An Academy, If You Can Keep It
Issue: November/December 2022
Author: Jonathan S. Jones, MD FAAEM
In my last article, I discussed the purpose of academies in general and of ours in particular. I am glad that we have an Academy. But how long will we have it?
Is emergency medicine in a crisis? Probably. But it also seems to me that most everything is in crisis now. War in Ukraine, nuclear weapons in Iran and North Korea, inflation, global warming, partisanship, and the fact that one day recently the school lunch was supposed to be pancakes, but they did tacos instead. For some reason, my daughter most definitely does not like tacos. I don’t add the last remark to belittle the preceding issues, but rather to suggest that a crisis is subjective.
Just over 30 years ago, I think emergency medicine was in a crisis. EM residency programs had been founded, the American Board of Emergency Medicine (ABEM) was administering exams, and in 1982 the Accreditation Council for Graduate Medical Education (ACGME) approved specialty requirements for residency training in emergency medicine. This all sounds great and the opposite of crisis. But there were problems. And while my direct knowledge of the situation in the early 80s is limited, it is fascinating talking to our founders about this period. Challenges were made to the legitimacy of residency training and board certification. The exploitation of emergency medicine physicians was growing exponentially. Even the specialty societies tasked with defending the specialty of emergency medicine were failing and actively subverting the interests of individual residency trained, board certified, EM physicians.1
For true EM physicians at that time, it was a crisis. And while crises don’t make visionaries or leaders, they sure help differentiate true leaders and hone their skills. Luckily, almost 30 years ago (next year, 2023, will be our 30th anniversary), there were leaders and they were brave enough to found the American Academy of Emergency Medicine. They saw a problem and determined the best way to address the problem was to reorganize and form the Academy to be the Champion of the Emergency Physician. We are all reaping the benefits of their action. But now it’s on us to keep the Academy. I suppose the pressure is most specifically on me as President and on our Board. My last few columns discussed actions the Academy can do to improve EM for all of us. Now I focus on how we actually improve the Academy and ensure that we’ll not just be around for another 30 years, but that we will be stronger than ever.
The first step is understanding a bit of history. That’s why I wrote these first few paragraphs. If I don’t understand the environment in which the Academy was formed and the purposes for which it was formed, it will be hard for me to be a good steward. That is not to say that the goals now are the same as the goals 30 years ago. No, some goals’ importance fades away while other new ones rise to prominence. And hopefully some goals get accomplished and checked off the list. But the thought process, the impetus behind the goals, and the reasons those goals were set 30 years ago should likely remain unchanged or minimally changed. And if you haven’t surmised from some of my comments in previous reports or my paraphrasing of Benjamin Franklin to start this column, I find history quite interesting in general.
The second step is reading and contemplating on the official Vision and Mission of the Academy. Ours can easily be found online or on the inside front cover of every issue of Common Sense. We currently list six specific items in our Mission. And while they may be listed somewhat based on priority, each one is vitally important. We recently updated our Mission Statement and formally changed it during a Board meeting at AAEM 22 in Baltimore. Significant work went into examining and updating the statement. Wisely and with full Board support, my predecessor as President, Dr. Lisa Moreno, appointed a task force to study and examine the issue over several months. She and I both served on this task force. Why did she ask so many people to spend so much time examining one statement? Because updates to the Mission should not be taken lightly. The changes made were vitally important, but also relatively minor or incremental. This is not contradictory, rather it was deliberate. For what good is a Mission if wholesale changes are quickly made? To me, that would have been the definition of those tasked with ensuring the success of the Academy of not “keeping it.”
But as dangerous as making sweeping changes would be, single-minded or absolute devotion to any one single aspect of the Mission is also dangerous. While each one of us values each of the six pillars of our Mission differently, we must support them all. As President, one of the most difficult challenges I have faced is defending the Academy as a whole from being subsumed by any one single special interest. Seeing, hearing, and experiencing some of our member’s incredible passion for certain aspects of emergency medicine is enthralling. But while I am excited by passion, it is my duty as President to at times check that passion if it endangers the Academy as a whole. For example, we are not the Academy of Emergency Access, nor the Academy of Physician Wellness, nor the Academy of Diversity, nor the Academy of Emergency Education, nor the Academy of International Emergency Medicine. We are the Academy of Emergency Medicine. We stand for all of the above so long as they don’t interfere with our ability to accomplish initiatives in any of the others. This is nuanced, subjective, and difficult, and in my opinion, is the primary duty of the President, and it weighs on me heavily.
Now that we have an Academy, “keeping it” is not just the duty of the President, the Board, or the committee chairs. Every member has an obligation to help “keep it.” Fulfilling that obligation is best accomplished by being active in the Academy. Sure, we don’t mind that much if someone just pays their dues and then never does anything, but that actually does not help the Academy very much. While there are many ways to be active, for this column, I want to focus not on committee involvement, rather on attention to leadership and direction. While the Board of Directors is tasked with leading the Academy, the Board is fully and directly responsible to every member. Unlike the vast majority of medical societies, the at-large Board positions as well as all Officer positions are directly and democratically elected by members. So…
Do you vote?
Did you vote last year? And the year prior?
Do you know how to vote?
Do you know the requirements to vote? To run for any position?
And slightly different, but perhaps more important…
Did you know the platforms and agendas of each candidate running last year?
Do you know how the current Board members and officers represent the Academy?
If the answers to all of those are yes, then you may actually be doing better than I am. (Well, I have at least voted in every single election since I became a full member, and I have also selfishly voted for myself every time I had the opportunity.) But going back to the above questions, I suspect there will be many answers in the negative. Why is this and how do we fix it?
I view the situation similarly to how at times patients don’t do exactly what we as their physician would like them to. Why? The cynics blame lazy patients. But in my experience, I have seen very, very few lazy patients. I have seen patients who don’t know that hypertension is the same as high blood pressure, patients who can’t afford their prescriptions, patients who can’t make the follow-up appointment because they were the sole caregiver for a child or elder, and so on. Just as the solution to ensure better medical compliance isn’t criticizing the patient, so the solution to ensuring better Academy leadership isn’t criticizing members.
Possible solutions, among many others, may be to: make voting easier (but still secure and accurate), advertise pertinent Academy policies pertaining to elections, encourage more candidates, ensure member access to candidates prior to elections, clearly publicize candidates’ statements as well as answers to pre-set questions, increase communication from sitting Board members and officers, and increase town-hall style opportunities to engage with Board members and officers.
This can all be done. And we are working towards some of this already. The Past-Presidents’ Council as well as the Women in Emergency Medicine Section have spearheaded some excellent recent improvements to the elections process. In an attempt to build on their progress, several months ago, I appointed an Elections Task Force chaired by Dr. Bruce Lo to examine the state of our elections and suggest possible improvements. Work is progressing well and should dramatically improve the election process.
Ultimately though, the Academy needs you. The Academy needs each and every one of us. I need you. I need you to engage with our new election initiatives. I need you to learn about each candidate. Before and during candidate forums, I need you to ask questions, hard questions. I need you to follow-up after the elections to check-in and ensure that, once elected, we are doing what we said we’d do.
More important that any of that, I need you to run. I need you to be a candidate. Yes, it is difficult, but also enormously rewarding. It can also be a bit intimidating, but it needn’t be. I can help, all of the Board can help. Staff can help. But still, why should you run? Maybe you’re not a committee chair, or you’re still relatively new to the Academy, or you’re unsure if you have anything valuable to offer. None of those matter. Think of being a candidate like how most of us (OK, at least my generation) were taught about doing a lumbar puncture, which went something like, “If you think the patient may need an LP, then they do need an LP.” Well, if you think you may run for the Board, even if only to think of reasons why you shouldn’t, well, it’s been decided, you should run for the board (unless of course you’d rather have an LP).
A Republic, if you can keep it.
An interesting aspect of the English language is that the singular and plural of the second-person pronoun is the same, you. When Benjamin Franklin uttered that reply, I think he was both referring to the citizenry as a whole as well as to individuals. While no individual can accomplish nearly as much as a group, no group can accomplish anything without the dedication of individuals.
You have an Academy. Can you keep it?
- For more in depth discussion, see “History | AAEM - American Academy of Emergency Medicine” at aaem.org/about-us/our-values/history, and please also review the 1994 Macy Foundation Report “The Role of Emergency Medicine in the Future of American Medical Care.”