ACEP needs them. These physicians have unique and important perspectives. Without representation of the physicians who staff these smaller EDs, the perspective of the College shifts. It shifts to the experiences, opinions, and issues of the academic and larger centers and staffing groups. How about political advocacy? Who can better advocate for the patients and the public in rural and remote locations than those who work there? Often, these are the non–EM boarded physicians. These non–EM boarded physicians are well-known in their communities and to their political leaders. These physicians represent community opinions. They vote. They get heard!

So, why don’t we just send our residency-trained emergency physicians out into these places? We don’t have enough, and we won’t for a long time. The studies are compelling. Review them for yourself.^1,2 You should check into the pay, the available resources, and the struggles of these physicians in these smaller EDs. Better still, come visit me in rural Tennessee. I’ll be happy to show you around. Visit any number of other smaller or rural EDs in the country; speak to those emergency physicians. The stories will be pretty similar.

So what do we do to promote and advocate for these non–member-eligible physicians, their patients, and the public? We should not “let” them join? No, we shouldn’t. Rather, we should “ask” them to join and participate in the College. Let’s all work together to advocate for and provide the highest quality care to all emergency physicians, patients, and the public. ACEP then best fulfills its leadership role and lives up to its mission statement. All emergency physicians, patients, and the public benefit alike. It’s hard to see much wrong with that. Sure, ACEP’s meetings, sections, and educational resources are available to members and non-members alike. Non-members are assessed additional fees for their non-membership despite a willingness to join.

ACEP’s logo represents the missing specialty within the house of medicine. Within our College, it looks like that logo could have additional meaning if ACEP limits membership to only EM board-certified physicians. The missing piece is that group of emergency physicians who cannot join. They are very real, not going away, and very much missing. Let’s open the College so ACEP represents all emergency physicians, their patients, and the public. After all, it is our mission.