As I was working my way through Virtual ACEP14, a wonderful resource, I was suddenly overtaken with sadness. Since Jerry Franklin died, I am the only doctor I know among all the DOs and MDs who work with critical access hospital (CAH) emergency departments here in West Virginia who gets to be dazzled by rock star master teachers, such as Amal Mattu, and to see all the latest and greatest on the exhibitors’ floor. My colleagues are excluded from ACEP membership because they come from family practice backgrounds, which, as my own and other research shows, is the reality of rural emergency medicine. These physicians are filling the need where no residency-trained emergency physicians want to work but are excluded from the best educational resource in the field. Not only is this sad, it is a betrayal of ACEP’s mission. This policy is sustained by those with no skin in the game.

Back in the Cold War, ’50s and ’60s, when nuclear war was imminent, a social critic, Ping Ferry, proposed a reality check deterrent stating that 200 of the elites’ children should be educated in the capital of opposing power, 100 American children in Moscow, 100 Russians in Washington, D.C. Before “pushing the button” that would incinerate millions of children and adults, the Soviet premier and American president would be required to personally slit the throat of each of the opposing camp’s children. This would remove the idea of nuclear carnage from the abstract. In a similar way, the terrible idea of excluding family practice–trained emergency physicians from ACEP only flourishes in the abstract. If the advocates of this policy actually spent some time visiting CAH EDs, spending some time in our shoes, many would better understand why exclusion from ACEP is clearly a move in the wrong direction if improved ED care in the United States is the goal.

Equally asinine is the sophistry used to rationalize this policy of exclusion. The faulty reasoning goes that since the predominantly family practice–trained MDs and DOs who provide CAH ED care are not EM residency trained, they are not “real emergency physicians” and hence can be excluded from the ethical obligations of ACEP. Not only is this as irrational as declaring the person flying the airplane not to be the pilot, it is insulting to our life’s work. In denying the life of fellow physicians, this exclusionary policy has rejected and abandoned a vital part of the American EM workforce.

Single-coverage rural EDs with no or little specialty backup, sometimes also serving as hospitalists because of physician shortages, this is our life work. To insult us by declaring us not to be ED doctors just pisses us off and leads us not to care about ACEP. All this undermines the ACEP mission of “promoting the highest quality emergency care” and being “the leading advocate for emergency physicians, their patients, and the public.” The physicians who have created or advocate this policy should be tarred and feathered, at least metaphorically.

Actually, this exclusionary policy has little to do with us in the sticks; it grew out of a spat over plum jobs in plum locations, with a view of creating a differentiated “residency trained” brand that would exclude competitors from the “good jobs.” Just look in the back of this paper—the branding campaign has worked, but the unintended consequence was to exclude the emergency physicians of the 1,376 CAHs from ACEP. Our jobs are essential, but we have trouble finding staff.

These are easy fixes. Create an associate ACEP membership contingent upon completion of a program modeled after the two-year certificate in emergency medicine offered by the West Virginia University Department of Emergency Medicine. In the process rural EM would improve, my colleagues could marvel at how good Dr. Mattu and other master teachers are, and our political action committee would get a considerable increase in membership because our political interests are the same.

So I, a grandfathered ACEP member who was at the Detroit Renaissance Center for my first College meeting in about 1982, obviously view the policy of excluding non-ABEM physicians from any participation in ACEP as unethical and wrong. I will happily argue my position at the Boston Scientific Assembly in October should ACEP choose to sponsor such a debate and to provide a venue. The proposition to be debated being “ACEP membership should or should not be open to all physicians who run emergency departments.”

Dr. Leveaux is an emergency physician in Sutton, West Virginia.