The future of emergency medicine: Update 2011

In 2009, representatives from many of the major stakeholder organizations in emergency medicine convened in Dallas, TX, to discuss the future of emergency medicine, with a focus on workforce. The consensus article was subsequently published and remains a vital resource for projecting emergency medicine workforce needs. In reaction to the enactment of the Patient Protection and Affordable Care Act, representatives from the same major organizations in emergency medicine convened in Dallas in January 2011. There was consensus that health care reform had the potential to increase the percentage of physicians, not just emergency physicians, employed by large groups or hospitals. Concerns were also raised about the need for physicians to gather non-value-added data that do not benefit the patient. The following additional areas emerged as topics of concern: the projected physician workforce requirements in emergency medicine, the provision of quality care in rural areas, effect of health care reform on the practice of emergency medicine, particularly the threat of increased employment of physicians, the role of nonphysicians in providing emergency care within the ED and in the out-ofhospital setting, and the use of telemedicine to expand the reach of the emergency physician workforce. The group agreed that (1) emergency care should be provided by physicians who are board certified by the American Board of Emergency Medicine (ABEM)/American Osteopathic Board of Emergency Medicine (AOBEM) in emergency medicine or residency trained in emergency medicine, and when of necessity care is provided by non-board-certified physicians, such individuals should have additional training, oversight, and continuing medical education; (2) all providers of emergency care should maintain lifelong learning in emergency medicine in addition to the requirements of their primary specialty; (3) rural emergency care requires the same skills and training as urban care and perhaps is more challenging because of the lack of ready access to consultants; emergency physician shortages will likely be more pronounced in rural areas in the near future; (4) ideally, all health care providers in emergency departments (EDs) will have access to the expertise of an emergency physician either on site or through telemedicine; (5) the clinical practice of emergency medicine should be based on the benefit to the patient ("value-added"); (6) quality measures of emergency care should be developed by the specialty of emergency medicine and should be evidence based and validated; and (7) the electronic medical record should enhance the practice of emergency medicine and benefit the patient. Specific to the Affordable Care Act, the group suggested that (1) areas of special interest for emergency medicine include alternatives to hospital admission, alternatives to advanced imaging, alternatives to consultation, confronting issues of futile care, and facilitating early palliative care; (2) a compendium of possible options or alternatives to traditional ED care be devised that would include observation medicine, case management, callback systems, community paramedicine, telemedicine, home health care, and telecommunication vehicles; and (3) physicians, particularly young physicians, be made aware of their rights in vany employment model.