Just as the original visionaries of emergency medicine foresaw the creation of a new specialty, it is now time for another major paradigm shift. We need a visionary concept of emergency medicine that not only anticipates the rapidly changing landscape of health care but actively shapes the future and provides new opportunities on our terms. Our viability and ability to serve our patients depends on no less. Lofty idea? Perhaps. But the original notion that emergency medicine should be an independent, autonomous specialty was also initially viewed as unrealistic and met with considerable skepticism. Many of you may doubt that a new transformation can occur. However, if we are to address the multiplicity of issues facing the emergency medicine community and our patients, and elevate our standing, we have to think and act boldly. Only by doing so can we advance the field for the benefit of emergency physicians and the patients we serve, and gain the deserved recognition for the heroic and noble profession that defines who we are.

BOARD OF DIRECTORS

Candidates for ACEP Board of Directors responded to this prompt:

What are the two most pressing issues facing members and how would you address them?

Daniel Freess, MD, FACEP

Current Professional Positions: Emergency Medicine Physician, Hartford Hospital Emergency Department; Assistant Professor, Department of Traumatology and Emergency Medicine, University of Connecticut School of Medicine

Internships and Residency: Emergency Medicine Residency, University of Connecticut Integrated Residency in Emergency Medicine (2010)

Medical Degree: MD, Jefferson Medical College, Thomas Jefferson University (2007)

Response: How long can we keep doing this? Emergency physicians are experiencing increased work-related stressors, and this threatens our career sustainability. Every day we are faced with the influences of private equity and corporations, changing training and workforce standards, and increased violence in the workplace. Although multifactorial, I feel two of the most pressing factors affecting our future outlook are threats to reimbursement from payers and the emergency department boarding crisis.

Here in Connecticut, Medicaid rates have not changed in 17 years. There are currently additional efforts to limit out-of-network reimbursement, which will affect hospitals, emergency physicians, and the health care safety net. Nationally, Medicare rates are decreasing compared with inflation and the No Surprises Act has been badly misinterpreted to heavily favor insurance companies. Mandates under EMTALA leave us little negotiating power. Despite ACEP’s tireless work on the legislative and regulatory front, we need help. We need the press to spotlight our crumbling health care safety net. We need patients to convince politicians, administrators, and the public that emergency medicine matters. We need to highlight how patients on Medicaid have no access to consultant care. We need patients calling their legislators to discuss predatory high-deductible health plans and lack of access to follow-up. We need to stimulate a national grassroots effort in order to stabilize financial insecurities, allowing for the maintenance of the high-quality care we provide.