Internally, we are faced with the challenge of unifying the multiple voices in EM into a strong and effective chorus. We are a diverse group and bring many different perspectives together in order to care for our varied patients. Companies with greater diversity have been shown to be more successful from a business perspective. ACEP will be more successful through embracing diversity, and not just gender and race diversity but the many aspects of our practices—gender, race, ethnicity, large groups, small groups, academics, rural providers, young physicians, individuals near retirement, etc. Together, we can agree on specific topics and issues and work together collaboratively on these. This will strengthen our voice. On other topics, we can continue to disagree respectfully and professionally without personal attacks. Speaking with one voice will allow us to be heard above the discordant clamor found in Washington, D.C., and in many state capitols.

Emergency physicians are caring, thoughtful professionals. We work hard, and we play hard. We care about our patients and for our colleagues. ACEP and EM play a critical and ever-increasing role within the healthcare system. I will work together with our many partners to forcefully advocate for EM and to sustain and to grow the support for our important work. Working together, we can and will make a difference.

William Jaquis, MD, FACEP

Current Professional Positions: senior vice president, Alliance Operating Unit–Envision, East Florida Division; attending physician, Aventura Hospital, Aventura, Florida

Internships and Residency: emergency medicine residency, Case Western–Mt. Sinai Hospital, Cleveland

Medical Degree: MD, Medical College of Ohio, Toledo (1989)

Response

Externally, the biggest threat is our current form of funding and paying for healthcare. The “system” is far from a coordinated entity but more a collection of stakeholders with their own interests exceeding the needs of the system as a whole. Those who fund and pay for the care are often deeply separated from the consumers of care, and the complicated approach to payments leaves us all confused. Consumers should have more transparency about what the cost to them for their care will be, but we are unable to give it to them because we have no idea across our delivery system how we will be paid, if at all. We have insurers who have hidden lists for which they will retrospectively deny payment, and every day it seems there is a new story or “study” that highlights “excessive” ED costs. In this setting, it is incredibly difficult to provide timely care for patients, help them understand the costs of that care to them, and appropriately staff and reimburse our providers. EM is unique in this battle from our EMTALA mandate to see all patients regardless of ability (or intent) to pay. Addressing this issue will take all of us acting in many different venues. For our patients, we need to continue to advocate for access by requiring essential health services to be covered and paid according to prudent layperson laws. This also has and may continue to require legal action such as the current suit (July) against Anthem. We have some solutions that are improvements to the issue of fair coverage, and that message needs to continue through coalitions, the courts, social media, and public relations.

“We have insurers who have hidden lists for which they will retrospectively deny payment, and every day it seems there is a new story or ‘study’ that highlights ‘excessive’ ED costs. In this setting, it is incredibly difficult to provide timely care for patients, help them understand the costs of that care to them, and appropriately staff and reimburse our providers.” —William Jaquis, MD, FACEP

Internally, our biggest threat is our inability in many situations to find a shared vision as a physician community. As the phrase goes, we have met the enemy and he is us. I cannot determine how many meetings I have attended where the physicians spent a great deal of time arguing with each other while the non-physician team stands by, leading to no directed action. Through many means in society as a whole, we are becoming more polarized rather than recognizing what is shared in the middle. This is true of EM at times as well. Do not misunderstand: I highly value the discourse of opposing views, as they often lead me and us to a better understanding of an issue. We must, however, make sure that, in doing so, we do so with respect, and we understand there must be a forward direction. We can do so by continuing the dialogue on our important issues with civility, keeping our criticisms more private, and moving forward publicly with a shared vision and praise.