Every year, ACEP Now interviews ACEP’s President. This year, Dr. Chris Kang, the first Asian American to hold the position, sat with our Medical Editor-in-Chief Cedric Dark, MD, MPH, FACEP, on Veteran’s Day to discuss important issues pertaining to the practice of emergency medicine.

Happy Veteran’s Day to you, sir.

Dr. Kang: Well, thank you very much. I appreciate the sentiment and appreciate obviously the service of all our members who have served honorably in the armed forces.

Maybe you could tell us a little bit about your day job at Madigan Army Medical Center.

Dr. Kang: [Madigan] was my last active-duty assignment, and afterwards, obviously, I fell in love with both the people as well as the mission. And when my service obligation was over, because of my love with the facilities, the people, as well as the residency program, they asked me to stay on as a civilian, and I’ve had the privilege of staying on there ever since.

Let’s get down to ACEP business now. How are you going to ensure that ACEP is making sure that emergency physicians retain their role as leaders in emergency departments around the country?

Dr. Kang: I think it’s remembering our primary mission and the reason for our organization is to represent emergency physicians. And I want to thank Dr. Schmitz (ACEP’s immediate past president) for her leadership over the past year. One of the things that I think has come out well from that is we have had interactions and communications with our colleagues, we’ve had discussions with employers as well as residency programs about where we think we are right now and where we need to go next.

One of the things that has come out of it is to make sure and continue to emphasize that emergency physicians are the leaders of the emergency care team, and I don’t think anyone disputes that. Where we start to get into a little trouble is different environments, different settings, and then different expectations from all of the professions. How can we make sure that we all have the same mission? If we remember that commonality, I believe that in time we can continue to make sure that emergency physicians continue to be the leaders, and, as a result, ensure a better quality of care for our patients and better career satisfaction for our members.

As candidate for President a few years ago, we asked about the emergency physician workforce. Now that you are the President, how will you ensure that business interests do not supersede patient care and that the needs of patients and emergency physicians take priority?

Dr. Kang: I think you’ve seen that manifested, both as what most of the candidates have said over the past several years, but also in the messaging that we’ve seen from the College. With recent events this past summer, the patient-physician relationship, that is, the relationship with our patients at the bedside always comes foremost. One of the things that we’ve heard from many members is concern that somewhere along the way, business interests, whether it’s on the individual, on the local, or on the macro level, may impede that relationship or interfere with it. The physician-patient relationship must continue to be sacrosanct.

Second, we need to have discussions when and where we believe that there is a direct impact on our ability to establish rapport, evaluate, treat, and disposition our patients at the bedside. That migrates into many other issues, whether it’s actual clinical decisions, business decisions, and staffing decisions. As long as we remember what our primary mission is as an organization and remember the patient physician relationship we’ll continue to mitigate those effects.

How do you plan on challenging the monopolization of health care services?

Dr. Kang: I think there are two reasons monopolization becomes a concern. One of them is we have seen consolidation in every aspect of health care as economies of scale, as people try to find better ways and sometimes cheaper ways of doing things. And we’ve seen that not just with employers, but also with entire health care systems, and even sometimes some of our physician groups. First and foremost, we must recognize those direct as well as potentially insidious effects of this trend.

The second one is vertical integration among a lot of health care organizations and, in particular, insurers. Although I’m still learning about it and talking with some of our experts, some insurers now actually serve as their own complete health care networks. How does that impact patient care but also our practices and our careers over time? And so I want to make sure that we continue to take a look at both of those, because they are among the challenges right now to the current well-being of our physician community as well as career satisfaction.

How do you think emergency medicine will transform itself over the next five to 10 years?

Dr. Kang: I wish I could give you a good answer, except I’m optimistic. As we’ve all known over the last three years, the COVID-19 pandemic has had profound influences, probably accelerated or revealed a lot of cracks in the health care system. And whether there will be fundamental changes demanded by the public, by legislators, or by the health care community, moving forward will be an interesting time. But if we all identify our commonality on what we do best and how we can better become the coordinators of all of acute unscheduled care, and then have better relationships with the coordinators of inpatient care, our hospitalists, I think that we can go ahead and say that we are going to be on the right trajectory for a better future for our specialty.

Second, emergency medicine must promote what we do best and then find new innovative ways of to deliver that care. Whether it’s telehealth, whether it’s improved team dynamics, whether it’s different employment models, I think that our members are always innovative, always seeking how they can deliver their care and exercise their skill sets better, and I’m optimistic that when you find those opportunities and support them, in the end, the cream will rise to the top.

You just mentioned team dynamics. What do you think is the best way that we can incorporate and also train physicians to work alongside emergency physicians in the emergency department?

Dr. Kang: First and foremost, we need to recognize and make sure that everybody agrees that we are the leaders, and with leadership comes responsibility. And that is, we can just say, “Well, they’re part of the team. How can we help others improve both their skill sets, but also make sure that they complement the overall team mission?”

Part of it is their education and training. Many programs do have some curricula that exposes and educates and affords the opportunity to have patient care and learn how to deliver patient care better in the emergency environment. But we also know that there are a lot of training programs that unfortunately don’t always have sufficient patient care, much less experience in the emergency care setting. If they’re going to function in the emergency department, like almost every other profession there, including our nursing colleagues, there is a special skill set that requires education, training, and onboarding to make sure that we can all deliver optimal emergency care.

Second, we need to be respectful for each other. We are going to have disagreements; but as long as we recognize the team dynamic and also respect each of the professions in that we all have the same mission, I believe most of our differences actually will fade away.

Last year, we did a special issue in May during Mental Health Month focusing on some issues as they pertain to emergency physicians. What do you want ACEP members to know about mental health?

Dr. Kang: I think it comes down to both our patients and ourselves. That’s why I’d like to advocate and prioritize mental health over this next year or maybe even two years. We know every day when you show up at work, mental health of our patients is a critical issue, not only in the volumes that we see, but sometimes the severity, whether it’s violence, despondency, or delirium.

Secondly, we are all impacted by the boarding of mental health patients when the entire system doesn’t have the inpatient or outpatient resources to help us. I’ve heard stories in the Southeast where we have patients who are boarding the ED for over 180 days. And today, I learned in the Midwest there’s a patient that’s over 230 days. How is that right for the patient? How is that right for their families? And how is that right for the ED? Which then transitions to what do we do for ourselves? And part of it is reducing the stigma, recognizing the burden, the privilege that we’ve had over the last several years, continuing to work and show up daily throughout the pandemic; and now we’re being asked to do even more with less—not only resources, but respect.

With the Lorna Breen Act, with recognition that we are sometimes heroes, but we’re also human, how can we make sure that our members know that they’re heard? As we’ve seen recent campaigns with ED violence, now we’re going to press forward with boarding and then press forward on mental health. Again, I want to reinforce it’s not just patients; it’s also for ourselves.

I hope to catch up in Philadelphia at ACEP 2023. I hear you’re a foodie. So, are you going to Gino’s or Pat’s for your cheese steak?

Dr. Kang: Three things. One, Pat’s versus Gino’s: I’ve heard the controversy. I know that there are loyalists. Believe it or not, DiNic’s Pork & Beef sandwich actually is comparable. Second of all, for cheese whiz, the right time, the right setting, does fill a need and it can be delicious. And then third, in terms of being a foodie, I just like to find people who create things and then try to enjoy and see what vision they have. And most times, the experience is not only with the food, but also meeting them in person.

Dr. Dark (@RealCedricDark) is associate professor of emergency medicine at Baylor College of Medicine and the medical editor in chief of ACEP Now.