issue. It challenged a foundational principle of our specialty: emergency departments should be physician-led.
The issue became even more urgent here in Kentucky. During the 2026 legislative session, Senate Bill 12 proposed allowing Level IV trauma centers to operate without physician staffing in the emergency department. At the same time, Kentucky ACEP was advocating for legislation supporting a physician in every emergency department. Suddenly, what began as a national discussion became a real legislative battle in our own state.
Kentucky's Emergency Physicians Respond
Kentucky emergency physicians responded. Academic and community physicians, large and small groups, urban and rural practices all came together with a unified message. We testified before legislators, educated policymakers, and worked alongside our partners to explain why physician leadership in the emergency department matters, not only for trauma patients, but for every patient who walks through our doors.
ACEP Relationships Move Policy
At the national level, ACEP moved quickly. The Board revised ACEP policy to make it unmistakably clear that every emergency department should be staffed by a physician, with residency-trained, board-certified emergency physicians representing the gold standard. Working collaboratively with the American Medical Association and engaging directly with leadership at the American College of Surgeons, ACEP focused on relationships rather than rhetoric.
That approach worked.
The newly released ACS-COT Optimal Care of the Injured Patient standards now require physician staffing in Level IV trauma center emergency departments 24 hours a day, seven days a week. The document also references ACEP's updated policy regarding physician supervision of advanced practice providers, reinforcing the physician-led team model that has defined emergency medicine for decades.
This outcome demonstrates what effective advocacy looks like. It isn't always loud. It isn't always public. More often, it is built through trusted relationships, thoughtful conversations, and a willingness to engage with partners who share the common goal of improving patient care.
Perhaps the most encouraging outcome for me was watching Kentucky emergency physicians become engaged in advocacy. Physicians who had never participated in legislative efforts stepped forward, testified, contacted legislators, and joined ACEP because they recognized that protecting our specialty requires all of us.
Advocacy Belongs to Every Emergency Physician
Advocacy is not someone else's responsibility. It belongs to every emergency physician.
This victory reminds us that when we speak with one voice, we can shape policy, protect our patients, and preserve the future of emergency medicine. It also serves as a reminder that some of ACEP's most important work happens long before the headlines appear. Behind every policy victory are countless conversations, relationships, and dedicated physicians working to ensure that emergency medicine remains physician-led and patient-centered.
That is the value of ACEP…and that work continues every day.
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