Dr. Mark Rosenberg outlines his goals for the year and the challenges of being ACEP President during COVID
Explore This IssueACEP Now: Vol 39 – No 12 – December 2020
At ACEP20, Mark S. Rosenberg, DO, MBA, FACEP, began his term as President of ACEP. He spoke with ACEP Now Medical Editor in Chief Jeremy Faust, MD, MS, MA, FACEP, in late November over Zoom. Some of the questions were provided by the Editorial Advisory Board of ACEP Now. This interview has been edited for clarity and continuity.
JF: Congrats on being at the helm.
MR: Well, thank you. It’s only been a month.
JF: Let’s start with a really hard-hitting question: How’s the job going so far?
MR: It has always been my dream and goal to lead the College, and sometimes I wake up and I pinch myself wondering, is this real? Am I really president of ACEP? And then I realize that I am, and it is a wonderful feeling. I’m doing this as a full-time commitment, so I’m not tied to clinical work. I’m now chairman emeritus, and so it gives me a lot more time to really understand the problems, concerns, and issues that our members have. And I’m learning a lot.
One thing that I’m doing this year is I’m going to each and every state chapter with the power of Zoom and trying to better understand what their needs are and how ACEP can better support them.
JF: What’s on your desk today related to our COVID response?
MR: One of the best parts about having a new administration is President-Elect Biden and [Vice President-Elect] Harris put together a task force. We were lucky enough to have a member, Rob Rodriguez, be on the task force and we’ve had several conference calls with Rob to see how ACEP can be supportive of his task force initiatives.
Then we have some of our advocacy issues. We want to make sure that we get legislation passed that helps support emergency physicians—for PPE [personal protective equipment], for funding, and also for our wellness, such as the Lorna Breen Provider Protection Act. So many of our members are suffering. We really need to make sure that we can protect, treat, and do harm reduction on all emergency physicians to make sure that they remain healthy and we can have the strongest workforce possible.
Jeremy, what I found that’s so amazing is what ACEP has been doing over the years. A lot of our initiatives seem to be coming together as a fabric to help us move forward. Whether we’re dealing with health equity or a pandemic response or staffing, all of these pieces seem to be coming to a head right now. It’s so exciting because, at the end of the day, the support of ACEP, the support of the entire team, means we will have better solutions in a year than we’re walking into right now.
JF: We definitely have embraced our role in testing. For example, tents and adjacent facilities, if not in the emergency department, are certainly run by the emergency department in many cases. Do you foresee that vaccine distribution might work similarly? On one hand, you could say, “Well, the emergency department is isn’t the ideal place to have people lining up for vaccines.” On the other, again, meet them where they are.
MR: Well, a large portion of the population comes to emergency departments for primary access to health care, and we have to ask ourselves: What is our role in vaccine distribution or administration of monoclonal antibodies and different treatments? I don’t want to be so bold to say what our role is because I don’t know, but that’s where the question comes in. Where can we be part of the solution here? We already are part of the nation’s solution when it comes to managing trauma, managing overdoses, managing all these different aspects that plague society. What’s our role when it comes to COVID-19?
JF: Looking beyond COVID-19 into the future of ACEP, big picture. With the changing landscape—increasing access to online training, EM subspecialty groups, virtual meetings—what exactly is the value proposition of ACEP itself in the year 2020 and after?
MR: We can’t stick to what was status quo. There are evolving needs and roles of emergency physicians, and we can break it down into new graduates versus mid-career versus late career. We could break it down into practice environment, whether we’re dealing in rural emergency medicine or academics. ACEP has a different role in each of these areas. This is not just an evolution. This is a complete change in how we managed things in the past and our current needs. We have to be more nimble than ever before because we don’t know what’s going to happen with the vaccine. We don’t know what’s going to happen with COVID long term. We don’t even know the evolution of emergency medicine when it comes to some future aspects of telemedicine, telemedicine policy, legislation, and payment. I believe that ACEP’s role and ACEP’s value proposition is bigger than it ever has been.
Every member has different needs, and ACEP can supply those needs to each member. I have always believed, “it’s ACEP for life,” because if you join us at residency or as a new attending, there are certain aspects of what ACEP can offer you—helping you build a nest egg, helping with your first contract and what it should and shouldn’t say, best practices when signing your first job contract. Mid-career, you really start to talk about different life challenges, and wellness and health becomes a bigger issue. What is our role in promoting physician wellbeing, physician support, and physician safety in their practice? As you get into later in your career, the evolution continues because now you’re looking toward retirement. How do you stay safe? How do you keep working? So, it’s one continuum that we’re talking about.
JF: How are we embracing new technology to reflect the changing world we live in?
MR: One of the things that we have done is try to make our current type of educational meetings fit into a Zoom platform because that’s all we understood. What we’re learning is if Zoom is part of our culture going forward, our meetings don’t have to be the same as they were in person. We tried doing a lot of different things at ACEP20. Some of those worked out really well, but we need to transition from an in-person meeting environment to one that incorporates virtual technology and still make it meaningful. Should a lecture be 20 or 30 minutes instead of 45 minutes or an hour? How long should a Zoom meeting take? Should it be asynchronous? We have an opportunity to find what works best for our members, but one thing for sure is we can’t expect it to be the same as completely in-person meetings.
JF: What should ACEP’s role be in shaping health care financing reform, and how do we balance concerns for our patients’ financial wellbeing with fair reimbursement for our services? How do we get around that inherent conflict?
MR: We’ve always heard that the emergency department has high costs. But a lot of that comes from the facility charge, not the physician charges. We need to come up with strategies that allow emergency physicians in their practice to earn a decent living, or we’re not going to have people working in emergency medicine.
If it was all about balanced billing, that would be one thing, but this really comes down to an insurance question and how health care should be managed and financed. We cannot continue to be paid at a decades-old price structure for the work that we’re doing now. There needs to be a whole evolution in payment strategies. We’re there 24-7-365 for all our patients. We have the unfunded federal mandate of EMTALA. So, to let the insurance companies be the go-between and restrict how much we get paid is an unfair system.
The emergency department offers a service, and we offer the full capability of the hospital with consultation services and everything else that’s available and a pure hand off to the next level of care. Nobody else can do that, and that’s where our value is. We are a rapid assessment, diagnosis, and treatment area that can get things done for patients regardless of an emergency, an urgent, unscheduled urgent, or unscheduled acute care situation. We’re there, and we have a lot of opportunity to evolve in our future.
JF: What are a few things that you think that ACEP will do over the next two or three years to transform itself and the specialty?
MR: I am in a diverse environment in Patterson, New Jersey. In Patterson, the life expectancy is 73 years, and six miles away, it’s 86 years in a more lucrative neighborhood. Why the health disparity, and what’s the role of emergency medicine when it comes to providing health equity? That’s one major area where I believe the emergency departments can help bring resources to their communities because most emergency departments are community emergency departments. What we are really dealing with there is health equity and using strategies to improve the way emergency medicine takes care of people regardless of their ability to pay, regardless of color, regardless of religion.
The second part is the role of telemedicine. During the pandemic, we saw that many people left nursing homes to come into the emergency department to be seen. In the emergency department, they got admitted to the hospital. The hospitals became crowded, but the nursing homes had lots of open beds because everybody moved out of the nursing home. There’s an opportunity to use telemedicine to expand our footprint into nursing homes and other places, plus telemedicine or telehealth into rural America. We always felt that the best emergency medicine is physician-led teams, and we always talked about the role of board-certified, residency-trained emergency physicians. With the help of telemedicine, we can bring that to every community in the country and make it possible that board-certified emergency physicians help lead the physician-led team in emergency medicine.
And, of course, pandemic readiness is now a major focus of emergency medicine. I saw the way we shifted our approach to pain and addiction when the pandemic exacerbated the problem with closed pain centers and doctors’ offices. I saw the way emergency physicians provided palliative care as they held the hands of those actively dying and helped families communicate over telemedicine. We did more than we ever thought was possible. In many ways, COVID brought out the best in emergency medicine. We can take those parts forward as we improve the safety of the emergency physician in this pandemic and any in the future.
I have assigned objectives related to these three issues to many of ACEP’s committees this year. We can take all these great minds and thoughts to work together in an ACEP think tank I like to call the Innovation Center. Within this structure, we can develop ways where we as emergency physicians can better solve these problems in our communities.
As we look at the job opportunities for our residents, I think a lot of it will be outside the bricks-and-mortar of the emergency department and will now allow us to really transcend into communities that we’re not even physically in at the time. There is a huge, huge opportunity for us. The future is bright. It’s pretty exciting where we’re going to go, but it’s not a one-year change.
JF: Let’s close by getting to know you just a bit better. What is something that the average ACEP member might not know about you personally that would help them understand who you are as a person and as a leader?
MR: When I got into emergency medicine, I really thought that you would be a superhero if you could save a life, and the only specialty that I knew of that would allow us to be superheroes every day was emergency medicine. Every day we set foot in our emergency departments across the country and we make a difference to the patients where we see them, some a small difference, some a major difference. Sometimes it could be just stabilizing somebody who’s depressed and suicidal versus somebody who has a cardiogenic shock from a massive [myocardial infarction] and needs to go to the cath lab.
I wanted to be a superhero. I wanted to have that ability. I don’t care about people knowing my name. I didn’t care about that piece. I cared about coming home and feeling the power that it is when you save a life.
One day, I got called to [labor and delivery]. It was May 25. Why are they calling me to labor and delivery? This is ridiculous. And why do I have to leave the emergency department? I go up to labor and delivery, and they said, “Doc, we need you to resuscitate this newborn. We’re doing an emergency C-section right now, and we can’t get the neonatologist. You’re it.”
I was in a small community hospital, and they hand me this pulseless, limp, infant baby, newborn. I had never resuscitated a newborn before, but I trained. I practiced on a mannequin over and over again how to intubate. I knew how to put in lines. I knew everything. Now, I had to do it. I remember looking in the airway, trying to get in the tube, and all of a sudden, things seem to magnify and slow down. And the tube went in and the line went in. By this time, the neonatologist comes in, and Michael Edward was breathing on his own and doing very, very well with a little assistance.
I went down the hallway back to the emergency department, and I’d never, ever in my life felt so good. I was floating. I felt absolutely amazing. And it’s that feeling that keeps me going every single day. But there’s another part to the story. That was my birthday, and I always work on my birthday.
One year later, I’m in the emergency department working on my birthday, and who comes in but 1-year-old Michael Edward. He was bringing balloons to give me a birthday wish, and his mom said, “You were the one who gave him his first breath. We wanted to be here for your birthday.” That may only happen once or twice in your career, but you want to know something? I felt like a superhero that day.
What we all have is the inner drive to go toward danger, not away from it, to treat each and every person, regardless of race and gender or anything else, as a person who we can help. When we do, they may turn around at the end of the day and say, “What was that doctor’s name again?” And it doesn’t matter. They know we were emergency physicians. They know that we were the best thing they saw on their worst day. That’s what makes emergency medicine special.