There are certain benefits in larger numbers. Some of our smaller contract groups that have one, two, or three contracts sometimes need help. I think the College represents both the individual practitioner and members who work for a large management group that helps support their practice. Our members are free to choose their employment model, but I really hope they become ACEP members because of what the College represents: the physician at the bedside and the patient rather than these other entities.

“Just go to the chapter meeting and step up to say this situation is intolerable or headed to an intolerable level. ACEP is there to listen and ready to solve problems. An organization can’t be successful or have the resources to put forth to solve a problem unless it has members. Members are our lifeblood.”
—Michael J. Gerardi, MD, FAAP, FACEP

KK: Consolidation is occurring, systems are growing, and the way we deliver care is changing. Some have asked whether free enterprise has extended into unfair business practices. Do you have any thoughts on that?

MG: I don’t see that coming from the consolidation of hospitals, systems, contract management groups, or ED groups. I see unfair practices being implemented against emergency physicians by payers right now. In the negotiating process, we are at an extreme disadvantage. Unless you’re in a rural market where they have very limited choices, where they can’t play one group off of another, payers are using the excuse of the rising cost of health care as a justification to mistreat emergency physicians. The better ACEP is able to get us fair treatment and demonstrate our value, the more your practice is protected at the bedside. That’s why out-of-network care, the greater-than-three rule, and being treated fairly are such big issues for the longevity and the viability of our specialty and the choice to practice in the environment that you want. For some, being an employee is a good thing. For some, it’s anathema to their personal DNA. We have to let members have choices because when people have options, you find drivers to create efficiency and satisfaction with their practice.

One of our major initiatives last year was to look at the wellness and the longevity of our physicians. We have to find ways to make it so that every shift is like that occasional shift you have when everything clicks and goes just right. That’s going to take a unified effort from different practice environments and people with different resources. I believe in accomplishing this through collaborative relationships with the Emergency Department Practice Management Association and other professional organizations like the American Academy of Emergency Medicine, American College of Osteopathic Emergency Physicians, Emergency Nurses Association, and American Medical Association.

KK: What are your thoughts on advanced practice providers and how they should be incorporated into the workflow and staffing models in emergency medicine?

MG: I think advanced practice providers—and I want to include scribes—are great career enhancers, people who can take some of the work that we are caught up with that distracts us from our highest abilities and practicing to our level of expertise. We need to be able to use our brains and experience to handle the more-complicated issues because our patients are getting more elderly and more complicated with comorbidities and very complex diseases.