The Council considered a resolution on family and medical leave and adopted it in part. The resolution was submitted by Megan Dougherty, MD, FACEP; Sarah Hoper, MD, JD, FACEP; the Iowa Chapter; the Vermont Chapter; and the American Association of Women Emergency Physicians Section.
The resolution called for ACEP to support the AMA’s effort to study the effects of Family Medical Leave Act expansion; conduct an environmental survey and create a paper on best practices regarding maternity, paternity, and family leave for emergency physicians; and issue a new statement in support of paid family leave. The first resolved was adopted, and the third was referred to the Board of Directors.
Resolution 47 notes that the United States is one of six United Nations member states that does not have a federal policy mandating paid maternity leave.4 ACEP’s current Family and Medical Leave statement, which was revised in 2019, does not specifically support paid family leave but encourages employers to “ take into consideration what can be done to support the individual financially” by offering at least 12 weeks’ leave for child birth or adoption, four weeks’ leave for a co-parent in child birth or adoption, and flexible work schedules for both parents before and after a new child.5
“I have friends who do not work in medicine, and when I told them you can be a doctor, work in a hospital, and not have paid maternity leave, they thought that was insane,” said Hilary Fairbrother, MD, MPH, FACEP, an emergency physician in Houston who was not involved in the Council resolution.
Dr. Fairbrother was six months pregnant when she accepted a new job in 2017. The three months she took off from work after delivery were mostly unpaid because she hadn’t accrued vacation or sick time that she could apply to her leave. Dr. Fairbrother also only partially qualified for short-term disability because her insurer considered her pregnancy to be a preexisting condition.
With her second child, Dr. Fairbrother was able to use accrued vacation and sick leave and apply for short-term disability, “which contributed to a different fiscal reality,” she explained. Dr. Fairbrother had established childcare to take care of her 2-month-old when she went back to work. She especially appreciated being able to do telemedicine and administrative work from home during the third month after giving birth, which helped her establish breastfeeding.
She said she supports a federal paid leave policy, but that employers should address the issue in the absence of a national policy. “In consulting, if you want diversity, if you want to attract and hire women, you need to offer paid maternity leave plus flexibility for when they transition back to work,” said Dr. Fairbrother. “We should advocate for the same standard in emergency medicine.”
Resolution 71: Emergency Medicine Workforce by Non-Physician Practitioners
The Council did not adopt Resolution 71, which was submitted by the Emergency Medicine Workforce Section. It called for ACEP to support the elimination of non-physician health care professionals in emergency departments except in cases where there aren’t enough emergency physicians to properly staff the facility.
The resolution notes the ACEP workforce study’s prediction that there will be an oversupply of board-certified emergency physicians by 2030.6 Nurse practitioners and physician assistants are currently supplying about 20 percent of emergency care across the United States, according to the study.
Workforce projections from the ACEP report are not reliable because they are based on extrapolated data from a few years ago, according to Jesse Pines, MD, MBA, FACEP, who is the national director of clinical innovation for the physician contracting company US Acute Care Solutions. They also do not include innovative models in emergency medicine beyond what was happening in brick-and-mortar emergency departments. “Telehealth, for example, is a growing field that needs more emergency medicine physicians,” said Dr. Pines, who is professor of emergency medicine at Drexel University College of Medicine and has conducted research on ED staffing.7
“What we can conclude from that report is there is probably not going to be an undersupply of emergency physicians [in the United States] by 2030. Much like today, there could continue to be an undersupply in rural areas and smaller emergency departments,” explained Dr. Pines.
Sudave D. Mendiratta, MD, FACEP, chair of emergency medicine at University of Tennessee College of Medicine, said current reimbursement models will ensure that advanced practice professionals are here to stay. “The question we should be asking is how we can ensure they have the appropriate scope of practice and support,” he explains.
Dr. Mendiratta, who is also the President of the Tennessee Chapter of ACEP, explained how emergency physicians, nurse practitioners, and physician assistants must collaborate in the face of nursing shortages.
Dr. Pines agreed. “A collaborative model, with oversight of advanced practice providers by emergency physicians, has been shown to deliver similar care than an emergency physician–only model.” The important things, he added, are that health care professionals follow clinical guidelines and that there are mechanisms to catch any clinical mistakes and to engage in continuous quality improvement.
Stephanie Cajigal is a medical journalist based in Los Angeles,
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