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 four members to the ACEP Board of Directors when it meets in October, along with a new President-Elect, Council Speaker and Council Vice Speaker. 

Last month, we learned about the emergency physicians running for the Board. This month, let’s meet the candidates for President-Elect, Council Speaker, and Council Vice Speaker. 

President-Elect

The candidates for ACEP President-Elect responded to this prompt:

What new thoughts do you have in balancing board certified emergency physician

workforce distribution gaps and safe scope of practice for non-physicians?

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

Advances often come through focusing on executing fundamental actions particularly well. Coach John Wooden was famous for focusing on the fundamentals, sometimes called “little things.” When those same fundamentals done right achieve great success, they aren’t little at all. How does that apply to the role of the board certified emergency physician? Fundamentally, I believe every patient coming to an emergency department is best served by care delivered by board certified emergency physicians. Period.

So, to that end, I don’t believe there is a “balance” when it comes to board certified emergency physician anything and scope of practice for non-physicians anything. If that sounds distinctly definitive, then point purposefully made.

Does this lack of balance I promote equate to no role(s) for non-physicians in an emergency department? Considering I’ve worked with numerous physician assistants and nurse practitioners in emergency departments over my 25 years post-residency, you may correctly surmise I have found successful inclusion, which by my definition “successful” includes safety for all involved, of physician assistants and/or nurse practitioners on a physician-led team in an emergency department. Did I bold type “physician-led” in that last sentence? Good. Another point purposefully made.

As your national ACEP liaison to the American Academy of Emergency Nurse Practitioners (AAENP), I have the incredible honor, privilege, and responsibility to be your “voice” during AAENP Board of Director meetings. I assure you that I speak for you clearly, respectfully, responsibly, and always in a manner that promotes, first and foremost, the principle that board certified emergency physicians must be the leaders of care in any emergency department.

Today’s reality is many rural emergency departments are staffed solely by physician assistants and/or nurse practitioners. On functionally useless in real time to patient care on-call rosters, these same physician assistants and/or nurse practitioners may be “backed up” by physicians. Often these “backups” are located 20-30 minutes from being physically present when called to assist patient care at the bedside. Factoring such, an order to transfer the patient immediately by ground or air EMS is the only actual support per se these non-physicians receive. I believe that’s an untenable risk to everyone involved, particularly the patient expecting safe, clinically accurate emergency care.

Our Indiana ACEP colleagues have helped us all as emergency physicians in championing the passage of state legislation mandating a physician leading a hospital’s emergency department to be physically present in that hospital. While that law today does not specify that physician must be a board certified emergency physician, we can readily understand that to be the next step of progress in a future legislative bill that builds upon today’s advance in care. This is an important opportunity for board certified emergency physicians to secure those positions today, impressing upon hospital administrations the essential benefits to the patients, the medical staff, and the hospital itself uniquely enabled by board certified emergency physicians.

In select situations, technology may provide opportunities in the interim until similar laws can be promulgated nationwide. Colleagues at the University of Mississippi Medical Center have developed a robust telehealth network with over 25 critical access hospitals in that state. Physician assistants and/or nurse practitioners receive real-time telehealth consults from residency faculty, board certified emergency physicians in Jackson. The volume over time has allowed for full-time faculty shifts focused on telehealth consults. Today, not in spirit, but in true impact, care is increasingly emergency physician led in these networked emergency departments. We must always work against a balance. The weighting must strongly be on patient safety and on expanding the opportunities for board certified emergency physicians. ACEP advocacy, both nationally and increasingly through state chapter support, is more important than ever in achieving these goals.

Alison J. Haddock, MD, FACEP

Current Professional Positions: Assistant professor of emergency medicine, director of health policy: advocacy, assistant director of faculty development, department of emergency medicine, Baylor College of Medicine, Houston

Internships and Residency: Emergency medicine residency, University of Michigan, Ann Arbor

Medical Degree: MD, Cornell Medical College (2007)

Response

No patient should be seen in an emergency department (ED) without the involvement of a residency-trained, board-certified (or board-eligible) emergency physician (EP). ACEP defines this as the gold standard in emergency care. However, we cannot forget that rural areas face significant shortages of emergency physicians. Despite the growth we have seen in residency programs, we are not seeing more emergency physicians working in remote EDs. Recent data published in Annals showed that between 2013 and 2019, the percentage of clinicians working in rural areas who were emergency physicians actually dropped slightly. 

It is critical for our specialty to work on our rural pipeline. This means supporting efforts to recruit college students from rural areas in their pre-med years and support their transition into medical school, then continuing to expose medical students to the experience of rural medicine during their clerkship years. If we wait until residency for trainees from urban areas with only urban experiences to get firsthand experience in a rural setting, it may be too late to persuade them of the value of a rural career. This limitation does not mean that rural rotations should not be supported. Rural rotations for emergency medicine residents need to be prioritized and made much more accessible. Trainees should be incentivized to participate in these rotations with optimized scheduling, supported housing, and an additional stipend to cover the expense of being away from home. We must work to reduce structural and accreditation barriers to the availability of these rotations through enhanced collaboration with the ACGME, CORD and program directors, rural EPs and rural hospitals. Practicing in a rural area can be deeply rewarding with opportunities to spend more time at the bedside and develop deeper relationships with a smaller cadre of ED staff. The more positive experiences we can create for trainees within rural practices, the more EPs we can attract to these areas. 

As the problem of strengthening the rural pipeline cannot be solved overnight, in the interim, we will continue to see some nurse practitioners and physician assistants developing careers in rural emergency departments. Evidence shows that their presence has been increasing in rural EDs, and ACEP’s own Rural Task Force identified in 2020 that some rural EDs may not have sufficient volume to support dedicated ED physician staffing. However, both the Rural Task Force (2020) and the Telehealth Task Force (2021) agreed that telehealth supervision of NPs and PAs in rural practice environments by board-certified emergency physicians is a viable model for improving patient safety and extending the reach of the BC EP through the use of a physician-led team. A “hub and spoke” model allows a centrally located board-certified EP to collaboratively supervise NPs and PAs in multiple hospitals simultaneously. Continuous improvements in technology and broadband capability mean that this kind of supervision will become easier every year and can allow true team-based care even without an emergency physician physically present at the bedside. To optimize this kind of care, we must ensure that our trainees are learning the skills they will need to be effective in this role, including strategies for effectively supervising NPs and PAs and how to effectively use telehealth technologies to evaluate patients, from building rapport to performing video physical exams. 

Finally, in order to incentivize emergency physicians to practice in rural areas where patient volumes may be lower, we must seek out ways to compensate them for the hours they put in standing at the ready for critically ill patients to arrive. We do not fund rural fire departments solely based on the number of fires they respond to per year, and we should not pay rural emergency physicians based solely on the number of patients they see. A rural ED staffed by a well-trained EP is an essential resource in small communities that may be otherwise lacking in readily available healthcare resources. Both rural EDs and rural EPs should receive compensation reflecting the critical nature of that resource. All EPs are currently experiencing the pain of our current boarding crisis, and the lack of sufficient funding of our safety net and surge capacity is a contributor to that crisis. We cannot continue to make that mistake in rural America, where our neighbors deserve the same access to high-quality emergency physicians delivered in urban areas.

Ryan A. Stanton, MD, FACEP

Current Professional Positions: Emergency physician, Central Emergency Physicians, Lexington, Kentucky; medical director, Lexington Fire/EMS; medical director, AMR/NASCAR Safety Team; public safety medical director, Blue Grass Airport, Lexington; Kentucky and Florida medical director, AirMed International

Internships and Residency: Surgery internship, James H. Quillen College of Medicine, Johnson City, Tennessee; emergency medicine residency, University of Kentucky

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

Response

The workforce study shook the foundation of emergency medicine (EM). After decades of assumptions that we would “never fill all the seats,” we have been faced with the threat of an overabundance of emergency physicians which has led to some of the downstream impacts, including the match struggles. What is even more clear is that we continue to have a significant distribution issue within EM with abundance pushing down larger markets while rural and critical access setting still struggle to fill shifts. More recent data has demonstrated that the initial study significantly underestimated physician career longevity and attrition (which is an issue in itself), but it has provided an opportunity to address challenges that were known and unknown. The workforce efforts must continue with opportunities to guardrail residency growth, raise the bar on the skillsets of emergency physicians, and ensure we continue to recruit the best and brightest to this wonderful specialty. One of the major areas of focus must be on the distribution of emergency physicians with opportunities within residency to have substantive rural and critical access experience. This also means advocating for incentives that can assist attracting physicians of all career stages to rural and critical access settings. 

I have long felt that every emergency patient deserves access to an emergency physician. Non-physician practitioners have played an important role in the U.S. health care system, but ongoing efforts for expanded scope of practice and independence is not in the best interest of our patients. I absolutely believe in the physician led team. Within my own PDG, I continue to push towards more physician coverage with selective NPP coverage where appropriate. I believe the best care is provided by an emergency physician—period. If we truly are experiencing saturation of available emergency jobs, then we need to see growing access to emergency physicians in all environments of emergency medicine. 

Three take home points for what I believe. 

There is no substitution for the physician led team. Every patient in a U.S. emergency department deserves access to an emergency physician no matter their zip code.

At no point should a physician role be replaced by a NPP for any reason, but especially as a perceived profit/control strategy. 

ACEP must continue to fight expanded scope of practice or independent practice on the state and federal level. Independent practice is the privilege earned with having a MD or DO after your name. 

The workforce dilemma is a challenge we will face for years to come. I am proud that ACEP has been willing to tackle tough questions and work towards realistic solutions in the promotion of EM and our physicians. 

Council officer Candidates

The candidates for ACEP Council Speaker and Vice Speaker responded to this prompt:

How would you navigate through the challenges that may arise when the Council and the Board of Directors

do not share the same view on an issue?

Council Speaker Candidate

Melissa W. Costello, MD, FACEP

Current Professional Positions: Staff emergency physician, Baldwin Emergency Group, PC, Mobile Infirmary Medical Center, Mobile, Alabama; staff emergency physician, Emergency Room Group, LLC, Singing River Hospital System, Pascagoula, Mississippi; staff emergency physician, Envision Healthcare, Ascension Sacred Heart Hospital, Nine Mile Free Standing ED, Pensacola, Florida; clinical appeals consultant/utilization review, AirMethods Corporation, Denver, Colorado; EMS medical director for Mobile Fire & Rescue and Urban Search and Rescue, Federal Bureau of Investigation Mobile Division SWAT Medical, Baptist LifeFlight/Alabama Lifesaver/AirMethods, and Mobile Police Department and Police Surgeon; medical officer, Trauma Critical Care Team–South, U.S. Department of Health and Human Services

Internships and Residency: Emergency medicine residency, Johns Hopkins University School of Medicine, Baltimore

Medical Degree: MD, University of Alabama School of Medicine (2000)

Response

The work to avoid serious discord at the Board-level starts long before the resolutions come from Council to the Board for approval. Participation in resolution writing workshops and mentorship of resolution authors is the responsibility of all members of the Council, but it is particularly important for the Council officers. Getting solid ideas with sound language in front of the Council on the first try will significantly “grease the skids” towards making new policy.  Writing and editing the background material in order to help frame the debate and allowing asynchronous testimony to hash out the arguments ahead of time all help us arrive at our annual Council meeting at “first-and-goal” rather than “fair-catch at the 50,” or (to further torture this analogy) it is like arriving at Council as an SEC football team rather than ____ (fill in your team here)____.  [cough—Roll Tide—cough].  Building friendships and relationships over the long term is also critical so that coalition-building around any issue begins long before the gavel taps to open debate at the Council meeting or at the Board. 

The biggest challenge when the Council and the Board have different views is the same as in any organization: how to “disagree without being disagreeable.” After many years of Council meetings, it is not hard to predict which issues will be contentious on the floor and contentious in the Board meetings. The beauty of our parliamentary process is that we do not close debate until both sides have been heard on an issue.  This allows the Speaker and Vice-Speaker to prepare solid arguments in favor of the Council’s position and be well prepared to refute opposition from the Board members who try to alter the intent of a resolution passed by Council. Ultimately, it is about maintaining respect and decorum so that common ground can be found and the group can arrive at a constructive solution that contributes to the success of ACEP as a whole. 

Council Vice Speaker Candidates

Kurtis A. Mayz JD, MD, MBA, FACEP

Current Professional Positions: Chairman of pediatric emergency medicine and medical director of the Pediatric Emergency Center, Saint Francis Hospital, Tulsa, Oklahoma; attending physician, Heart of Mary Hospital, Urbana, Illinois

Internships and Residency: Emergency medicine residency, Stony Brook University Medical Center, Stony Brook, New York

Medical Degree: MD, University of Illinois, Champaign-Urbana (2011)

Response

The Vice Speaker and Speaker are the advocates in chief for the Council to the Board. My primary responsibility as Vice Speaker is to ensure that your voice is heard and the goals of the Council are achieved. When there are differing views I will use my skill as an attorney and registered parliamentarian to anticipate the challenges, collaborate with the Board, engage relevant parties, and propose alternative solutions.

As Vice Speaker, when conflict arises it is important that I clearly understand the intent and will of the Council. That work begins with careful study of the resolutions prior to and after council and thoughtful consideration and understanding of the testimony provided at Council. With the Council’s clear intent in mind, I can then anticipate the conflict and determine whether it is based on the position or viewpoint expressed or the underlying interest and intent of the Council. I will then advocate for positions that represent the underlying interests of the Council in a way that best represents the intent of the Council while addressing the concerns of the Board.

Just as the Council floor can be a challenging place to work out the finer details of a resolution, the boardroom too can be a difficult place to resolve conflict. Fostering relationships with individual board members and having personalized discussions regarding their concerns in advance, can help get to the heart of the underlying reasons, motivations, or values driving the disagreement. As Vice Speaker, I will work to anticipate specific conflicts, engage board members early in the process of discussing our differences, and collaborate to find solutions that satisfy the intent of the Council and allay the concerns of the Board.

As an advocate for the Council, I will also look to you, the Council membership for your expertise and opinions. I will use the engagED forum to disseminate information regarding Board discussions and concerns and use it as a place for councillors to bring up concerns, discussion points and proposed solutions. I recognize that to be your voice I also need to hear your voice throughout the process and not just on the Council floor.

If the Board makes a decision that does not reflect the will of the Council I will bring that decision back to you with detailed information regarding the Board’s decision including the positions and votes of individual Board members. I will then work with Council members to propose additional resolutions and alternative solutions to help resolve the disagreements in favor of the will of the Council.

As Vice Speaker I will listen as effectively as I speak, guide as effectively as I lead, and encourage as effectively as I advocate.  

Ultimately I will work to foster a spirit of collaboration and engage with the Board in ways which will allow the collective wisdom of College leadership to emerge in a way that meets our unified purpose, a strong College which represents all of its members well and ensures that your voice is heard.

Michael J. McCrea, MD, FACEP

Current Professional Positions: Attending physician and core faculty, Mercy Emergency Care Services, Team Health, and Lucas County Emergency Physicians, Inc., Premier Physician Services, Toledo, Ohio 

Internships and Residency: Emergency medicine residency, The Ohio State University Medical Center, Columbus

Medical Degree: MD, Medical College of Ohio at Toledo (2004)

Response

The Council Officers actively participate in ACEP Board Meetings to ensure that the Council’s will and voice is represented. Similarly, the Board attends and listens to Council debate to understand each resolutions’ intent along with the tenor of discussion so they can understand the impetus behind each Council action.  In the rare instance the Board would propose an action contrary to Council’s will, the Council Officers are the crucial link between the Board and the Council to assure ACEP keeps members’ interests at the core.  While not burdened with a vote, the Council Officers can devote their time fostering debate and building consensus that considers Councils’ directives.

The most likely scenario in which the Board would differ from Council would be on a controversial issue, especially a late breaking issue after the resolution deadline. We saw this just this past year during the rapidly changing landscape around reproductive health with its potential profound effect on both our members and our patients.  Our Council Officers ensured that the original intent and will of the Council was maintained while the Board amended the original resolution adopted by Council.

When it comes to maintaining our principles and building consensus around a time critical issue that impacts our members, I have proven expertise. I acted as our council officers did when I was serving as Ohio Chapter president.  In our state a residency program was thrown into turmoil when a contract group was abruptly changed. Over several days I actively listened to our members and gathered information to inform our Board how we could best help our members, especially the program’s residents. In the end, we were able to facilitate placement for many of the program residents to stay in Ohio and provide employment guidance for numerous faculty. Additionally, I helped arrange free access for the residents to the Chapter’s educational materials during the unexpected transition. Through this difficult time, I made sure all sides were heard to help build consensus within our Board while continuing to serve our members’ interests.

From this experience, I demonstrated the leadership skills to facilitate dialogue and navigate debate when viewpoints diverge. Combined with my experience on the Council Steering Committee and having served as Chair of Reference Committee and the College Bylaws Committee, I have the proven experience to represent the Council as your voice at Board meetings. If and when differences arise, I have the expertise to bring all sides together while adhering to our governing principles. As your council officer, I commit to ensuring your voice contributes to the best outcome for our College, our members, EM residents, and our patients.

Larisa M. Traill, MD, FACEP

Current Professional Positions: Attending physician and Director of Compliance, Quality, and Safety

Greater Midland Emergency Physicians (GMEP), MyMichigan Health/University of Michigan Health

Internships and Residency: Emergency medicine residency, Sinai-Grace Hospital Wayne State University/Detroit Medical Center

Medical Degree: MD, St. George’s University School of Medicine

Response

A Council Officer must possess substantial experience in moderating debate; I possess the skills necessary including the diplomatic talent and emotional and social intelligence, to not only negotiate interpersonal conflicts, but also to encourage a spirit of collaboration essential for the achievement of our shared goals. Anyone, who has successfully, and affably, chaired such excitements as Reference Committee A, as I have, has proven to be capable of advocating for all manner of issues, ranging from the esoteric to the straightforward. Moreover, there may be resolutions for which a novel or innovative way to present the background information might help to better inform the Council’s discussion (e.g., tables, graphics, hyperlinks, etc.). Greater clarity might minimize either anticipated or unexpected challenges on the Council floor.

The Council’s efficiency is paramount to navigating the challenges that may result from differing opinions. I will ensure that all opposing voices are heard, and I will also solicit opinions or considerations that may not have been previously expressed. I believe that with informed discussion, the Council would have the ability to reach a consensus, enabling it to cast a majority vote decision without having to repeatedly refer issues to the Board. The expertise of the Board should be primarily reserved for issues related to the strategic mission of the College, issues which require executive level insight and deliberations. I would also offer a friendly reminder to the Council Officers and the Board of their deliberative and strategic responsibilities to the College. Just as physicians have a fiduciary obligation to act in good faith and loyalty, not allowing their personal interests to conflict with their professional duty, so must the elected bodies of the College act in it its best interests and attempt to reach consensus whenever possible. I am invested in exploring innovative approaches to optimize the potential of the Council. We must all strive for clarity of purpose in the pursuit of growth, change, and development: I am committed to this agenda.  

Our Council should function not in rivalry with other organizations, not imitating others, but serving as an example to them, whether or not we all share the same views; such should be the Council in the hands of the many, not the few.  

“Our form of government does not enter into rivalry with the institutions of others. Our government does not copy our neighbors’ but is an example to them. It is true that we are called a democracy, for the administration is in the hands of the many and not of the few.” —Pericles Athenian General and Statesman. 