Much debate occurs around what the future holds for health care and for emergency medicine in particular. Some believe the world of emergency medicine is eroding, with the growth of urgent care, freestanding emergency departments, retail clinics, and virtual care that can compete for patients. On the other hand, some believe that same change in the landscape is evidence of an expansion of our specialty. I tend to believe the latter: with an aging population, an increase in the insured, and a shortage of providers, there will always be a continued need for unscheduled acute care. No matter where those patient needs are, we want to be there. Emergency medicine actually exists to fill that gap.
The road ahead will be a challenging one, with turbulence and days of unease. Things will likely get worse before they get better as the landscape transforms. The growth of high-deductible health care plans, the possibility that “essential health benefits” that include emergency care may be reversed, and the likelihood that reimbursement will enter a downward spiral all present significant challenges. The opportunity lies with carving out a well-defined and integrated role that creates needed value. Three key concepts can help emergency physicians take greater control over their destiny.
So where is all of this going? Emergency medicine must define itself in this new world, or someone else will. The good news is that we’ve done this before. Simply look at the ACEP logo. It is a series of squares with one missing. Early emergency physicians pointed out that our specialty needed to exist in order to fill a gap in health care. It took decades to establish our profession and fill that gap, but it all started with a single vision of caring for the patient and relentlessly articulating and building that unifying vision together.
The dialogue about health care reform has been focused on other issues: the uninsured, coordinating chronic care, and new payment models. Looming ahead is a focus on unscheduled and emergent care, including that for increasingly complex patients. Today’s emergency care is often fragmented and poorly integrated across a region. Integrated, regionalized emergency care can be the lynchpin that unites the various health care resources together around the needs of the patient. Primary care medical homes and accountable care organizations don’t yet address this need. Opportunity is knocking.
While issues like reimbursement, malpractice, and workload are truly important to the profession, those messages offer neither a compelling vision nor differentiate emergency physicians from any other specialty. I worry that, all too often, these are seen as our messages. Inversely, unfailingly articulating a vision that emergency medicine fills a growing gap in health care with an integrated and high-performing system of quality emergency care for our acutely ill or injured patients 24-7 begins to bring that need into focus. We are there when our patients need us the most. It must be all about our advocacy for our patients’ needs. When policymakers, payers, and the public grasp that, then the opportunity to better express our professional issues will open.