AAEM Position Statement on the State of Emergency Medicine

The American Academy of Emergency Medicine (AAEM) is gratified that the House of Emergency Medicine is discussing the workforce issue in our specialty. On Friday morning, the American College of Emergency Physicians (ACEP) hosted a virtual meeting, “EM Physician Workforce of the Future,” in which they presented the findings of a study commissioned by them and financially supported by several other emergency medicine associations. The AAEM Board of Directors voted not to financially support this project, since we were not offered the opportunity to participate in the selection of the project investigator, the research questions to be investigated, or the fee provided to the investigator.

AAEM has long been aware that circumstances have been created which have increased the supply of emergency care clinicians beyond the demand;¹ specifically, the creation of a substantial number of emergency medicine residency programs by for profit health care corporations and the training and credentialing of non-physician practitioners (NPPs) professionals to provide care in emergency departments.

Since the creation of emergency medicine residency programs by corporate entities practicing medicine, the Accreditation Council of Graduate Medical Education (ACGME) has substantially decreased the academic requirements for residency graduation by eliminating the requirement for the completion of a scholarly project, and the protected time (time paid by the physician employer to the physician for the development of academic teaching and research for the residency) afforded to program leadership has come under scrutiny.

The American Academy of Emergency Medicine has always been opposed to the corporate practice of emergency medicine, which is illegal in most states, and to lay control of emergency department policies and procedures as well as lay control of residency training programs. 

In a recent policy statement of the Academy,² we expressed our opposition to the independent practice of emergency medicine by NPPs on the grounds of patient safety as well as honesty and integrity in the representation of the clinician’s training and credentials. We support the role of nurse practitioners and physician assistants in the emergency department working under the supervision of a board certified emergency physician.

The Academy asserts that the corporate practice of emergency medicine diminishes the quality of care provided to emergency patients and interferes with the relationship between the physician and the patient. We assert that there is a conflict of interest between profit and education when corporations run residency programs. We oppose the use of the term “residency” to describe the training of nurse practitioners and physician assistants. We contend that these NPP training programs have no place in the emergency department in an environment where resident physicians are unable to find employment due to supply-demand mismatch that currently exists and is predicted to continue or worsen.

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Approved: 4/12/2021