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After the Game: Building Pillars for the Emergency Medicine Workforce : Emergency Medicine News


CAPE, workforce


The workforce study created a bit of a panic within emergency medicine, but Gillian Schmitz, MD, president of the American College of Emergency Physicians, who commissioned the study, told me said in a recent interview that the specialty can absolutely lessen the effects of imminence. surplus of emergency physicians forecast for 2030.

Dr Cook: As President of CAPE, you helped develop an action plan regarding the PE oversupply. You call this the five pillars. Did you find this slogan?

Dr Schmitz: You know, I don’t remember. Either way, I’ll own it. The five pillars are a framework that helps us realize that there is no one-size-fits-all solution. We need to address several elements that affect both the supply and the demand for emergency physicians. The discussion started when the EM workforce study was released. We needed to come up with solutions that mitigate the effect of the predicted oversupply of EP. You can’t just drop a bomb (the labor force study) and walk away.

Dr Cook: What was the mood in the room when everyone sat down to discuss it?

Dr Schmitz: It was, “Let’s get to work. So we started throwing things against the wall to see what would stick. Are you raising residency training standards? Are we all going to four-year residency programs similar to anesthesia in the 1990s? Are we raising the standards for nurse practitioners to work in emergency departments?

We had a series of town hall meetings. We said, “Give us your feedback. We want to know what you think of these ideas. Which should we pursue? And the one thing about ER doctors is that we’re not afraid to share our opinions. Some thought these were good ideas. Others said, “We hate this.” There was little support for going strictly to four-year programs early on, so we stopped pursuing that.

Another contentious issue is the development of standards for nurse practitioners and physician assistants. Currently, many nurse practitioner programs are completely online. It can be a few hundred hours of teaching online, but never touching a patient. Then they go straight to a rural emergency department or a small hospital without supervision. So the thinking was, “If we create a higher bar, it will limit the number of nurse practitioners getting these jobs.”

However, the rebuttal to this strategy is that if we develop standards for a different group of health care providers, are we in effect saying that if they meet them, they are “certified” providers? Could this be used to pursue independent practice and undermine residency training in emergency medicine? Isn’t this the standard EM residency training and board certification? So that was another idea that we decided not to pursue.

Dr Cook: Tell us about the five pillars.

Dr Schmitz: The first concerns accreditation standards. ACEP, AAEM, CORD and SAEM do not define them. The ACGME sets them and reviews them every 10 years. Luckily, the emergency medicine exam was scheduled for 2022. This allows us to do a thorough analysis to see if we can raise the bar to prepare our residents for a changing job market. The goal is not to limit the future supply of PE, but if this is a side effect of rising residency standards, so be it. The focus is on preparing for the future of our specialty.

Second, it is to examine expanding the scope of practice of non-physician providers and how to combat their ability to practice independently. This is accomplished through advocacy at the state level. We need to help our legislators and the public understand what it means to be an emergency physician. We believe in the valuable role Physician Assistants and Nurse Practitioners can play in physician-led teams, but we must make it clear that our skills are not replaceable by someone less trained. We must oppose dangerous policies that allow independent practice by non-physicians.

Number three is rural emergency medicine. Some of our labor issues are geographic. Historically, many emergency physicians do not want to work in rural settings. It’s not always about compensation. In my state of Texas, rural jobs often pay more than double urban and suburban jobs. Part of the reluctance to accept these jobs may also be due to lack of health care resources. It can be intimidating for new graduates to practice in an environment they have never experienced before. So we are considering incentives like paying off tuition loans and expanding exposure to rural emergency medicine in residency to help future graduates feel more comfortable in this practice environment.

Dr Cook: Did you push the idea of ​​rural EM rotation requirements to the ACGME?

Dr Schmitz: We believe rural MI should be an important consideration for the ACGME when reviewing standards. Some residency programs are geographically far removed from rural areas, which could have unintended consequences. For residents with young children or elderly relatives at home, a mandatory rural rotation may interfere with their ability to provide needed care to family members. However, we will encourage the ACGME to require programs to offer an optional rural rotation. Rural emergency medicine is very difficult. My first job was in a rural emergency department. Organizing transfers with an EMS truck and a two-hour drive to the nearest referral hospital changes the way you think about and provide care.

Dr Cook: OK, that’s three of the five pillars.

Dr Schmitz: Four increases the demand. Recently, CAPE launched a task force to examine what emergency physicians can do in acute care medicine outside of a hospital emergency department. Just as anesthesia turned to pain management, where can we expand our practice? The SAEM has also expressed interest in this and we have met this week to collaborate on expanding our range of unscheduled acute care.

Finally, number five prioritizes patients over profits. This involves difficult conversations with hospitals and health care systems that have started residencies over the past five years. What are their motivations? Are they familiar with the Workforce Study?

Initially, when we met several of them, they didn’t believe us. Unfortunately, many have relied on older data indicating a shortage of emergency physicians. They thought they were part of the solution by rapidly increasing the number of residency-trained emergency physicians. Our response was, “The data is different now. In fact, you are causing harm by increasing the number of graduates in residence too quickly, especially in certain markets. You gotta stop.” While we can’t force them to stop creating residency programs, we can pressure them to continue growing GME in other specialties that don’t have labor issues. -planned workloads we face in emergency medicine.

Read the first and second parts of this interview on

Dr Cookis the director of the emergency medicine residency program at Prisma Health in Columbia, SC. He is also the founder of 3rd Rock Ultrasound ( Friend with him, follow him on Twitter@3rdRockUS, and read his past columns on