As your national ACEP liaison to the American Academy of Emergency Nurse Practitioners (AAENP), I have the incredible honor, privilege, and responsibility to be your “voice” during AAENP Board of Director meetings. I assure you that I speak for you clearly, respectfully, responsibly, and always in a manner that promotes, first and foremost, the principle that board certified emergency physicians must be the leaders of care in any emergency department.

Today’s reality is many rural emergency departments are staffed solely by physician assistants and/or nurse practitioners. On functionally useless in real time to patient care on-call rosters, these same physician assistants and/or nurse practitioners may be “backed up” by physicians. Often these “backups” are located 20-30 minutes from being physically present when called to assist patient care at the bedside. Factoring such, an order to transfer the patient immediately by ground or air EMS is the only actual support per se these non-physicians receive. I believe that’s an untenable risk to everyone involved, particularly the patient expecting safe, clinically accurate emergency care.

Our Indiana ACEP colleagues have helped us all as emergency physicians in championing the passage of state legislation mandating a physician leading a hospital’s emergency department to be physically present in that hospital. While that law today does not specify that physician must be a board certified emergency physician, we can readily understand that to be the next step of progress in a future legislative bill that builds upon today’s advance in care. This is an important opportunity for board certified emergency physicians to secure those positions today, impressing upon hospital administrations the essential benefits to the patients, the medical staff, and the hospital itself uniquely enabled by board certified emergency physicians.

In select situations, technology may provide opportunities in the interim until similar laws can be promulgated nationwide. Colleagues at the University of Mississippi Medical Center have developed a robust telehealth network with over 25 critical access hospitals in that state. Physician assistants and/or nurse practitioners receive real-time telehealth consults from residency faculty, board certified emergency physicians in Jackson. The volume over time has allowed for full-time faculty shifts focused on telehealth consults. Today, not in spirit, but in true impact, care is increasingly emergency physician led in these networked emergency departments. We must always work against a balance. The weighting must strongly be on patient safety and on expanding the opportunities for board certified emergency physicians. ACEP advocacy, both nationally and increasingly through state chapter support, is more important than ever in achieving these goals.