Under the Big Top: An Ode to ACEP

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The annual ACEP Scientific Assembly is an absolute circus, but it’s also an unparalleled display of talent, passion and innovation. I wouldn’t miss it for anything.

Last month in Las Vegas, the American College of Emergency Physicians met under an astrological event. Ever so often the moon is 15 percent closer to the earth and when it coincides with its full phase, the vision is spectacular. The enlarged moon was only rivaled by the beauty of the Southwest American desert – which is spectacular despite what we have done with it.

The week of ACEP began as it always does with the ACEP Council Meeting, a collection of almost 400 representatives sent from the States, Puerto Rico, the Government Services and each special interest section of the College. It is an impressive collection of minds and special interests that speak both their hearts and their souls with passion – and occasional eloquence. The superiority of this Swiss Canton type democracy to the current national freak show is painfully obvious. People went to the microphone and no one insulted anyone. No one was called a liar. No one was called a lecher. Amazing. What a concept. It was assumed that everyone had the best interests of emergency physicians at heart. The country could learn something from both the civility and sincerity of this mini-democracy.


Did this coming together of the council produce anything? Absolutely. The function of the council resolutions is to convey feelings more than specific goals to the board of directors. With perception being the only reality, the hopes and fears of 37,000 members were sent in carefully encrypted messages to those who would craft policy and release it publicly. Board members ignore these missives at their own peril.

The concept of reserving special seats on the board – which I wrote about last time – was soundly and roundly rejected. As a refresher, there was a resolution to enshrine a seat for a “young physician.” The discussion was brilliant. The slippery slope of “special seats” is disgusting to a true democracy. If you need to qualify that way to hold such a place, it’s because you couldn’t get there on your own. We have had large numbers of women board members and presidents. We’ve had black board members, Jewish board members, etc… who got there the old fashioned way: they earned those spots fair and square. What a concept.

The entire question of diversity of leadership was referred to the board of directors as if they are going to be able to solve a problem no one else has in this society. They are going to grapple with this situation like anyone else has: with the best of intentions and poor result.


The perpetual discussion of single-payer healthcare was again given its airing with little discussion of specifics. Remember that no other nation our size does governmental health insurance on a total society basis but rather in sub-units. The Canadians use the Province and I would suggest a state-by-state system could be accomplished in our country successfully. We are not Denmark. We need to think about this in broader terms. With the almost total collapse of Obamacare, the Feds will have no choice but to do something, no matter who is elected.

After many years of marijuana discussions, the issues of decriminalization [not legalization]were referred to the board. I will say that the discussion this year on the issue was the most intelligent and balanced I have heard yet. Everyone now realizes that like alcohol [which was consumed by more than a few at this event]cannabis has its problems. It’s still not good for your teenagers. And no one in the council wants their 16-year-old kid smoking dope instead of doing well in high school.

The overdose literature which is being generated out of Colorado is sobering – no pun intended. This, along with the growing opiate problem, is going to require both State and Federal action. I hope the board is up to this challenge. It will not go away.

Lastly, the Council did what it was really sent there to do. We are a professional trade organization, period. We are not the salvation of everyone. We are not the solution to every problem. We acted to advance the position of the membership. That means discussions of revenue, liability, lifestyle, and healthcare politics. The only way you can predict the future is to make it. For those of you who are “too busy” to participate, understand you will live off the scraps that fall from the tables of power.


Now on to the mega meeting itself. Almost 7,500 members showed up, which made it by far our largest ACEP meeting ever. This is our Broadway. This is the place where those who aspire to greatness come. Looking down the list of faculty is a veritable Who’s Who of emergency medicine. When you have the likes of Thom Mayer and Amal Mattu, who needs to hear from an old guy like me anymore? Truth is I go to hear them as well.

To satisfy those millennials, the 25-minute rapid fire courses were a big hit. Considering their ever-declining attention spans, I can only predict that this trend will continue, with future courses clocking in at five minutes or less.

There is one thing I’d like to say to the millennials: Life is more than a Tweet. The coming together is the surest way to recharge our intellectual batteries. For those of you who do not believe in energy and synergy, stay home. This is the greatest emergency medicine show on earth. Not only do you see colleagues but you can have those infamous hallway conversations about what works and what doesn’t in your department. Who works and who doesn’t is also discussed and the thousand common problems that unite us as a culture.

The greatest tool you have to fight burnout and workload depression is to come together and realize that you are not alone. To say that misery loves company is a gross understatement. Anyone who stands up claiming to have the perfect department and having solved all the problems is at risk of being beaten with a hose.

Lastly, I believe you can trace the maturation of the profession – and by extension American healthcare – by the exhibit show floors. In 1976, I attended my first ACEP meeting in New Orleans, which was held in the Superdome and hosted about 80 vendors. It was a far cry from the over 300 display booths we have today.

But it is not just the number of exhibitors present but the very wares they are hawking. There are still the drug houses to be sure, telling us tall-tales about their products, claims that would make P.T. Barnum proud. But now there are new vendors representing changes in the market. I went to one booth that was nondescript. “What do you do?” I asked. “We do the legal analysis in cross-state mergers and acquisitions,” she said, as if everyone would know or should have known what they did. “So, you arrange financing for such acquisitions?” I queried. “No, of course not,” she said. “That’s done by acquisition financiers, who are two booths down. Would you like me to introduce you to them?” “No thanks,” I said. “The only thing I need to finance today is lunch.”

The maturation of the specialty is reflected also in booths that deal with skincare, retirement financing investments and disability insurance. In other words, these people consider that we are now shriveled old prunes – who need to eat prunes – who aren’t smart enough to handle our own money and are so infirm that we can’t even work anymore. I resemble that remark!

The show floor also revealed that the new types of jobs opening up to experienced emergency docs are staggering, from Saudi Arabia to the CIA. I asked the lady and gentleman at the CIA booth what I would be doing should I join the CIA. They assured me that I would be doing nothing since I was clearly too old to be deployed. “Okay, fair enough. But what should a healthy 40-year-old doctor expect to be doing with you?” They were very vague about this. Finally I couldn’t help myself. I had to say: “So you could tell me but then you’d have to kill me.” They weren’t amused. I had to move on.

ACEP is always mind-blowing in scale. It is maybe one clown short of a circus and how I love the circus. I ran away with this circus over 40 years ago and I’m still traveling with the show, mostly cleaning up after the elephants.


Dr. Henry is the founder and CEO of Medical Practice Risk Assessment, Inc.; past president of ACEP.

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