The differences in training, competencies, and scope of practice among physicians and between physicians and non-physicians must be clearly defined and delineated when it comes to acute, unscheduled care. There remains much debate, even among ourselves, on the establishment of minimum standards for education, training, and competence of EM NPs and EM PAs. However, standards must not be misconstrued as training a non-physician practitioner to replace the physician.

It is unacceptable to have an emergency department that is not led and staffed in real time by a board-certified emergency physician with sufficient time to oversee the department and engage with patients.

ACEP and our chapters continue to advocate strongly at national and state levels against independent practice of NPs and PAs in emergency care. At no point should the role of the emergency physicians be performed by an independently practicing non-physician practitioner.

• Set the standards for emergency medicine so every patient has access to a board-certified emergency physician

Every patient, no matter their zip code, should receive the same high-quality care when they need acute, unscheduled care to improve overall patient outcomes and as a matter of equity. ACEP has developed accreditation programs in ultrasound, geriatric emergency departments, and pain and addiction care emergency departments. We believe the time is right to explore the merit, feasibility, and operationalization of an emergency department accreditation program that categorizes emergency departments. Similar to the American College of Surgeons’ Trauma Centers, there should be a “gold standard” that patients should expect from their emergency department and from those who are providing the care. We believe every patient seeking emergency care should have access to a board-certified emergency physician. We support board-certified emergency physicians as the decisionmakers regarding staffing within emergency departments specific to physicians, NPs, and PAs.

• Broaden the umbrella to expand emergency medicine physician scope of practice

As evidenced by the many sections within ACEP, the skill-defined practice of an emergency physician is already broad. There is opportunity to deploy systemic solutions around what many emergency physicians already do: observation medicine, acute psychiatric emergencies, EMS medicine, and telehealth, among others. It is important to continue research in these and other emergency medicine practices to document improved quality of care and patient outcomes when care is provided and/or led by board-certified emergency physicians. Opportunities exist to create new or evolve current focused-practice designations toward formalizing additional EM subspecialties—disaster medicine, community health (public health), health care administration, informatics, pain management and addiction, telehealth, emergency psychiatry, and others.