An Open Letter to the Specialty of Emergency Medicine

Recently, the ACEP EM Physician Workforce released the results of a study determining the current and projected supply of EM physicians in 2030. The study concluded that the current trends in EM would result in a surplus of 9,413 emergency physicians in 2030. AAEM and AAEM/RSA have been warning our specialty of the potential for significant oversupply of EM physicians since 2016, when a study by Reiter et al., Past President of AAEM, stated “within the next 5 to 10 years, there will be enough board-certified or -eligible emergency physicians to provide care to all patients in the U.S. EDs.” Indeed, this analysis appears to have been wholly accurate.

Two significant factors have led us to this point.

  1. Between 2012 and today, the number of accredited EM training programs has grown by over 100 programs, from 160 to 265. (ACGME)
  2. There has been a more than 100% increase in the number of visits seen by non-physicians, particularly NPs, since 2010. (AAPA)

All of our specialty societies can agree, objectively, that the specialty of emergency medicine is facing a significant oversupply of physicians. Given this, it is imperative that our specialty take collective action to address the issue immediately.

AAEM/RSA supports the multi-organizational effort being organized and suggests four key interventions be taken in order to adequately address the security of our specialty and safety of our patients.

  1. We must purge our specialty societies from the influence and funding from corporate entities. This conflict of interest has prevailed in our largest organizations and prevented the adequate advocacy and security to acknowledge the issues we are now facing, as they evolved. False narratives have led to delays in combating both the over-expansion of EM residency programs by CMGs and corporate hospital groups, and the expanding scope of practice of midlevel providers.
  2. We must have a moratorium on new EM residency training programs and address the ACGME’s longtime inaction in prohibiting corporate entities from opening and funding EM residency training programs. AAEM/RSA believes that the ACGME has been complacent in allowing the significant oversupply of EM physicians. The substandard training requirements have and continue to be exploited by corporate entities to produce programs of questionable quality. The commandeering of medical training for cheap labor and to influence supply and demand economics by these profit driven corporations has been a significant factor in resident oversupply. We must demand the ACGME not only make requirements more stringent for future programs, but hold a moratorium on all new residency program applications until these issues are addressed.
  3. We must end all NP and PA “fellowships” and begin to replace non-physicians with physicians. NPs and PAs have historically been physician extenders during a time of physician shortage. Without this shortage, there is no longer a need for physician extension through the use of midlevel providers, and the most qualified individual to care for patients should do so. We must not give priority to non-physicians, in education or in department jobs, when there exists a market of thousands of graduating EM physicians who do not have employment opportunities and are significantly more qualified to fill these patient care roles.
  4. We must formally consider broad unionization of EM physicians. The considerable control of contract management groups and corporate entities on our profession has and continues to erode multiple facets of our profession. Their ability to significantly influence the specialty, including by manipulating the workforce and undermining our duty as physicians through replacement with NPPs, must be halted. Unionization may be the only feasible option to having a stronger independent voice within the corporate practice of emergency medicine. As emergency medicine becomes increasingly controlled by corporate entities, unionization may be the only measure in ensuring the needs and protections of emergency physicians.

AAEM/RSA is exceedingly concerned with the future of emergency medicine. Our residency positions are expanding uncontrollably under the influence of profit driven corporations, our patients are being more frequently treated by non-physicians, and because of these and other failures, our graduates are entering an increasingly impermeable job market. AAEM/RSA believes that should we want our specialty to survive the impending market failure, we must take drastic actions as listed above, not only for the health of our profession, but for the safety of our patients.

Haig Aintablian, MD
President, AAEM/RSA

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Approved 4/10/2021