Common Sense

Purpose


Issue: September/October 2022

Author: Jonathan S. Jones, MD FAAEM

What is the purpose of a specialty society or association? Or, perhaps, more specifically for us, what is the purpose of an academy? I think we all know what our mission statement is, maybe not verbatim, but we know the gist. As should be the case, some of us identify with or hold in high esteem one part of our mission more than another. However, what I believe is that all of us agree with the mission in general, otherwise, we would not be members. While I think about our mission statement every day and I read it prior to every AAEM meeting, recently, I’ve been thinking more broadly about societies, associations, and academies.

One thing I always emphasized when teaching students and residents is that if you don’t know the answer to something, look it up. I wasn’t entirely sure I knew what these words specifically meant, so I looked them up. Edited slightly from Merriam-Webster:

Society: a voluntary association of individuals for common ends; an enduring and cooperating social group whose members have developed organized patterns of relationships through interaction with one another; a community, nation, or broad grouping of people having common traditions, institutions, and collective actives and interests

College: an organized body of persons engages in a common pursuit or having common interests or duties

Association: an organization of persons having a common interest

Academy: a society of learned persons organized to advance art, science, or literature

After a bit of reflection, the first thing I decided is that, while all of these words apply to what we do, I am glad that we are an Academy. And after seeing that the definition of academy included the word society, which itself included the word association, I felt a little better about the fact that I couldn’t really tell the difference between all these words. I really contemplated each part of these definitions trying to understand if the American Academy of Emergency Medicine is living up to it’s potential.

First, we are a “voluntary association.” While this seems obvious on the surface, I think there are different degrees of “voluntary.” Many organizations which are ostensibly voluntary really are not. Physicians are often pressured into joining organizations either from their employer or from belief that membership is “required” in order to keep or advance their career. I am proud that AAEM is truly voluntary. While I want our Academy to grow, I don’t want to grow if even one single member feels coerced into joining.

Next, we associate with “common interests” and “for common ends.” Our common interests are the practice of emergency medicine and our common ends are described in our mission statement. Simple enough.

And we’re a society of “learned persons.” I like that. Next time you’re having a bad day, just remember that you are indeed a learned person. And we aim to advance art, science, or literature. And when AAEM operates to its full potential, I think we can easily change that “or” to “and.”

I have been reflecting and writing about specific words and definitions, not because I plan to take the MCAT again, but because I am concerned that many organizations, ours included, don’t always act in ways consistent with their purpose. The Andy’s (an affectionate term for the current and most recent Common Sense editor) will not like this, but I think a cliché may help: You can’t be everything to everyone.

What started this entire thought experiment for me? Simple, several recent actions the Academy has taken have been somewhat divisive with our own members. I have received feedback, written and verbal. I have received praise and concern for our actions. While I won’t bore you with another cliché about pleasing everyone, I do know this is impossible as well. However, I would be derelict in my duties as president if I didn’t consider possible causes and solutions to member disengagement. So, I have, and the prior few paragraphs describe how I started.

And my plans moving forward can be explained with two somewhat different words: Focus and Specialization.

Focus

The general focus of the Academy will be to stay tightly bound to our mission statement. I will encourage us to focus on our core values and issues. I’ll paraphrase our mission statement a bit, but to me, our core issues are: unencumbered access to expert physician-led care for all patients; the importance of our specialty, residency training, and board certification; the personal and professional health of EM physicians; and the development and propagation of EM knowledge.

These are truly the common ends which should unite us all. And that is what I want to focus on—what unites us. In my last Common Sense message, I stated that I wanted the Academy to be a “safe space” for all of us. What this means is that regardless of your individual priorities, opinions, and other organizational involvement, if you believe in our mission, then you belong. And more than this, you need to feel that you belong. One member recently wrote to me stating that he is led “to believe that there is no room” for someone like him in the Academy. This affected me deeply.   

If you endeavor to provide the best possible care to every patient in your ED, then there is room for you. If you despise the undue influence of the corporate practice of medicine and its detrimental effects on patient care as well as physician well-being, then there is room for you. If you want to educate yourself on the newest advances in the field and help propagate this knowledge, then there is room for you.

In fact, it’s simpler for me to think of people who we actually don’t have room for. Do you sign sham agreements with hospitals to deprive highly trained physicians of practice rights? Do you replace said physicians with lower trained alternatives? Do you withhold the best possible care to any patient for any reason? If so, then I’m sorry to inform you but we’re currently full and there is no room for you. It’s really that simple.

I will focus general Academy business, resources, statements, and effort on initiatives which unite us, on initiatives core to our mission. Another way I think about this is how I work recruiting new members. They ask, why should I join? And, what does the Academy stand for? Our answer should be simple and clear. It should be something that no ethical EM physician can disagree with. The hard part should be convincing the potential member that the cost of joining is worth it, not that our work is noble and good. That should be obvious.

Specialization

You may note that I used the word “general” several times above. This is on purpose and not out of laziness. The general work of the Academy needs to be as above. However, that does not exclude specific work of the Academy. Just as physicists can have a general and special theory of relativity, so can the Academy have a general and also a special purpose (my undergraduate degree is in physics, so apologies for the analogy). Special or specific work of the Academy is that which is obviously related to emergency medicine, but which does not directly or not consistently affect each and every member.

Depending on your practice setting, sub-specialization, or simply just your interests, the specific aspects of EM may be more important to you than the general aspects. What should we do for people with passion in specialized areas? Well, first of all we need to make sure that we have “room” for these members too. But I don’t simply want to make room for members with specialized interests and expertise. I want to ensure the Academy has opportunities to allow these interests to develop while at the same time ensuring that one single sub-specialized interest or area does not overtake others or the Academy in general.

This is why we have Sections. And thanks to the foresight of my predecessor, Dr. Lisa Moreno, AAEM now has more Sections than ever. This is wonderful. Sections are different than committees, task forces, and interest groups. Sections already have a degree of internal autonomy which sets them apart. Section leaders are directly elected from Section members. Sections have semi-independent finances and structure. And while all Sections and members are obviously part of the Academy and all support the Academy’s mission, their specific areas of emphasis differ. The final distinction of Sections is that while membership is restricted to Academy members, individual membership is completely voluntary.

While above I mentioned that I will work to focus general Academy business on initiatives core to our mission, I must add to that. In order for this Academy of learned persons to reach its full potential, I must also work to provide effective opportunities for our members’ specialized interests and skills. And so, I will continue to work to provide Sections with an even greater level of autonomy within the Academy. Specifically, discussions are underway to facilitate more timely and independent action by each Section.

This may sound odd at first, but I view it as a strength when members of one Section disagree with members of another or with members who are not in any Section. This is diversity of thought and this is good. Indeed, I welcome robust and difficult discussions on areas of importance to EMS, Women, JEDI, Ultrasound, or Young Physicians. Agree or disagree with initiatives of which these Sections view as vitally important, as long as we offer respectful advice, consistent support, and a welcoming hand, then it doesn’t matter. In the end, and possibly after a heated debate, we need to always remember one thing—AAEM’s mission. We support patients, we support true emergency medicine specialists, we support each other’s health and well-being, we support robust research and education.

Combining Focus and Specialization for the Betterment of the Academy

I’m not suggesting that we do anything new, novel, or untested. Strength in diversity is not a new idea. Working together for a common end is not a new strategy. Just reach into your pocket and pull out any coin (but maybe not if you’re in Malta this September for the MEMC). E pluribus unum. Out of many, one. This motto first appeared on a US coin in 1795 and has by law been included on every coin since 1873. While I suppose the pessimist could say this was an early case of government propaganda, I don’t think so. I think someone realized that what this early country was trying to do was hard, that it was important, and that it may fail. I also feel it is not a coincidence that the motto became more prominent shortly after ratification of the 13th amendment. It is also important to remember that this motto is not a statement of fact, rather is a stated aspirational goal. We may make it happen, we may not, but we must try (sorry Yoda). And while we are not fighting for the survival of our country, we are fighting for the survival of our specialty.

That is my vision for the Academy. I foresee an Academy with a laser focus on practice rights, corporate practice of emergency medicine, and physician autonomy and well-being. Within this Academy, I envision groups of learned people coalescing to focus on specialized areas within this field. It may seem contradictory or even counterproductive, but it can work. The United States of America has shown that it can work. This model will need consistent evaluation and adjustment, but it will work.

That is my plan. But I want yours as well. I want feedback. I need to know why you joined, why you pay dues, and why you volunteer. Also remember the governing structure of the Academy (which I am proud is the most directly responsive to members of any medical organization of which I belong). The president can lead but the true work is done by the fifteen member democratically elected board of directors, which has final approval of nearly everything.  And the call for elections will come soon. Be on the lookout and consider running or nominating another. Reach out to me or any board member. But always remember the aspirational goal from over two hundred years ago: E pluribus unum.

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