During yesterday’s Council meeting, William Jaquis, MD, FACEP, a Florida-based emergency physician, assumed the ACEP presidency. Dr. Jaquis is an attending physician at Aventura Medical Center in Florida. He was elected to the ACEP Board of Directors in 2012 and 2015, and served one year as vice president. He also is a past president of the Maryland ACEP chapter. He is the senior vice president of Envision Health East Florida Division. Dr. Jaquis earned his medical degree at the Medical College of Ohio and completed his residency at Case Western-Mt. Sinai Medical Center in Cleveland. The following is a transcript of his speech to the Council outlining the areas he plans to focus his attention during his tenure.
Good afternoon, and congratulations on the important work you have done in the last two days. I am incredibly humbled and honored to have the opportunity to serve as your President for the upcoming year.
As I have been working with staff and the Board, including the executive leaders in preparation for the coming year, I have determined three areas that will need significant focus – workplace, workforce and wellness. Certainly, the area where the patients and physicians meet, the workplace, is an important part of ACEP’s agenda. Getting effective acute unscheduled care to all parts of the country … even internationally … will require continued attention to the workforce. Finally, but as important, the current state of our teams related to burnout and depression must have ongoing intention to improve our individual and collective wellness.
For many of us, a typical day in our departments is increasingly challenging. Our patients are more complex with a shift in acuity and age. Our evaluations are more comprehensive, and with more low acuity patients being treated in sites outside our departments, many of us also have created split flow models. These changes do improve efficiency, but also bring more intensity in the main ED. Add to that environment the mandate to work faster, and we have a very challenging workplace. Finally, when the workday ends, “pajama time” comes – time to finish up those charts that you simply could not get to at work.
Improving the workplace must continue to include conversations about technology. Since 2016, ACEP has endorsed Collective Medical’s EDIE program to streamline the ability to know more about our patients when they come to the ED. Having worked with a robust health information exchange (HIE) in Maryland, I truly understand how a well-designed approach to HIEs makes an ED visit better for the patient AND the physician. EDIE, which is currently being used in 39 states, continues to develop and bring additional information to more EDs that will help you provide the highest quality care for your patients.
In July, ACEP hosted a HIT Summit. More than 90 technology representatives met with our leadership, staff, and content experts to have a meaningful conversation on how those vendors could assist with better interfaces to remove some barriers to patient care. In addition, after considering how best to attack these issues, I created and appointed the HIT Committee that will meet for the first time here in Denver. You know us – when emergency physicians see a problem, we build a solution.
About a decade ago, I dabbled with HIT by representing my health systems’s medical staff in introducing an electronic health record and physician order entry. I got a glimpse into the value of a human interface between the clinicians and the technicians. Many of our own emergency physicians have surpassed me greatly with their enthusiasm and knowledge in this area. As ACEP leaders, we believe the committee structure will give more intention to this tremendous need, help with creating new content, and build relationships with other standing committees that may benefit by this expertise.
No discussion on workplace in the current climate can leave out the paramount issues related to fair payment and fair coverage. I do not intend to go into the depth Dr. [Vidor] Friedman shared in his speech yesterday, but our attention to this issue must not only be maintained but also broaden in scope. Our DC staff, led by [ACEP Associate Director for Public Affairs] Laura Wooster, and our physician advocates, led by Dr. Friedman, have worked incessantly on this issue. For those in the room or outside of it who are skeptical of the value of ACEP, this issue alone is worth every bit of dues you will pay for many years.
I certainly understand we have a lot to do to get to even a palatable solution, but without their work, this effort would have settled out a long time ago – with an unfavorable outcome to emergency physicians. Your payment rates would have been set with at least a 30 percent drop, and the freefall to the bottom would have continued unabated. This work must continue – not only to ensure current and future generations of physicians choose our specialty, but to make sure our hospitals can continue to provide emergency care for our patients, especially in rural and other underserved communities.
But as a specialty, we cannot only look to others to determine payment. We have also worked through value-based payment systems for years; initially in a very small way, but now in increasing importance. As with many issues, Dr. Gerardi was prescient almost fiveyears ago in creating the Alternative Payment Model Task Force. I have had the pleasure of representing the Board for this effort, which has been led admirably by Drs. Jeff Bettinger and Randy Pilgrim. As you may recall, this risk-based payment model would allow our EDs to look at several common symptom complexes, and with the support of additional funding for care coordination, would allow us to receive additional value-based payments.
The journey of the AUCM model has been quite tedious, but awesome, and just last month we received word that Secretary Azar at HHS believes that core concepts of the model should be incorporated into other models that are being developed.In addition, because of interest from other payers, ACEP will continue to introduce this model to other entities, such as commercial payors.
During the Scientific Assembly, I will convene the first meeting of the Future of Emergency Medicine Task Force. We have already started by selecting a group of thought leaders and querying them for the areas of medicine they believe will be crucial to address in assessing the near-term approach to the success of EM. At the meeting this week, we will have a group discussion on the areas of focus and suggest content experts. We plan to produce a document that addresses those areas in depth, hopefully continuing to lay the groundwork for our approach as a College.
We cannot talk about the paths to more effective and meaningful workplaces without addressing the violence that occurs in our communities – and then into our EDs. Until Help Arrives is a new community-based initiative for ACEP members to provide CPR and first responder training to citizens in your local schools, community centers, and churches. Find out how you can become an instructor at untilhelparrives.com. and at booth 125 in the Exhibit Hall during ACEP19.
And emergency departments are not immune to this violence. Workplace violence is one key area where ACEP and ENA can work together to effectively address this problem that impacts all of emergency care. We need our workplaces to be safe for each other, our patients and their families. Today, I’m excited to announce that ACEP has teamed up with our nursing partners at ENA to launch the “No Silence on ED Violence” campaign.
The goal is to raise awareness about workplace violence in the emergency department, offer resources and build a broad network of supporters committed to advocating and finding solutions for this problem. Visit stopEDviolence.org and use #StopEDViolence on social media to share your stories and join the conversation on how we can end this problem with which we are all too familiar.
As an aside, I believe we are stronger where we can find a shared vision with those who ultimately share the same goals. While understanding we may have differences on some issues, focusing on our shared goals will create more productive relationships. ACEP has led, in concert with multiple other organizations, on many of these issues, including workforce, scope of practice, medical merit badges, and fair payment. We will continue to develop projects and resources that emphasize our inclusiveness. Whether it is two voices that bring a resolution to our council, physicians that work in a single hospital group, or those that work for multi-specialty organizations, we want to help you make your workplace more effective – a destination where our patients receive excellent care and where you find joy in your practice.
We cannot have an effective workplace without an engaged and active workforce. The number of new residencies and its impact on future job opportunities and compensation is front of mind for many of us. For the past two years, I have been working in Florida, where my clinical time is spent working in a newer residency program. The considerations around finding the “right” number of residencies are certainly complex. To address this, Dr. Friedman created the EM Physician Workforce Task Force. ACEP, along with our supporting partners ABEM, ACOEP, AOBEM, CORD, EMRA and SAEM, have launched a 2-year comprehensive study of the current and future workforce in our specialty. We have engaged a nationally recognized expert, Ed Salsberg, as well as the task force Chair Dr. Catherine Marco and Board Liaison Dr. Chris Kang to help us project the supply and demand for emergency physicians in the future, ensuring job security for all of our residents.
As part of that effort, the Scope of Practice Task Force was also mobilized. All of the EM specialty organizations have joined with our physician assistant and nurse practitioner colleagues on this task force. Engaging this wide-ranging group will allow us to establish best practices in emergency care delivery for our patients.
One of the discussions we continue to have, including at this Council, is the desire to have board certified emergency physicians be a part of every emergency visit. One of ACEP’s vision statements it that “Patients seeking emergency care are treated by board certified emergency physicians who are supported in their practices with all resources necessary to provide the highest quality medical care.” Despite that vision, the dichotomy remains that as a specialty, we have not placed enough of our BCEPs in rural communities. In some of my recent residency visits, I asked how many thought they would practice in a rural setting. I can give the answer on one hand. In that regard, I do not believe we can fully answer the challenges of workforce and scope of practice until we find more effective ways to address the delivery of emergency care in rural and other underserved settings.
Finally, ACEP continues to be recognized as a leader in emergency medicine from many perspectives. The Board, in consideration with our staff, agreed that we need a higher level of attention to our international efforts to expand ACEP’s reach. As president, I have the pleasure of starting the first committee for International EM, using that venue to determine how to work purposefully with our colleagues in other countries and societies. As part of this effort, ACEP will host an International Summit in Spring of 2020 to enable emergency physicians and policymakers to be recognized in the same way the other specialists are recognized, allowing for better support and job prospects in international areas.
Improving the workplace and understanding how to develop an effective workforce are important goals. Closely interrelated is the need to improve the wellbeing of those who are delivering the care. In 2013, Medscape began to produce surveys on physician burnout. In the six years since, that percentage has risen steadily to now 44 percent of those surveyed. If we look at our future, our residents, studies suggest about 35 to 75 percent report being burned out. In the surveys about burnout based on specialty, emergency medicine remains near the top. In addition, those surveys suggest that 15 percent of physicians are significantly depressed. At the end of that spectrum are the 400 physicians who commit suicide every year. Clearly, this has to change.
To begin, we need to remove the barriers that prevent physicians from getting help. We have been working with the Federation of State Medical Boards to find ways to make the credentialing and licensing process more supportive by changing how they query our physicians for depression and mental health. Our Well-Being Committee and Wellness Section will also continue to develop resources on systemic wellness strategies, tutorials and evidence-based practices that support wellness. Their work will be supported by the Academic Affairs Committee and EMRA to make sure we cross all levels of practice. We have engaged in these activities for several years now with all of the EM specialty organizations and will continue to do so.
In addition to all the great work you will do for ACEP and your emergency medicine colleagues, I do have one additional ask of you: Be kind. We know that as a College, we have a wide representation of our society. Unfortunately, the divisiveness we see everyday spills over, not only internal to our communications, but often to external audiences who are watching. Many of those kinds of interactions are clearly available for anyone to see.
Fundamentally though, I believe that all of you, and all of your partners in care, go to work every day striving to provide the best care you can for your patients. You will see us as a College refocus on messaging that emphasizes our immense strength; the strength that is in the breadth and depth of talent we have within the specialty, the strength we show in supporting the diverse practices of all emergency physicians, the strength of promoting the areas of connection and passion that bring us together, and the strength that serves as a point of reference that defines ACEP and emergency medicine.
A year is not a long time, and these are challenging issues. I can assure you that our leadership and staff are highly engaged in our mission. We presidents have the honor of focusing for a year on areas that need more attention, but the organization is dynamic and continuous.
Thank you for your attention and support. I look forward to the next year with great anticipation.