Twice a year, the Medical Editor-in-Chief of ACEP Now sits down with the ACEP President to discuss issues relevant to the College and important to emergency physicians. This article is an excerpt of the conversation I had with L. Anthony Cirillo, MD, FACEP; it has been edited for length and clarity.

Dr. Cedric Dark: With me today is ACEP’s president, Dr. Anthony (Tony) Cirillo. Thank you very much for joining us. You’ve been president for maybe about a month now, and hopefully you’ve had a chance to get your feet wet. I wanted to start off with a really difficult question, though.

It’s about our current ACEP Now poll, sparked by a lecture at ACEP25 where one of the presenters was talking about who’s actually reading their own X-rays. Because of the liability that might be there if a radiologist missed something, or if there’s something subtle that we’re looking for that the radiologist doesn’t know to look for, I want to ask you. Do you read your own X-rays?

Dr. Cirillo: I read them all. I personally look at them, and again, to your point, I know where the boo-boo is, right? I know where they hurt. I know what the exam was like. When I look at the X-ray, if I see what I was expecting, I’m usually comfortable. Nothing against our radiology colleagues, but we’re finding that sometimes official readings take a while. And if somebody has rolled their ankle, and they’re tender over their lateral malleus, and they’ve got a non-displaced fibula fracture, and they’re neurovascularly intact, you’re like, I think I’m good. I always go back, though, to make sure that I look at the official reads at some point.

Dr. Dark: Let’s talk about what began as the One Big, Beautiful Bill, now officially called H.R. 1, which was the big tax law that was passed this summer. There are a lot of Medicaid provisions that impact emergency physicians because of EMTALA. An article in The Hill recently quoted Vice President J.D. Vance as saying:

“If you’re an American citizen and you’ve been to the hospital in the last few years, you’ve probably noticed that wait times are especially large, and very often, somebody who’s there in the ER is an illegal alien. Why do those people get health care benefits at hospitals paid for by American citizens?”

I wanted to get your take, as President of ACEP, on that statement, and how the new tax law impacts us in the emergency department.