Dr. Mark Rosenberg talks about the challenges ahead and how COVID-19 has reshaped emergency medicine

When Mark S. Rosenberg, DO, MBA, FACEP, assumed the ACEP presidency at ACEP20 last October, the pandemic was still the biggest challenge for emergency medicine. Now, in the eighth month of his term, U.S. vaccination numbers are rising, COVID-19 cases are falling, and we’re starting to consider the shape of the postpandemic world.

Dr. Rosenberg recently emailed with ACEP Now Medical Editor in Chief Jeremy Faust, MD, MS, MA, FACEP, about his goals for the rest of his term and some of the challenges emergency medicine has ahead.

JF: The ACEP EM Physician Workforce of the Future report has turned a lot of heads. What’s the biggest area of concern you’ve heard about from members regarding its findings and recommendations? 

MR: Our members are concerned about the impact of market consolidation, fragmentation, and health care economics on our specialty. They are frustrated that board-certified emergency physician hours and contracts have been eliminated in favor of more cost-advantageous physician assistant (PA) or nurse practitioner (NP) hours, at the detriment of patients and our workforce. They are aware of how the COVID-19 pandemic has exposed vulnerabilities that had been increasing in our health care system.

These concerns were clarified through the data in this report. External forces are reshaping our specialty, accelerating the pressures and the urgency of taking immediate steps to ensure and maintain a sustainable emergency medicine workforce.

JF: How do you respond to these concerns?

Dr. Mark Rosenberg

MR: First, we understand that, in the face of frustration and uncertainty, our members want solutions. That requires both listening and action. The framework offered by the ACEP Board is being used to engage all within the specialty of emergency medicine to work together to identify solutions to address this market-driven instability and improve the specialty for the future.

As for action, ACEP and our Task Force partners worked to uncover the data that analyzed and quantified the threats to our specialty’s future. That same methodical rigor is being applied now to ensure we move forward with data, focus, and intent. I can promise you that ACEP is committed to leading the charge to influence and support a landscape that sustains a balanced, fulfilled, and thriving workforce that continues to provide high-quality emergency care.

JF: As I have gotten to know you, you’re an incredibly upbeat, “make lemonade out of lemons” type of guy. What is one thing in this report that worries you in particular? What’s the steepest climb we have ahead?

MR: Emergency physicians chose a specialty that requires us to be there for our patients during some of their most challenging circumstances. We meet their uncertainty and fear with our expertise, experience, decisiveness, and compassion. Now, we must tap into these same strengths to navigate our own period of uncertainty.

Too many of our members and residents—and their families—are already directly affected by threats to the careers and livelihoods that they have worked so hard to build.

I believe the biggest challenge facing ACEP is our responsibility as the leading EM association to help all those we represent—from our newest residents to our most experienced senior physician leaders, from those who practice in busy Level I trauma centers to those who work in community hospitals in rural areas. The breadth of perspectives in emergency medicine is one of our greatest strengths. We must ensure that we embrace this diversity as we align to protect the future of our profession while safeguarding the excellence of care our patients deserve.

We must not let the report’s findings divide us. There is not one magic solution or a simple, quick fix. These are complex, nuanced issues that will require all of us working together for many years … to not only address the potential oversupply but also to better position emergency medicine in the nation’s changing health care system.

JF: The opioid epidemic continues. Recently, the Biden administration announced that the X-waiver requirement for prescribing buprenorphine for opioid use disorder will no longer be necessary. Does that mean no more training courses? What’s the upshot? 

MR: The new guidelines are a welcome step to increase patient access to buprenorphine. We are pleased that the eight-hour training course requirement will be eliminated. However, you currently still have to notify the Substance Abuse and Mental Health Services Administration of your intent to prescribe buprenorphine and wait for their approval. ACEP is also getting some clarification on a 30-patient limit included in the guidelines to see how or if it would apply to emergency physicians.

These guideline changes are positive progress toward reducing barriers and helping patients get access to this lifesaving treatment, and we are hopeful that Congress will take action to fully eliminate the X-waiver.

ACEP has been advocating for years to repeal this requirement, and we strongly support the Mainstreaming Addiction Treatment (MAT) Act, which would completely eliminate the outdated requirement.

Many emergency physicians have been seeing an uptick in opioid overdoses during the pandemic. ACEP members from across the country are eager to discuss the importance of ED access to this treatment with members of Congress, one of several important topics we will address with legislators during ACEP’s Leadership & Advocacy Conference in July.

JF: The emergency department should be a safe place for everyone, but we know doctors and nurses and our colleagues are victims of violence at work. What is being done on workplace safety?

MR: Emergency physicians go to work every day driven by their commitment to caring for patients, and we shouldn’t have to fear being attacked. Unfortunately, violent incidents that put health workers at risk are on the rise, even during the pandemic.

ACEP strongly supports the Workplace Violence Prevention for Health Care and Social Service Workers Act of 2021. This bipartisan bill will help strengthen workplace safety standards, enhance incident prevention, and allow you to focus more on patient care.

The No Silence on ED Violence campaign, organized by ACEP and the Emergency Nurses Association in 2019, continues to share stories of those who suffer physical and emotional injuries after workplace assaults. The campaign strives to build awareness while also providing resources and a peer network to support emergency health care professionals.

JF: The COVID-19 pandemic has taken a toll on emergency physicians but has also revealed problems that were already there. Can you tell us about the Lorna Breen mental health legislation? GovTrack.us gives the bill a 3 percent chance of ever passing. What is ACEP doing to raise those odds?

MR: Dr. Lorna Breen’s legacy will extend long after this pandemic is over. The bill carrying her name will be a lifeline for emergency physicians who absorb extraordinary levels of grief, anxiety, and other stressors but feel their only option is to struggle in silence.

The bill authorizes funding for mental and behavioral health services for physicians, supports education campaigns to encourage healthier work conditions, and calls for research on causes and impact of physician burnout, among other provisions.

As you know, though, it can take time for a bill—even with the best bipartisan goals and outcomes—to gain enough traction to become a law. That’s why it’s so important for all emergency physicians to contact their members of Congress and urge them to support the Dr. Lorna Breen Health Care Provider Protection Act. It’s a very easy step on the ACEP website we all need to take. [Editor’s note: Visit ActionCenter to send a message to your legislators.]

We know there is a legitimate fear of consequences that deters many emergency physicians from getting the care they need. In a statement ACEP developed, along with more than 40 other medical organizations, we recommend removing existing barriers to seeking treatment, including the fear of reprisal.

ACEP also supports The Joint Commission’s stance that history of mental illness should not be used as an indication of a health professional’s current or future ability to practice medicine. And, for our members, ACEP offers free mental health counseling sessions, peer-to-peer support, meditation guides, and other resources.

Changing the culture of medicine will not happen overnight, but the pandemic is shining a light on the urgent need to protect physician mental health, which has been pushed under the rug for far too long.

JF: I’m going to use my editor’s privilege here to ask a question that interests me regarding tone policing and open dialogue. A couple years ago, ACEP Council voted to ban the use of the word “provider” in any official ACEP publication. The idea was to stop lumping emergency physicians and other clinicians into one basket because this one particular word is seen as somehow devaluing emergency physicians. I get that there’s a bigger debate about scope of practice, and that’s not what I’m asking about now. In your view, does the banning of certain buzzwords in our official publications—and I’m not talking about truly vulgar words—reflect well on us as a College, who we want to be, and how we want to foster debate and solve problems?

MR: I think my colleagues on the ACEP Council were focused specifically on ensuring that emergency physicians are identified in a way that acknowledges our role as the head of the team. I do not think it was intended as a restriction of speech but as a way to delineate the unique role we play.

The beauty of the ACEP Council is that each year we have the opportunity to rethink any and all positions, and I welcome a continued, evergreen discussion on ensuring the healthiest debate possible.