Each year, ACEP’s Council elects new leaders for the College at its meeting. The Council, which represents all 53 chapters, 40 sections of membership, the Association of Academic Chairs of Emergency Medicine, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents’ Association, and the Society for Academic Emergency Medicine, will elect the College’s President-Elect and four members to the ACEP Board of Directors when it meets in late September. Let’s meet the candidates.

President-Elect

The President-Elect candidate—running unopposed—responded to this prompt:

What do you believe is the single most divisive issue in emergency medicine at this time and how would you address it?

Aisha T. Terry, MD, MPH, FACEP

Current Professional Positions: associate professor, emergency medicine and health policy, and senior advisor, emergency medicine health policy fellowship, George Washington University School of Medicine and Health Sciences, Washington, D.C.

Internships and Residency: emergency medicine residency, University of Maryland Medical System department of emergency medicine, Baltimore

Medical Degree: MD, University of North Carolina School of Medicine, Chapel Hill (2003); MPH, Columbia University Mailman School of Public Health (2011)

Response

“The world is getting too small for both an Us and a Them. Us and Them have become co-dependent, intertwined, fixed to one another. We have no separate fates, but are bound together in one.” —Sam Killermann

Divisive issues—those that tend to foster disagreement and even hostility—create the illusion of there being an “us” and a “them.” This illusion creates a sense of competition wherein there must be a winner and a loser, allowing little to no space for listening and compromise. Time and time again, divisiveness has resulted in stress, anxiety, and damaged relationships. As we continue to weather the far-reaching impacts of the pandemic and find ourselves coping with unprecedented amounts of burnout, it is especially important that divisiveness be stamped out as it only further depletes our energy and hope for a brighter future.

Most acknowledge that divisiveness is a problem and would appreciate a path forward. In fact, the Public Agenda/USA Today Hidden Common Ground survey from Feb. 2021 found powerful consensus across political affiliations that our country needs to move beyond the destructive nature of political divisiveness. It also found that most think that there is more common ground amongst the public than is typically acknowledged, but that disagreements tend to be handled destructively rather than constructively.

Whether the issue is firearm violence or the role of private equity in health care, we know that our specialty will continue to grapple with really tough topics. Divisive issues are typically related to ethics and personal choice, which foster strong opinions as well as proposed solutions that tend to be polarized and inflexible. Rather than focus on the issue, we must determine how to minimize the destructive potential of the divisiveness. An issue does not in and of itself create division; rather, our approach and accompanying emotions involved with resolving the issue determine the degree of vitriol felt. In the words of Eckhart Tolle, “rather than being [our] thoughts and emotions, [we must] bethe awareness behind them.”

As a two-term ACEP Board of Directors member, I marvel at how well my fellow Board colleagues struggle with and come to important decisions on challenging issues. We are diverse, having representation from various geographic locations, political ideologies, and demographic backgrounds, yet we spend hours having cordial and honest discussions about a myriad of complex and controversial topics; we listen to each other and respect each other’s perspectives. Perhaps most importantly, we are influenceable. We realize that there are several ways to reach an end goal, and that one must be open to exploring them all, while factoring in key elements like unintended consequences, justice, timing, and practicality.

Having led health policy efforts as an associate professor and advocate in our nation’s capital for over a decade, I understand the necessity, yet challenge of achieving bipartisan wins. The divisive issues in Washington, D.C. are many, but the skilled policymaker and advocate focuses on discovering and exposing commonalities on both sides of the aisle. The best bills are those that are bipartisan and have a Senate and House version; this approach tends to be most efficient relative to energy and often successful.

As we seek to mitigate the effects of divisiveness, being mindful of our emotions, listening, being influenceable, and intently seeking to discover and expose commonality are examples of strategies to employ.

Board of Directors

The candidates for ACEP’s Board of Directors responded to this prompt:

Considering ACEP’s strategic plan, what do you consider to be the top two issues and how should they be addressed?

William B. Felegi, DO, FACEP

Current Professional Positions: medical director, Van Buren County Hospital emergency department and Van Buren County Hospital ambulance, Keosauqua, Iowa; EMS medical director, Farmington Ambulance; medical director, Atlantic Health, Morristown Medical Center, Travel MD, Corporate Health

Internships and Residency: emergency medicine residency, Morristown Memorial Hospital, Morristown, New Jersey

Medical Degree: DO, University of New England College of Osteopathic Medicine, Biddeford, Maine (1989)

Response

Career Fulfillment: Tackling tough issues head-on and working with you to tackle frustrations that get in the way of career satisfaction. Unless we have satisfied members, our membership will dwindle or other organizations may be more appealing to our membership, including possible unionization. It is imperative that the College continue to recognize that in order to fulfill our important responsibilities in caring for this nation’s emergency needs, we must ensure that every emergency physician has a safe and secure working environment, adequate resources to perform our vital role, and fair compensation. ACEP needs to maintain its integrity with membership. A long time ago, I learned at an ACEP leadership event that integrity was doing the right thing at the right time for the right reasons. We need to base our priorities, interest, and messaging on strengthening our integrity for members. Our college needs satisfied members, and physician satisfaction starts in the workplace regardless of location (urban, suburban, rural) and regardless of the physician model (independent contractor, locums, hospital—community or academic, contract management group owned by a democratic group, publically traded company, or private equity firm). No one else in America has been given the privilege of dealing and caring for the sickest and most critically injured. Yet, we work in a dangerous and complex environment. The college needs courage in addressing inequities and advocate for an emergency physician “Bill of Rights.”

Practice & Innovation: Revolutionizing acute, unscheduled care, developing new career opportunities, and taking the lead in reshaping the emergency medicine workforce landscape. The latter is a clear top issue. It is important to demonstrate that residency trained physicians are the most preferred clinicians based on education, training, and procedural skills. We need to demonstrate that the quality of care and outcomes are the highest when patients are treated by an emergency physician.

Jeffrey M. Goodloe, MD, FACEP

Current Professional Positions: attending emergency physician, Hillcrest Medical Center Emergency Center, Tulsa, Oklahoma; professor of emergency medicine, EMS section chief, and director, Oklahoma Center for Prehospital & Disaster Medicine, University of Oklahoma School of Community Medicine, Tulsa; chief medical officer, medical control board, EMS System for Metropolitan Oklahoma City & Tulsa; medical director, Oklahoma Highway Patrol; medical director, Tulsa Community College EMS Education Programs

Internships and Residency: emergency medicine residency, Methodist Hospital of Indiana/Indiana University School of Medicine, Indianapolis; EMS fellowship, University of Texas Southwestern Medical Center, Dallas

Medical Degree: MD, Medical School at University of Texas Health Science Center at San Antonio (1995)

Response

Career Fulfillment and Member Engagement. Even a cursory review at acep.org/strategicplan will show my bias about career fulfillment. You’ll find on reviewing the many leaders, members, and staff involved (over 100!) that I’m incredibly privileged to co-lead the Career Fulfillment team with David McKenzie, CAE, ACEP’s incredible reimbursement director. Now, you might jump to the conclusion that we believe all career fulfillment is found through money, money, and more money. No. Does money matter to emergency physicians? Well, sure, just as it matters to non-emergency physicians, too! Just ask our neighbors, friends, and patients. Money is only part of the equation. We all want to feel valued and respected in non-monetary ways, too. Due process, safe work environments, clinical and administrative opportunities at hospital and health care systems, ACEP state chapter, and national ACEP levels can enhance our emergency medicine careers. I’m concerned about the dynamics of a U.S. health care system that can exploit our dedication and commitment to patients, which reach far beyond the regulatory demands of EMTALA.

How do we improve career fulfillment? Many ways, including success in workforce and scope of practice dynamics through a strong, vibrant ACEP. We listen to one another, seek areas of common ground over the challenges and limits to advancing our careers, then equally invest in “best practices” among our members, helping to share local successes so they disseminate throughout our members’ practices.

When we do this, genuinely promoting our members, creating opportunities to highlight their insights, experiences, and talents, we create increasingly accessible resources available through ACEP. These solutions can be internet-accessible—creating guides, educational forums, and point-of-care apps. We can create stronger peer networks, virtual and in-person events. As ACEP becomes more tangible in helping emergency physicians in the workplace, in personal development, and in wellness to name just few key areas of importance, this tangibility advances member engagement and loyalty—leading to a bigger,stronger, more creative ACEP. This isn’t a “zero sum” equation whereby one emergency physician’s advance must come at another emergency physician’s loss. Our unity on career enhancements in emergency medicine serves to strengthen us all.

Gabor D. Kelen, MD, FRCP(C), FACEP

Current Professional Positions: chair, department of emergency medicine, Johns Hopkins University, Baltimore; physician-in-chief, emergency medicine, Johns Hopkins Medicine; director, Johns Hopkins Office of Critical Event Preparedness and Response; principal staff, Applied Physics Laboratory, Johns Hopkins University; professor of emergency medicine, anesthesiology, and critical care medicine, Johns Hopkins University School of Medicine

Internships and Residency: internship, University of Toronto, St. Michael’s Hospital; residency, University of Toronto, St. Michael’s Hospital; emergency medicine residency, Johns Hopkins Hospital

Medical Degree: MD, University of Toronto (1979)

Response

The newly developed ACEP strategic plan has five pillars and 23 imperatives. Each of these imperatives is of top-line importance. All of them need to be addressed.

Inherent in the essentials of the strategic plan is the underlying drive to proactively address and promote the dignity of the emergency physician in all deliberations, and the nobility inherent in emergency practice. Our many threats—feeling like cogs in a system, CMG and sense of autonomy loss, encroachment of scope of practice, fair remuneration, fair treatment, due process, and violence in the workplace, diminish our sense of self and our specialty. Upholding and advancing the dignity of the emergency physician and respect for our practice must be the unwavering compelling force in addressing the key priorities and all activities of the College.

Jeffrey F. Linzer Sr., MD, FACEP

Current Professional Positions: professor of pediatrics and emergency medicine, Emory University School of Medicine; medical director for business affairs and compliance and EMS/pre-hospital care coordinator, Division of Pediatric Emergency Medicine, Emory + Children’s Pediatric Institute, Children’s Healthcare of Atlanta

Internships and Residency: pediatric residency, University of California, Irvine; allergy-clinical immunology fellowship, Children’s Hospital Los Angeles; pediatric emergency and transport medicine fellowship, Children’s Hospital Los Angeles

Medical Degree: MD, Centro de Estudios Universitarios Xochicalco, School of Medicine, Ensenada, Baja California, Mexico

Response

The College needs to help simplify and streamline our practice to eliminate nuance and pointless frustration in our practice to ensure practice sustainability and fair compensation. Specifically, addressing misuse of ICD diagnosis codes by payers to deny reimbursement. Payers need to be held accountable for their “proprietary” diagnosis lists that inappropriately downcode. EHR vendors must make their diagnosis calculators more physician friendly so that the proper terminology can be easily found.

The College needs to work with state and federal authorities and support state chapters in resolving these issues that can adversely affect patient care.

Are there too many resident programs? In 2020 there were 265 EM resident programs with 2,665 available positions. In this last match there were 277 programs offering 2,921 positions. This represents an increase of 4.5 percent in the number of EM residencies but an almost 10 percent increase in the number of positions.

The report coming from the ED Accreditation Task Force will help provide direction for the College to meet its workplace strategic goal. We also need to work with our partner groups to help ensure that residencies are not just being developed as a source of inexpensive labor, but that they are providing high quality training preparing their trainees to provide care in a range of environments. We must take care that the expansion of programs does not risk dilution in the quality of training. While, through supply and demand, there is a potential that their influx could drive down reimbursement in competitive markets, this could be countered by ACEP supporting programs that could help reduce graduate medical school debt.

Kristin Bond McCabe-Kline, MD, FACEP

Current Professional Positions: vice president/chief medical information officer, AdventHealth Central Florida Division; EMS medical director, Flagler County/City of Palm Coast/City of Flagler Beach; chief medical officer, WaterSafe, medical director, Flagler Technical College EMT Training Program; medical director, AllCare Medical Transport

Internships and Residency: residency, Advocate Christ Medical Center (IL)

Medical Degree: MD, University of Texas Medical School, San Antonio

Response

The ACEP strategic plan is key to serving our members and specialty. Rather than selecting two issues, I prefer to distill the strategic plan into two top priorities to be addressed: 1) the future of emergency medicine and 2) the culture of emergency medicine.

Globally, emergency physicians transformed emergency departments into front doors of hospitals and key access points throughout the community via free standing sites. Granularly, emergency physicians leveraged ultrasound equipment utilized by others to provide patients with immediate results while under our constant bedside care. Innovation is essential to the future of emergency medicine. As emergency physicians, we are well positioned to identify gaps in care where the system has failed our patients, embrace opportunities to meet their needs, and reimagine the delivery of our unique skillset in service to patients.

The compensation of care and measurement of quality are critical to our specialty, making advocacy essential to the future of emergency medicine. ACEP must be at the table, leading discussions around reimbursement models, speaking to the value of the care we provide, and developing metrics that support evidence-based practices translating to the best outcomes for our patients. Advocacy on behalf of our members is key to preserving our reputation as fierce patient advocates.

As emergency physicians, we are subjected to the harshest of circumstances and held to the highest of standards, which can undermine even the most resilient emergency physicians. While providing individual resources for emergency physicians to foster wellness, ACEP must step up to provide solutions for system-level issues that undermine the positive mindset, physical health, and connectivity to others necessary for emergency physicians to thrive. Career fulfillment where emergency physicians feeling appreciated, free to explore a variety of career options, and fully supported when things are less than ideal, is essential to maintaining a healthy culture of emergency medicine. Providing opportunities for career fulfillment should highlight diversity as ACEP has members with a variety of interests, pursuits, backgrounds, and practice environments.

Engagement and trust highlights the value of every individual member of ACEP, milestones of our careers, and opportunities for growth and mentorship as part of a greater community of emergency physicians. When we engage with one another in meaningful College activities, there is a level of mutual support that positions ACEP as a vital force for wellness for emergency physicians.

Both the future of emergency medicine and the culture of emergency medicine cannot be optimized without appropriate infrastructure; thus, resources and accountability are an essential component of addressing all other areas of the strategic plan.

The future of emergency medicine is bright with innovation and advocacy efforts that highlight the importance of the value and contribution of emergency physicians in service to our patients. The culture of emergency medicine is being restored as we learn to address systems level issues that affect us collectively and individually, care for ourselves and one another, and discover opportunities for growth on our journeys as emergency medicine physicians.

Henry Z. Pitzele, MD, FACEP

Current Professional Positions: attending physician, Jesse Brown VA Medical Center and Advocate Illinois Masonic Medical Center, Chicago; attending physician, Mesa View Regional Medical Center, Mesquite, Nevada

Internships and Residency: emergency medicine residency, University of Illinois at Chicago

Medical Degree: MD, University of Illinois at Chicago College of Medicine (2000)

Response

For me, the most important of the College’s missions has always been advocacy. Within the advocacy pillar of the strategic plan, several of the strategies resonate with me, specifically the plans to standardize advocacy strategies across the federal, state, and workplace levels. To that end, a few of us in the State Legislative/Regulatory Committee have begun a project which we think will help meet these goals—a dashboard of the most common legislative hurdles faced by all of us. Each ACEP member will (once we are up and running) be able to look at this dashboard and see how each state has handled the most common legislative issues (Medicaid, scope, unfunded mandates, etc.); if one of us has had a winning strategy, others won’t have to reinvent the wheel—they’ll be able to reach out to the stakeholders in the chapter that has done well and use some of those strategies themselves. We think that this will not only help us meet our legislative goals but will help unify the College when members see all of the work that is being done on their behalf.

Secondly, I want to highlight the final strut in the Advocacy pillar—that of creating awareness around the business of EM. I feel very strongly that the interests of the major EM corporations do not align with the interests of the frontline EP, and I want ACEP to be very clear, to one and all, that the mission of the College is to better the working lives of those frontline docs. I am quite proud of what the College has done already this year, not just the act of adopting the strategic plan to reaffirm our mission to support individual EPs, but on this particular objective of creating awareness of the interests of business. In one of the most important months of ACEP’s recent history, we filed an amicus brief supporting AAEM’s lawsuit about the corporate practice of medicine, the Board came out with a statement about private equity in EM, and we wrote a letter to the FTC/DOJ perfectly and succinctly summarizing how corporate interests are eroding the specialty and negatively affecting both docs and patients. I can’t really express what a Mjolnir-esque blow these three back-to-back events had–not just to EM as a specialty, but to me personally. They showed in the most public way, to our members, and to those watching outside that ACEP is here for us, not for an industry enriched by our blood and sweat. The College represents us. Now, do I feel like these three momentous events mean that our work on this issue is done? Absolutely not! It’s merely a starting point–and a very encouraging one–and it means that, if we continue in this vein, and keep making change, this College can and will be the unifying force through which together, emergency physicians can make the next phase of EM a place in which we truly look forward to working.

Ryan A. Stanton, MD, FACEP

Current Professional Positions: emergency physician, Central Emergency Physicians, Lexington, Kentucky; EMS medical director, Lexington-Fayette Urban County Government; medical director, AMR/NASCAR/SRX/RTI Safety Teams; medical director, Blue Grass Airport, Lexington;

Internships and Residency: surgery internship, James H. Quillen College of Medicine; emergency medicine residency, University of Kentucky

Medical Degree: MD, James H. Quillen College of Medicine (2003)

Response

The strategic plan is all about focusing on the emergency physician and our practice of emergency medicine. The two biggest challenges are uniting a profession in a time of great divide and protecting the profession from those that work to undermine emergency medicine, whether intentional or as a byproduct.

We clearly have seen growing divides in this country and more positions that land in the “my way or the highway” realm. We are at a place and time that ACEP leadership has received death threats and frequent calls to take firm stances one way or the other, often both. Our college is blessed with diversity in beliefs and passions. I still remember as a Kentucky councilor when the question was asked among ~500 emergency physicians in attendance their political leanings, and the vote was within a handful of 50/50. We need that diversity and those difference in viewpoints, but that also presents the challenge of being the leading voice in EM and how do we best represent our physicians and patients.

We must all double-down on listening more, being open to disagreement, and working towards a common ground that can help us move forward. We are all emergency physicians and that is the cornerstone of our work, advocacy, and opportunity. It is integral that we unite and fight as one voice with a diversity of opinions and viewpoints because we are under attack from many angles. Whether it is scope of practice, moral injury/burnout, entities putting profits over patients, insurance industry games, corporate influences, documentation bloat, or another unrealistic metric that provides no beneficial patient-oriented outcome.

The patient care part of EM is the easy part, but we are seeing ever increasing challenges and pressure from outside the treatment room. This is exactly why a strong unified voice through ACEP is integral. Individually, we are vulnerable; together, we are a force that can truly move the needle. The five pillars of the strategic plan are built on the foundation of the emergency physician and how we as the College best advocate, communicate, and provide the best return on investment regarding membership and a fulfilling career in EM.