March 27, 2023

March 2023 Board Blog - ACEP Leaders Say EM's Systemic Challenges Need Shared Solutions

Chart Sources: 1ERAS Preliminary Data as of 2/23 each season; 2NRMP advanced data tables 2023; 3Medscape National Physician Burnout & Depression Report 2018 to 2023

Christopher S. Kang, MD, FACEP
ACEP President

Aisha T. Terry, MD, FACEP
ACEP President-Elect

Gillian Schmitz, MD, FACEP
ACEP Immediate Past President

Bruised and battered, physically and emotionally. Emergency physicians were already feeling weary after the last several years. Couple that with a second difficult - but not entirely unpredicted - Match Week and you find many inside and outside of the emergency medicine community proclaiming the demise of our amazing specialty.

Among all of the match results shared this past week, these critical data points stand out. Over the past 6 years, we know the number of positions offered has increased by 32%. But we also know that the percentage of emergency physicians reporting burnout has increased by 44%, particularly in the last two years.

Compare the list of contributors to burnout and workforce concerns, and they’ll include many of the same suspects: Boarding and staff shortages. The consolidation and corporatization of medicine. Scope of practice battles. Workplace violence. Loss of autonomy. Lack of respect. Fear of violence.

Medical students see all of this. They see burnout rates that are spiking as the pandemic has slowed. They see, despite a workforce report calling for the contrary, new programs and positions in existing programs just keep growing.

Emergency medicine has systemic challenges that need shared solutions, not blame. And now more than ever, we need to come together and begin to solve these problems. We must be honest about what we have the power to correct and where we have the responsibility to use our collective voice to influence the decisions of others.

Since its inception, ACEP’s role has been – and always will be – to harness the power of our collective voice, empower all emergency physicians, and ensure the best care for patients. We commissioned and published the multi-organizational workforce study in 2021 just as we do with our many policies, Council resolutions, advocacy work and other initiatives – because we know that emergency medicine is a specialty built by problem solvers. It’s in our DNA. And we couldn’t be prouder to see it in our next class of #embound residents. ACEP welcomes you with open arms; we appreciate the passion and diverse you bring to our EM family.

Being transparent and honest about the range of possibilities that might happen with our future workforce is the only way for emergency physicians to be part of the change. Through collaboration, we have proposed standards to the ACGME to raise the bar for residency accreditation. No organization can tell a residency program they cannot open or expand. But ACEP and others can say that we believe each program MUST look inwards and truly ask if they are growing because emergency medicine needs more trainees, versus any financial or non-financial motivations. We commit to making the workforce research and assumptions transparent and accessible. We will put the model from the report online and let anyone test the assumptions, add new data and explore different and evolving conclusions.

Similarly, no organization can single-handedly change the ways consolidation and corporate investment are impacting health care. We can’t stop any emergency physician practice from existing. But we can stand behind our policies for fair employment standards and require all emergency physician employers who advertise or exhibit with us to disclose their behaviors and strive to adopt best practices. We believe that transparency and honest, objective dialogue are the ways to harness the power of the collective, so you are prepared to make informed decisions for your career around choices that matter most to you, throughout your career.

ACEP’s voice is your voice, one that is stronger and more effective when we work together. We can demand the changes needed to improve emergency medicine. We stand against any threats that limit your autonomy or ability to provide the best patient care. We stand together to protect the physician-patient relationship as the moral center of medicine. We push back with legal and regulatory action against bad practices by insurers AND employers. We raised a national call for corrections to the broken systems of boarding and violence that are in our ED yet outside our control. We have launched campaigns against emergency care scope creep by NPs and PAs, and constantly fight for physician-led teams at the local, state and national levels.

ACEP will not take the easy route. Our members are hurting and we will not back down in their defense. We will continue to ask difficult questions, push through the doors of decision-makers and use our collective voice to strengthen and grow our beloved specialty. We are stronger together.

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