CE: I see our specialty changing. I don’t want to use the word “gatekeeper” because it has such a negative connotation for so many health care professionals, but it’s a role I think we’re going to end up playing. We’re going to be directing more than just the emergency care. I can see the emergency department of the future having more to do than provide emergency department care. I can see us essentially responsible for driving front-end cost for health care, which is everything up to, and possibly including, the admission or everything up to the consultant coming in. I can see our role changing, and if we’re indeed going to be responsible for that and accountable for these outcomes, we’re going to need a lot more influence and a lot more power over what happens to the patients we’re responsible for.

KK: That is a great perspective, and that actually leads me to my next question. I’m going to ask you all just for one line about whether you think the scope of practice in emergency medicine will be shrinking or expanding in the next couple of years.

EG: Expanding

CE: I agree absolutely.

JH: Yes, I would see it expanding to more alliances with hospitalists, potentially radiologists and anesthesiologists.

GH: I agree entirely with John’s sentiment.

KK: Do you think these current times [health care reform] in emergency medicine are more critical than previous eras?

EG: Yes, most critical.

JH: Yes, this is another Wiegenstein moment.

GH: Yes, totally agree, most critical.

CE: I can’t say that it is, but I need to qualify that. It’s been close to 40 years that I’ve been involved in emergency medicine, and every big change that we’ve seen was a challenge for us because, at that point, we didn’t have the tools, expertise, or organization to manage it. And from that, we grew ACEP, we grew EDPMA, we grew some amazing talent within our specialty. I see this as just another opportunity for us to learn more about what needs to happen in our specialty, another opportunity for people who want to step up and take a greater role and who have opinions and new ideas to put them into play.

KK: Could you briefly state what your role is, and how your role impacts emergency medicine?

EG: My role I really see as an advocate for emergency medicine and a facilitator. When Greg and I cofounded EDPMA with others more than 15 years ago, we looked at what we were doing to support the specialty, and obviously we couldn’t be members of ACEP because we weren’t physicians. We needed a trade umbrella to represent the various interested stakeholders to go to Washington and go to the state capitals, and it became the vehicle for us to be able to channel all of our energies. It was started in a crisis, the Medicare reassignment crisis, and then we had prudent layperson and Medicaid restrictive diagnosis and triage fee crises hit us right afterwards in the late ’90s. We’ve helped emergency medicine because, as one of our colleagues said, when we come together in EDPMA, “we take off our respective company uniforms and focus on the greater good and on achieving results.” It’s rewarding on many levels because we have been fortunate to be part of something larger than each of our companies or ourselves. The association also facilitated our partnership with ACEP and other EM stakeholders. It’s been a fantastic working relationship, and I believe we have made a difference because we cared and we worked together.