We also acknowledge that resident salaries have remained relatively flat despite increased academic indebtedness. We encourage research to determine if low salaries have contributed to program expansion and/or limited opportunity in emergency medicine for students from less well-off financial backgrounds.

• Support practicing physicians to encourage rewarding practice in all communities

A consistent EM workforce issue is the undersupply of residency-trained, board-certified physicians working in rural and underserved communities. ACEP’s report from the 2019–2020 Rural Emergency Medicine Task Force  affirmed that rural emergency departments represent 53 percent of all hospitals in the United States and 24 percent of total ED patient volume, yet the number of EM residency–trained or EM board–certified physicians working in rural emergency departments has not changed over the past 10 years. ACEP is not saying that graduating residents should see working in a rural emergency departments as their only option. Instead, we invite the entire EM community to look to the objectives proposed and help identify ways that we can better support those who wish to choose a rural practice. One item to note is our commitment to engage further with the federal government or other non-governmental organizations to expand existing or create new rural, Indian Health Service, and public health scholarships to provide debt forgiveness and salary support for service in these areas.

ACEP remains dedicated to working together with those who share our commitment to identify data-driven solutions that promote both patient safety and emergency physician opportunities.

Support for practicing physicians is not limited to rural or urban location. It pertains to the many different employment models emergency physicians choose to practice in. ACEP continues to update and evolve our policies, many as directed by Council, to support all practicing emergency physicians. Most recently, this includes updates to our policies on Emergency Physician Rights and Responsibilities, Emergency Physician Contractual Relationships, and Compensation Arrangements for Emergency Physicians. ACEP policy statements can be found at www.acep.org/patient-care/policy-statements/. Work continues on other key Council resolutions that were approved or referred to the Board last October.

• Ensure appropriate use of nurse practitioners (NPs) and physician assistants (PAs) to protect the unique role of emergency physicians

Emergency medicine is a medical specialty that requires advanced education, training, orientation, credentials, continuing education, and certification. The emergency department is a unique environment with significant challenges of dynamic patient care, limited information about patient present and past illness or injury, and unpredictable patient acuity and volume. It is unacceptable to have an emergency department that is not led and staffed in real time by a board-certified emergency physician with sufficient time to oversee the department and engage with patients.