Fair reimbursement is another long-term issue in emergency medicine that has only worsened in recent years. The RAND report highlighted the decrease in emergency physician reimbursement from both governmental and commercial insurers. Health insurers have consistently demonstrated bad behavior in denials and underpayment to emergency physicians. Since 2001, Medicare reimbursement to physicians has actually decreased by 33 percent when adjusted for inflation.

None of this is sustainable. ACEP must continue to fight back against the bad behavior of the health insurers. This can be tackled through the legal system, legislation, and the media. ACEP must continue to lobby Congress to pass legislation to hold the insurers accountable and reinforce the “prudent layperson standard.” Additionally, ACEP must continue to work with Congress to create a permanent reform to the Medicare payment system that is both fair to physicians and sustainable for the future.

Steven B. Kailes, MD, MPH, FACEP

Current Professional Positions: Emergency Medicine Physician, Emergency Resources Group (ERG); Director of Governmental Relations, ERG

Internships and Residency: Basic Surgery Internship and Emergency Medicine Residency, Naval Medical Center San Diego (1998–2004)

Medical Degree: MD, Tufts University School of Medicine (1998) MPH, Tufts University School of Medicine (1998)

Response: The two most pressing issues facing emergency physicians are the erosion of physician autonomy and the growing burdens on our specialty without adequate support or resources. First is the erosion of autonomy. Emergency physicians are being asked to do more with less: less time, support, compensation, and say in how we practice. Decisions that affect care and physician well-being are increasingly made by nonclinicians—administrators, insurers, and regulators. This fuels burnout and disconnection, as we’re sidelined from decisions central to patient care. To address this, ACEP must continue advocating for fair reimbursement, protection of independent practice models, and policies that return clinical decision-making to the bedside. Just as important, we must equip members with the tools to lead in their own institutions and communities—to advocate for themselves, their teams, and their patients.

Second, emergency medicine is increasingly stretched as the safety net for a fractured health care system. Patients arrive sicker and with more complex needs—often because they’ve been denied care or have nowhere else to Meanwhile, reimbursement continues to fall. Adjusted for inflation, we earn about 33 percent less than 20 years ago, even as the cost of becoming a physician has soared. This threatens not just morale, but staffing and sustainability.