What does the future look like for emergency medicine clinicians?

I know a lot of emergency medicine clinicians are worried about the future. There are lots of concerns about there being less demand for this specialty in the coming years, and how that might impact the ability to make a reasonable living as an EM clinician in the future.  

There has been a lot written about this topic, some of it is misinformation, but there are some legitimate concerns for the clinicians affected by this.  

There was a workplace study that come out near the beginning of the pandemic that said there was going to be a surplus of about 9,000 emergency physicians by the year 2030 and people really started to have serious concerns. The discussions surrounding the study quieted down for a little bit because we had the great resignation in health care and that included a lot of emergency medicine physicians retiring, however the concerns have come back up recently because of the surplus of EM residents.  

The thing is, there are some questions about the study that originally caused this stir. It looks like they may not have taken the aging workforce and attrition rate fully into account, or considered the creation of new roles and opportunities as telemedicine evolves.  

Throughout the pandemic there was, and remains, a shortage of emergency physicians at the moment, and the workforce study before this one had said that we were going to be in trouble because there would be a huge shortage coming.  

So yes, I think there are going to continue to be changes in the emergency medicine landscape in the future, but I believe that emergency physicians do not need to worry about having a job. We will always have emergency departments because we will always have patients who need not just unscheduled care, but unscheduled, emergent care. 

What are your thoughts on the utilization of nurse practitioners and physician assistants?

There seems to be a common, misconstrued concept amongst physicians that everyone in the business of health care is intent on replacing all emergency physicians with NPs and PAs, and that we are utilizing them in ways that are dangerous, untrained and unsupervised.  

Everyone has a different approach toward the role of NPs and PAs in our specialty. Some are more conservative, and some are more aggressive. Some are responsible and some are not. I don’t think it’s fair or accurate to paint with a broad brush.  

In reality, nurse practitioners and physician assistants can be very valuable members of emergency medicine care teams and really help us provide better access to high-quality care for many patients. 

What is the impact of private equity on health care and, specifically, emergency medicine?

The current environment can feel like a house divided on this topic, with lots of doctors throwing darts at any organization, and there are many in the space that utilize private equity as a funding mechanism. Again, on this topic, there is a lot of misinformation and some legitimate concerns, and we must be careful not to paint with a broad brush.  

I understand why some people have fears about outside investors trying to reap profits off the backs of emergency physicians. But every group, every investor isn’t the same. When I came out of residency, there were people shouting about how contract medical groups were evil, and that was before it was common for them to be partnered with private equity.  

When I made my choice, I could have joined a local private group. I know many doctors who made that choice and were treated terribly by the physician owners of that group. 

Instead, I joined ECI, one of the legacy companies of SCP Health, and a contract medical group. I was treated very fairly and compensated well, really as a local group that was being supported by the contract group.  

There are some private equity companies that have more ownership and exert more control over strategy and there are others who really let the experts manage the strategy, like we have at SCP Health. One thing I find compelling is that our company has continued to reinvest in SCP, and that’s allowing us to continue to innovate and invest in our clinicians and our patients.  

How do you feel about the current practice environment in emergency medicine?

It’s true that the tide has started to turned and hospitals are, in general, looking better today than they were a year ago at this time, but you know, our environment is still really difficult.  

As a specialty, we still don’t have enough nurses, there are too many holds in the emergency department, and possibly the most frustrating is that people don’t understand that even though the pandemic is ‘over,’ we are still dealing with the long-lasting impacts of that crisis. 

I also think it’s unrealistic for any of us to believe that it’s ever going to be the same as it was before. Medicine and staffing are not the same, and we have to be able to evolve in how we approach the practice of medicine, especially hospital-based medicine.  

That’s one reason innovation is so crucial. Innovation is not about turning to telehealth to eliminate jobs. It is about ensuring we are able to change and evolve with the environment and patient expectations, so that we can continue delivering care. Innovation is absolutely necessary as we navigate the health care challenges, and that’s why we spend so much time on it.  

I have so much appreciation for all our frontline worker that go out there, from physicians to nurses to techs and others, the people that go out there day in and day out and just take care of patients regardless of the environment. I have tremendous respect and appreciation for every single one of them.