Leading an organization as large and diverse as ACEP requires a focus on both the urgent problems of the moment and the long-term health of the organization and its members. For ACEP President Vidor E. Friedman, MD, FACEP, centering his efforts on improving life for emergency physicians and advocating for shared areas of concern have allowed him to tackle both current issues and long-term strategy initiatives.

From a leadership perspective, Dr. Friedman has accomplished much in a short time. Instead of spending the usual year as ACEP President-Elect, he only spent three months in the role before assuming the presidency in September 2018. He was elected by the ACEP Board of Directors in June 2018 to serve as President-Elect following the resignation of former ACEP President-Elect, John Rogers, MD, FACEP.

Dr. Friedman recently sat down with ACEP Now Medical Editor in Chief Kevin Klauer, DO, EJD, FACEP, to discuss his goals as ACEP President. Here are some highlights from their conversation.

KK: Let’s talk about your initial goals as ACEP President. What did you really want to try to accomplish in this year?

VF: Well, these were interesting times. The reality is that most president-elects have a year to prepare. I only had three months to prepare, following John Rogers’ transition out of the role. I didn’t have as much time to think about what my personal goals were for the presidency. I wanted to do what I could in this year to improve life for emergency physicians and particularly for future emergency physicians. I think most presidents go into it thinking of the things that they would like to accomplish. However, the crises of the moment that we have to deal with have a tendency to hijack the agenda to a certain extent.

There were internal things that I wanted to try to accomplish this year. My goal was to help the Board be more strategic in its operations. What I mean by that is over the last 10 years, the Board has become very operational. I’m glad that our annual Board retreat went well and that we were able to focus on how to help the Board become more strategic in its functioning.

In terms of what’s happened since I’ve assumed office, I knew going into it that the issues around out-of-network billing were going to be important this year. There’s a tremendous bipartisan desire to do something in that arena. In fact, it’s including the White House and the Secretary of Health and Human Services. They’ve decided that [surprise] billing is something they’re going to focus on.

I’ve been advocating for our profession and our College in Washington, D.C., at least once or twice a month since the annual meeting. That doesn’t include multiple phone calls trying to bring all the parties to the table internally around this issue, which we have struggled with as a profession. I think we’ve made some good progress. Having said that, I think we have to be realistic that the forces against us are pretty significant. But we’ll continue to fight for our right to take care of patients in the way we want to care for them, for our profession, and for our right to be fairly compensated. That’s really been the central focus so far in my presidency.

KK: I’m certain you had imagined “the day in the life” of your presidency. How has that changed for you?

VF: I think the biggest difference is that I didn’t anticipate the amount of time that would be required during this presidency for our lobbying efforts in D.C. Our D.C. office is doing a tremendous job, and I don’t intend to take anything away from their efforts. However, as president, I’m the spokesperson for our College, and I need to be there articulating things from the physician’s perspective that are best delivered by the president. I knew this would be a piece of what I did this year but didn’t realize it was going to be such a big piece. Like you said, the issues of the day really help define the presidency.

I’ll try to highlight some of the things that I would like to see the College do. One area that I would encourage the College to be engaged in is firearm injury prevention and firearm safety. I recently met with the American College of Surgeons (ACS) last month. They put together a meeting of 49 medical specialties and societies to discuss this issue. I really have to give the ACS kudos that they internally did a deep dive and were able to come to some consensus on the things they did agree on around firearm safety. That helped their leadership be more focused and more proactive. I want our College to do that as well. Are we going to agree 100 percent on everything? No. But instead of focusing on the issues that split us apart, I’d like us to be clear about the things that we do agree on so that we can advocate for those together. We can advocate better if we have a clear understanding of where our membership stands on the issues.

KK: How do you meet the needs of the membership on such a polarizing topic without disenfranchising a component of the membership?

VF: Well, you’re never going to meet everyone’s needs 100 percent of the time. That’s a fool’s errand. However, we can ask them where they stand on particular aspects of this issue and try to get a clear understanding of where the majority, hopefully the vast majority, does agree. That’s a reasonable place to start, which may be accomplished by doing a survey of our Council, the representative body of our College. [Editor’s note: At its April meeting, the ACEP Board of Directors voted to survey the Council for a representative viewpoint on firearm-associated research, safety, and policy.]

I don’t think anyone wants our patients to continue to suffer from firearm injuries. It’s just a question of what we see as reasonable solutions. Frankly, we know that there’s a paucity of research in this area. I think that there’s broad consensus that supporting research into firearm injury prevention is worth doing. That’s one example of a place where I believe there to be consensus.

KK: You’re so right. You can provide the greatest benefit, perhaps, by tackling some of the most challenging topics, so I’m glad you’ve taken it on. Moving to another topic, are there any successes that you’d like to share with the membership?

VF: Well, I can’t really take credit for it, but it happened on my watch. The conversations that we had with The Joint Commission about the ability to eat in the emergency department on your shift may be the thing that I’m most remembered for as president. That’s a huge success.

KK: Well, I personally will thank you and our staff for that one, Vidor.

VF: You’re very welcome, Kevin. I had little to do with it. But since I get to take all the credit for the things that go wrong, I might as well take a little credit for some of the stuff that goes well.

KK: That’s fair enough.

VF: I think we have continued to improve and deepen our collaborative efforts with other specialties and with the American Medical Association (AMA). I think that we have worked very diligently to position ourselves well within the AMA over the last decade. Our AMA delegation continues to grow and be very impactful.

Another area I feel strongly about is emergency physician well-being. Physician suicide is the endpoint of a predictable continuum. Depressed physicians have a difficult time accessing appropriate resources to deal with that depression. One of the things that I’m pushing us to do is to help our chapters advocate to state medical boards to refine their questionnaires for licensure. Similar efforts should be taken with the hospital credentialing procedures.

Many, if not most, processes ask, “Have you ever been treated for mental illness?” An affirmative response is often interpreted as a red flag for patient safety. Being treated for medical or mental illness is no one’s business unless it will prevent you from doing your job safely.

I’d like us to work with the AMA to expand the offerings that physicians have, improving access to resources when they’re in trouble. Burnout is a big issue in emergency medicine, with depression being a key component.

KK: What do you hope to accomplish with the remaining time you have, Vidor?

VF: I’ve been working with our staff to develop end-of-life care initiatives. There’s a tremendous need to decrease health care costs in this country, and we, as emergency physicians, have a better understanding of where some of that excess cost exists. Most people don’t have end-of-life care orders. This is partly because up until two years ago, physicians in the United States were not reimbursed for conducting advanced care planning discussions. That’s changing, but slowly. I think it would behoove us, and our membership, to accelerate the adoption of conducting those important conversations while patients are still in a position to do so. This is an area that I’d like to work on.

I also want to continue to work on physician wellness, not just around resiliency, but to work on the environmental causes that lead to burnout. I think our BalancED conference was a really good start, and I hope we’ll be able to continue that effort in the coming years.

KK: Those are all wonderful goals. If anyone can accomplish that much in the second half of a presidential term, it’s Vidor Friedman. Thanks for the time, Vidor, and thank you for your service and excellent leadership.