At its October 2017 meeting, the ACEP Council elected John Rogers, MD, FACEP, of Macon, Georgia, as ACEP’s President-Elect. Dr. Rogers will assume the presidency at next year’s meeting in San Diego, California. He recently sat down with ACEP Now Medical Editor in Chief Kevin Klauer, DO, EJD, FACEP, to share his views on the specialty and his goals as President-Elect. Here are some highlights from their conversation.
Explore This IssueACEP Now: Vol 37 – No 01 – January 2018
KK: You’ll be President next year during our 50th anniversary; what an exciting time, John. Can you share your thoughts on the Council election process?
JR: My observations on these elections are that they’re almost always very close, and it was again this year. The [President-Elect] candidates are all excellent. They’re all very skillful, knowledgeable, and have committed and dedicated themselves not only to the specialty, but the College for many years. I truly feel honored to have been elected. I hope it was because everyone felt that I was the right person for the job at this time. I did my best to convey that I possess the skills to do the job, especially during our 50th anniversary. Having experienced our wonderful specialty, going back decades to a time when residency training was very limited, and sharing the specialty’s core value today that the gold standard is exclusively residency training and board certification, I hope to help bridge generations of emergency physicians.
KK: It’s a rare situation for a President-Elect candidate to be elected their first year running. I don’t remember the last time that happened. You ran last year also and didn’t get elected. Why did the Council elect you this year?
JR: Many of the councilors don’t really know all of the candidates well. As a candidate for President- Elect, you have five minutes to talk to the Council, and then you have three sessions where you answer their questions. I think the first year is mainly an introduction. Then, the second year, they are a little more comfortable with you. I truly believe my message this year really resonated with people.
KK: For those who don’t know you, tell us about your background.
JR: I’ll start way back. I grew up in Iowa and got a swimming scholarship to a university in Ohio. I had every intention of becoming an architect. I spent two years in architecture and then came to realize that really wasn’t for me. I got introduced to the idea of medical school and came back home and went to a local college in Illinois, Augustana College. Ultimately, I attended medical school at the University of Iowa in 1974. The internal medicine department strongly recruited me, but I felt more in tune with the surgeons because of the type of work that they did, caring for the acutely ill and injured. They’re the ones that ran the emergency department back then. I did my first year at Iowa and then moved down to Georgia and completed my surgery training. From about 1979 on, I also began working in the emergency department independently as the attending, and I continued doing that throughout my career until about 1994 when I really was doing emergency medicine full time, following closure of the American Board of Emergency Medicine (ABEM) practice track to board certification which occurred in 1988.
KK: So you were board certified as a surgeon?
JR: Correct. Yes, board certified in surgery. I was supposed to begin a surgical oncology fellowship in Illinois, and I had to call them and say, “I can’t do this. This isn’t right for me,” and so I stepped away from all of that.
KK: Well we’re glad you did, John. You said you were elected by the ACEP Council because you’re the right person for the right time. Well, we’ve come a long way in almost 50 years. Tell us why someone who trained in surgery and was board certified in surgery is the right choice to be the President of ACEP next year.
JR: I think the particular skills that our President needs, that I believe the Council recognized in me, are the ability to speak and persuade and to represent the organization, the specialty, and those that practice it. The 50th anniversary marks the end of the first 50 years. The 51st marks the beginning of the next 50. I clearly see the value and benefits of residency training and board certification that I didn’t have the honor of experiencing. Because of that, and many other reasons, I strongly support residency training and board certification in emergency medicine, and most importantly, I always strongly support and advocate for our specialty. This symbolic passing of the torch provides an opportunity to reflect on, acknowledge, and respect our past, while securing a bright future for the next 50 years for those who represent what the gold standard is today and what the future should be tomorrow.
KK: What I’m hearing in your words and what I see in you as a great leader, John, is that you have experienced, and come from, a time where emergency medicine wasn’t fully developed, and you are a legacy member of the organization that sees the future and the vision of where the specialty absolutely should go. We can’t evolve appropriately as a specialty if we do not recognize, but also embrace, our past.
JR: There were no emergency physicians, and certainly none board certified, when I was in medical school or during residency. There was no one for me to model myself after. People that came closest were the surgeons, but there was not a board-certified surgeon in my community until 1989. In Augusta, the emergency medicine program here in Georgia didn’t get started until the late 80s, and the one at Emory didn’t get started until the early 90s.
KK: Some may believe, “50 years ago EM began and was instantly ubiquitous.” However, in reality, it started in just a few places and wasn’t available everywhere, so the beginning of emergency medicine in Georgia may not have been 50 years ago. What did your surgery colleagues say about you when you said, “I don’t want to be a surgeon anymore”?
JR: They thought I’d lost my mind. I was in my mid-40s with kids, and it was difficult. Back then, the doctors working in the emergency department were often viewed as inferior. Even now, in many rural areas—not only where I got my start, but throughout the country—emergency medicine is still delivered by those who are not trained in emergency medicine or even board certified. In some communities, it’s only delivered by a physician assistant or a nurse practitioner. Some may have misinterpreted what I have said about membership and including those that are not board certified and my thoughts on the Board of Certification in Emergency Medicine (BCEM).
KK: What were the misunderstandings about that John?
JR: It’s about the College recognizing its duty to improve emergency care regardless of the setting or who is delivering it. Over the years, and during my term on the Board, I think we’ve recognized it is our duty to pay more attention to rural emergency medicine. I really think a well-trained emergency physician has a great deal of impact when they go into a rural community.
It’s never been about saying residency training is unnecessary or there ought to be a different kind of board. No. I truly believe the only way to enter the specialty now is by residency training, and I truly believe the only boards are the two that we currently recognize. For those who don’t have the ability to go through residency and take the ABEM or American Osteopathic Board of Emergency Medicine examination, I think the BCEM exam has some value, not in certification, but in the preparation one has to go through to learn and elevate one’s knowledge and skill. There is no substitute for residency training and board certification via our recognized certifying bodies.
KK: Now I understand. Are you currently board certified?
JR: No. I did re-certify in surgery once, but then I wasn’t practicing surgery and I thought there was no reason to recertify again.
KK: Why did you choose not to pursue ABEM certification?
JR: I never had the opportunity. I never had the hours by the time the practice track closed. I understand why the practice track closed, but regret that I never had the ability to take the exam.
KK: Sure I understand. I don’t know that that would be obvious to people. I think some may just assume you chose not to, which would certainly devalue the process. It was not available to you because of the timing of your career transition.
What are your feelings about residency training and board certification as the standard for the practice of emergency medicine currently and in the future?
JR: I think it’s a mistake for anyone to think they can just do this work without residency training. Someone who is residency trained and board certified is distinctly different, to me, than someone who is not. My commitment to the residents should be evidenced by the fact that, in Boston a few years ago, the Emergency Medicine Residents’ Association (EMRA) was asking for more representation on the Council. I was the member of the Board that stood up and supported them.
KK: Your words aren’t forgotten. It’s also been noted that you said, “EMRA is the crucible in which the future of emergency medicine is forged.” Why did you say that? Was that just campaign rhetoric?
JR: No. I wasn’t campaigning for anything at that time. I was just standing up and speaking from my heart. I fully meant it.
KK: To summarize, it is not only possible, but in your case the reality, that someone that has practiced in a different era who didn’t have the same training and certification options can see the value and the foundational importance of residency training and board certification and recognize that as our future.
JR: Of course. Even when I was a resident—and this may surprise many people—there were many surgeons who were fellows of the American College of Surgeons who were not board certified. We should be committed to perfecting our craft. It’s our obligation, regardless of our background, to make sure that we develop emergency medicine, ensuring our specialty is on the right trajectory.
KK: Is it a conflict for you that you embrace residency training and board certification but you are a legacy physician? Are you not supporting ACEP’s legacy members?
JR: I support them to continue their careers. To fulfill their lifelong dream of being an emergency physician; I support them fully. That should not be seen as demeaning emergency medicine residency training or board certification. We’re talking about people that entered the specialty a long time ago. We’re not talking about now and in the future.
KK: What should our workforce look like today with the non-EM trained physicians and also advanced practice providers (APPs)?
JR: The crux of it has to do with two main issues: 1) scope of practice and 2) distribution. I do think the time will come that our workforce will be an entirely composed of those who are residency trained and board-certified. There’s cognitive dissonance where it’s acceptable for an APP to be sometimes practicing independently in the emergency department, but it’s not ok for a physician who doesn’t have residency training or board certification to do the same. It is a complex issue, but it just seems odd that we’re willing to accept someone who is not even a physician, but not a physician who is dedicated to emergency medicine. Again, I don’t think those physicians should be entering the workforce now, but the ones that are there should be supported and embraced.
My personal observation is here in Georgia. You could not be able to come close to meeting the workforce needs if it were not for physicians who are not residency trained or board certified. Even at my local hospital, 40,000 visits per year, we only have two. We do not have equal distribution of our workforce, and we certainly want the most well-qualified person caring for every emergency department patient.
KK: How will you, in your presidency, help to keep residents in training and young physicians engaged in membership and leadership opportunities.
JR: They will be involved in committees, task forces, projects, and work groups. Their involvement is critical to our success.
KK: John, your elevator speech. What is the value of ACEP membership?
JR: ACEP will give you what you need in the different phases of your career. Early on, ACEP will give you networking, camaraderie, education, getting back together with your residents to reconnect, and a sense of family. In the middle part of your career, ACEP gives you opportunities for leadership. It gives you opportunities to give back to the specialty and allows you opportunities to grow and expand personally and professionally. I see ACEP becoming your voice in advocacy. Later, like in my stage, it’s really about mentorship. It’s about giving back to the specialty. It’s my duty and it’s my role and my obligation to set the ground for those that are coming up behind me. That is an extremely rewarding thing to do.
KK: What are your goals for your presidency?
JR: There are three things:
- The first is the whole mental health issue. We can’t wait for others to fix this. We’re just going to have to step up and do it ourselves, like we have so many other times before. Whenever there’s a gap, emergency physicians step forward and fix it and always have, whether it be ultrasound, toxicology, or EMS. We are often the only ones developing creative solutions.
- Another is burnout, but I really think that’s the wrong word. Physician wellness and resiliency seem much more fitting. We are being robbed of our opportunity to spend time with patients, to have that truly full patient-doctor relationship that is crucial and that patients are hungry for, that doctors are begging for. When you’re not allowed to have that time, you feel like you’re not fully doing your job. That may start to make you feel resentful. That resentment carries on from day to day until it manifests itself as burnout. I really think we need to take back control of our profession. We can’t continue to allow regulators and administrators and legislators to control our profession. The only way we can regain it is through leadership. We must be very strategic and intentional about developing emergency physicians to take their rightful place in the C-suite, in the statehouse, and on Capitol Hill.
- I would begin to lay the groundwork for a leadership development program, not confined to the College, in a variety of venues, whether politics or administration. I want to start thinking much broader and really infiltrate emergency physicians throughout that whole broad spectrum of leadership in health care, and I believe that is our best strategy to begin to regain control of our profession.