AAEM NEWS FROM THE EDITOR’S DESK
We Need To Take Care of Our Children Andy Mayer, MD FAAEM
T
he statement above was made at a recent AAEM Board of Directors meeting. It may sound like a strange statement to be made at such a meeting but it carries great significance. Most physicians believe that there is a duty for each physician to encourage, mentor, educate, protect, and to take care of the next generation of physicians. Our profession is both an art and a science and we learned our skills from physicians who came before us and we owe a debt to those who will follow us. Emergency physicians need to look at the looming workforce issue with an eye towards protecting our patients and the young, dedicated, idealistic physicians who are looking to emergency medicine as a career. Choosing a specialty in which there is a rising certainty that new emergency medicine residency graduates will be unable to be empowered to advocate for their patients or have any control over their careers is disturbing at best and disastrous at worst. The health and safety of both these young physicians and the patients who they will care for in the coming years is at stake. There were lengthy discussions during this meeting related to the looming workforce issue which emergency medicine is facing. The projected surplus of graduating emergency physicians in the coming decade is something which cannot be ignored and certainly the time for action is now. The consequences of the projected glut on the house of emergency medicine is now the big hot topic. The roles of private equity and corporate management groups in this coming crisis are actively being discussed in many forums. The time for endless discussion and study is past and now is the time to do something to prevent a catastrophe for a generation of young intelligent physicians who will be entering a supersaturated job market with few reasonable options. These physicians will typically be shouldering a huge student loan debt at a time when most plan to be starting families and settling down into a long and fruitful career. What will be their reality and what viable options for a successful career will be available to them? Each emergency medicine organization looks at this issue from its own perspective and often with their own best interest in mind. The house of emergency medicine needs to put aside any self-interest or self-protective instincts and do what is right for our patients and our profession. The specialty has to come together and work in unison on this issue. Concerns about membership numbers and advertisement income need to be put aside. Letting private equity inflate a labor pool for shareholder’s profit at the expense of patient safety is such a strange and absurd concept to me that it is hard to believe our healthcare system could be so broken as to permit this onerous outcome. Let’s just consider if a glut of thousands of unemployable or under employable residency trained emergency physicians is good for our
patients? One might think that oversupply would lead to lower costs for the patient and therefore could be considered a good thing. I suspect few of you believe that any money saved, any significant salary reductions will be passed on to the patient. Do you think that the private equity and corporate management groups which are leading the push to produce this glut are doing this for the good of the American people? They want cheap labor who they can hire to work for a lower salary and at the same time require them to supervise more non-physician providers. These physicians will have to accept any job which they can get often with virtually no power to advocate for the health and safety of the patients. These young emergency physicians will be left alone in the middle of the night to treat and care for the sick while the corporate management group executives and the owners of private equity firms are sleeping soundly in their beds. Will these physicians be willing to speak out when they have a patient care or safety concerns related to staffing, boarding, or the increasing requirement for them to sign non-physician provider charts? I suspect these vulnerable physicians will feel compelled to remain silent to protect their fragile job security. They will not feel that they can afford to risk their job as they will know there will be another wave each year of new graduates competing for their job who will work for less and under worse conditions. AAEM is trying to take action and stop talking. We are encouraging other emergency medicine organizations to do the same. Dr. Mark Reiter, a past president of AAEM has done significant work on this issue and made a proposal to the board which was accepted as the policy statement below.
Raising Emergency Medicine Residency Standards Introduction AAEM has received much feedback from our members regarding concerns that the rapid proliferation in the number of emergency medicine resident positions, and increased utilization of non-physician practitioners at emergency department training sites has negatively impacted the quality of emergency medicine resident education.
Position Statement AAEM suggests the ACGME Emergency Medicine Residency Review Committee take action to raise emergency medicine training and quality standards by setting a minimum number of patients at the primary site emergency department per resident and setting a maximum percentage of emergency department patients seen by non-physician practitioners (NPPs). Specifically, AAEM advocates for the implementation of a standard of one resident per 3,600 patient volume at the primary residency training site and a maximum of 25% of patients seen by NPPs. Residency programs will be able to devote
>>
6
COMMON SENSE NOVEMBER/DECEMBER 2021
