Allowing ED physicians not certified in EM to join will fulfill our mission—and ultimately help patients

Courage is what it takes to stand up and speak. Courage is also what it takes to sit down and listen.
– Sir Winston Churchill

Should ACEP reopen membership to non–emergency medicine board-certified physicians? Absolutely. Before we get started, this is not an issue of emergency medicine board certification and whether that is considered the gold standard. Rather, it is an issue about who can join ACEP, our professional organization, and whom it represents.

Why must we reopen the College? Easy—it is our mission. Have you ever really considered ACEP’s mission statement? Here it is: “The American College of Emergency Physicians promotes the highest quality of emergency care and is the leading advocate for emergency physicians, their patients, and the public.“

Consider who this includes and what it says. “Promotes the highest quality of care.” Where? Everywhere. For whom? For all emergency physicians, their patients, and the public. “Advocate for emergency physicians, their patients, and the public.” The same group is addressed here. One could argue that, in order to be an emergency physician, you must be American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine certified or eligible, or members of ACEP as defined by the ACEP Board of Directors in 2011. If so, all of the patients and public who are served by the non–EM boarded physicians or physicians who aren’t ACEP members are left out, according to our mission statement. That doesn’t make sense. In order to fulfill our mission, we must embrace all emergency department physicians, their patients, and the public—not just a few, not some, not in certain places, not just EM board certified, but all the physicians who regularly provide emergency care, their patients, and the public.

Why must we reopen the College? Easy—it is our mission: “ACEP promotes the highest quality of emergency care and is the leading advocate for emergency physicians, their patients, and the public.

All across America, 24-7-365, there are professional men and women who cannot join our College but saddle up anyway and go to work in their local, often small, rural EDs—places where resources are often few, payment for work is often wanting, and recruiting is, at best, difficult. If they do not answer the call, who will? Often, these are the very physicians who cannot join our College. Like it or not, these physicians are necassary to fill the gaps in staffing at the nation’s emergency departments. It is the world we live in today and most likely tomorrow. These physicians, patients, and public need the full resources, advocacy, and support of ACEP. They deserve to be under the umbrella of the nation’s premier emergency medicine organization, ACEP.

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.

References

1. Groth H, House H, Overton R, et al. Board certified emergency physicians comprise a minority of the emergency department workforce in Iowa. West J Emerg Med. 2013;14:186.
2. Ginde AA, Sullivan AF, Carmago CA Jr. National study of the emergency physician workforce, 2008. Ann Emerg Med. 2009;54:349-359.

Dr. Smith is chair of the ACEP Careers Section and medical director of the emergency department at Cookeville Regional Medical Center in Cookeville, Tennessee.