Each year, the ACEP President sits down with ACEP Now’s Medical Editor in Chief to discuss issues of interest to members. This second interview, conducted toward the conclusion of Dr. Aisha Terry’s tenure as President, reviews her goal of strengthening the leadership pipeline for the College and follows up on challenges that arose during the past 12 months. This interview has been edited for space and clarity.

DR. DARK: Thanks Dr. Terry for joining us. When we last spoke and we had a good conversation near the beginning of your presidency, now we‘re kind of closing in on the home stretch. One of the things you wanted to accomplish was talking about the leadership pipeline for ACEP. What do you think you‘ve been able to accomplish during your term so far?

DR. TERRY: Well, first of all, thank you so much Dr. Dark. I appreciate the opportunity to share again and certainly a lot has happened since we last spoke. But in terms of the leadership pipeline efforts, we’ve definitely made some progress. As I mentioned before, my original plan was to first take a look at the landscape in terms of what leadership opportunities are out there currently, particularly relative to recruitment and succession planning. Those have been the key couple of areas that I’ve looked at in terms of leadership pipeline as well as highlighting those leaders in emergency medicine who are really outstanding examples of how to lead outside of the traditional kind of brick and mortar of practicing clinical medicine in the emergency department.

We’ve engaged the AAMC in terms of partnering when it comes to recruiting for our great specialty. We find ourselves needing to get back to the basics, of talking about why emergency medicine is an amazing specialty and why we are heroes, not just during COVID, not just during the pandemic, but in the job that we do in serving the health care safety net. We are taking that story on the road and sharing that particularly with medical students. We will be speaking at the AAMC again at their annual meeting in November. Again, just sharing the good word about what emergency physicians do and how we absolutely are looking for the cream of the crop when it comes to future generations of emergency physicians.

On the succession planning side of things, I am really focused on making sure that internally when it comes to ACEP operations and leadership operations, that there is a plan for the future.

There is a succession plan for all of the chairs of our committees and our sections as well as presidents of our chapters. There’s a clear president-elect in the wings waiting to take the helm in terms of leadership.

We want there to also be a diversity of leaders who have an opportunity to serve. Mentoring and preparing future generations to lead is absolutely critical.

Finally, we spent this year really having conversations with and highlighting leaders in emergency medicine who are doing things outside of clinical practice. We’ve had the honor of speaking with Dr. David Callaway, who is one of the national presidential scholars and also an emergency physician. We’ve had conversations also with Dr. Brad Barth who is currently the Executive Director of Alpha Omega Alpha and an emergency physician. And finally, most recently I had discussions with Dr. Joneigh Khaldun, who is the Chief Equity Officer of CVS and an emergency physician. I truly believe that you can’t be what you don’t see. And so, this has been an opportunity to really highlight the vast opportunities that we have as emergency physicians.

DR. DARK: I was looking back through our last interview, and you had said that only 39 percent of emergency physicians are women. Only 35 percent of emergency physicians are from minority backgrounds in terms of race and ethnicity. But over the past six months since we last spoke, we‘ve seen DEI come under attack. You spoke with the Rep. Greg Murphy who introduced the EDUCATE Act, which we‘ve mentioned a couple times in ACEP Now, and it‘s a bill that would‘ve essentially defunded medical schools if they happen to even have a DEI office. I know that you‘ve stated that it runs counter to ACEP‘s policies, but one thing that you did say, because I was sitting there at LAC, you said you‘re going to follow up with him. I want to know what kind of dialogue you have had?

DR. TERRY: I really appreciate you holding me accountable to that. I’m so proud of the College for how we handled that situation. It really was a moment that gave us an opportunity to stand up with courage and to really shout about our policies when it comes to DEI. As you know, I did speak with Representative Murphy about the bill. First of all, it’s pretty complex in that it has several components.

One of the components certainly speaks to defunding offices in schools of medicine that focus on DEI. There are all kinds of other pieces in there, but there are absolutely aspects of it that run counter to ACEP policy. My focus in having a conversation with him, which I thought was a reasonable dialogue—where we heard from him, he heard from us, and then we ended it with saying we’re going to follow up to see what comes next relative to ensuring that our workforce is equipped to take care of all patients from all backgrounds relative to diversity, equity, and inclusion.

Since then, we have had some conversations. We do know that some of the co-sponsors on that bill had staffers that were part of that LAC session and actually went back to their bosses, to say, ‘Hey, maybe we should take another look at this bill. Maybe we should reconsider.’ And so, for me, the whole point of that is that change comes in all kinds of packages. You don’t know exactly how it may be delivered. You don’t know who you’re going to impact and how it will come to fruition. But we do believe that what we did that day on that stage at LAC and having a dialogue and talking to Representative Murphy changed and impacted some minds.

Unfortunately, Representative Murphy has had some health issues of late and so certainly being very respectful of his time of healing and recovering. But rest assured, more to come about the ongoing dialogue on that bill.

DR. DARK: Let‘s talk about a piece of bipartisan legislation, the Physician and Patient Safety Act (H.R.8325). It was formerly introduced by an emergency physician Raul Ruiz in the House of Representatives and has a couple of cosponsors, one of which I believe includes Representative Murphy as well. This bill would ensure that emergency physicians are afforded due process protections under medical staff bylaws before a third-party employer can make any decision affecting our employment status. What can you tell us about that bill?

DR. TERRY: We’re really excited about having played an instrumental role in even having that bill introduced this year. It was one of our focus areas at Leadership and Advocacy Conference in terms of promoting due process for emergency physicians. When we say due process, what we mean is you cannot be terminated by your employer without having the opportunity to go through the process of defending yourself and to ensure that all of the policies are being adhered to appropriately. There tends to be a two-tiered system when it comes to some hospitals and how physicians are treated relative to due process. We want to make sure that emergency physicians, like any other physician in the hospital, is able to undergo appropriate processes when it comes to potential termination. We’re really proud of having championed this topic. It’s actually a topic that we have been championing for many years, but like many things, COVID and the pandemic really amplified the need to codify and clarify what the protections would be for emergency physicians when it comes to not having to deal with retaliation or retribution for speaking up when it comes to quality and fair and equitable patient care. We’ve connected also with AAEM, as well as the American Hospital Association around this bill with the hope of making sure that all stakeholders and partners are at the table to ensure the success of moving forward and getting this bill across the finish line.

DR. DARK: I wanted to bring up the contentious issue between EMTALA and the Supreme Court and how that interacts with Idaho‘s abortion statute. The Supreme Court essentially dismissed the case, which means that emergency physicians are still unclear what we‘re supposed to follow—whether it‘s the state law or EMTALA when a patient presents with a medical need for an abortion. What is ACEP‘s updated position on this specific issue?

DR. TERRY: ACEP’s position on this is still clear. EMTALA is a federal mandate that we adhere to and that we proudly have adhered to for the entire existence of our specialty. We should be protected as emergency physicians from being criminalized from simply adhering to EMTALA and the mandate that we have been called to perform when it comes to ensuring that all patients, including women who happen to be pregnant. We have fought from day one relative to ensuring that those protections remain in place.

It’s not about really the ethics or the morality around it as much as it is about not criminalizing physicians for simply doing their job. ACEP has actually signed on to a handful of various amicus briefs and we continue to pursue various advocacy efforts even in the wake of the Supreme Court’s decision. Medicine can be complex. That is why it really should be left in the hands of medical people, physicians who are trained to understand the nuance of providing health care to patients.

DR. DARK: Unionization is probably more relevant to your average emergency doctor that‘s working right now on shift. There was a group in Detroit that did a 24-hour strike back in April. Do you think that unionization is the next appropriate step for emergency physicians to regain their authority in a system that seems to have declining respect for physicians? And, if so, should ACEP be the one doing this organizing nationally?

DR. TERRY: We know that unfortunately we are finding that work conditions are not what they should be. That we’re having patients languish, there’s boarding and crowding in the emergency department like never before. We know workplace violence is ravaging our emergency departments across the country. All of these issues, due process, boarding, workplace violence, having to worry about maintaining and keeping your job, whistleblower protections and the like are really, really coming down on us all at once. Not to mention reimbursement issues. ACEP believes that unionization is a potential solution to some of these issues. We want to educate our members around the various facets of unionization, specifically for emergency physicians. Like most issues there can certainly be unintended consequences and those are the blind spots that we want to absolutely make sure that our members are aware of as they decide to pursue whatever decision makes the most sense for them and their particular practice. ACEP does strongly believe in collective bargaining but not at the expense of patient care. At the end of the day, whatever solutions we pursue, there should always be those pieces in place to ensure that patients still receive the care that they need in a timely fashion.

DR. DARK: What‘s your pitch to younger members as to why they should join ACEP or even some of those members that are on the fence as to why they should remain members of ACEP?

DR. TERRY: I can tell you that when I was in medical school, that is when I realized that I wanted to impact change on a large scale. That I really wanted to impact the masses through policy and not just at the bedside clinically. And what I understood was that to do that, health policy and public health would be my vehicle. When I was elected president of EMRA, I realized that organized medicine is the vehicle we need to create change on large scale. Perhaps, to your point, younger generations aren’t joiners, but I believe there is a sense of wanting to belong. There is an absolute sense of wanting to create change in a meaningful way.

Our newer and younger generations absolutely want to fight for rights and they want to fight for equity and they want to fight for better and improved outcomes. Organized medicine is the perfect vehicle by which to do that. Because the change that we need is hard. And it takes years and years of relationship building and resources and expertise. Organized medicine allows you to have all of those things in a nutshell. ACEP has been working hard in terms of advocacy for emergency physicians and our patients for many years. Through those years of expertise and experience that we find ourselves supporting things like the due process bill, we find ourselves in circles where influence matters. I can tell you that about a month ago I was in a room on Capitol Hill filled with congressmen and women who are in health care, who are physicians. Later that day, I had dinner with the Surgeon General, and those opportunities were only afforded to me due to my connection through ACEP, not because I’m special. So again, I really just want younger generations to realize that the change they want to see, that equity that they want implemented can oftentimes come through vehicles that are tried and true, such as EMRA and ACEP. Your membership dollars matter tremendously. Because it’s only through those membership dollars that we’re able to continue to have these advocacy efforts and for them to be impactful and influential.

That doesn’t mean that you’re going to agree with every single thing that the organization promotes. But you certainly can get behind the general sense that we’re promoting the highest level of quality emergency care for our patients and that we are advocates for emergency physicians.

DR. DARK: Thank you for joining us.

DR. TERRY: Super excited about Vegas ‘24. We are really looking forward to launching a brand-new format and approach to ACEP ‘24 that really facilitates more engagement.