American Academy of Emergency Medicine

The Macy Foundation Report on Emergency Medicine

The Role of Emergency Medicine in the Future of American Medical Care

Josiah Macy, Jr. Foundation is a private philanthropy dedicated to improving the health of individuals and the public by advancing the education and training of health professionals.

The Conference was held in Williamsburg, Virginia from April 17th to April 20th, 1994 to examine the future of the medical specialty of Emergency Medicine. The conference was chaired by L. Thompson Bowles, M.D., Ph.D.

Emergency care has dramatically saved greater numbers of patients whose lives are at risk, the demand for these services has escalated. Emergency departments are the first responders in a society that has been increasingly concerned about violence and addiction to drugs, and in which large-scale disasters seem to be more common. In addition, emergency departments have become principal providers of primary health care to the poor, the homeless, the unemployed, substance abusers, prisoners, and to all others who have no regular source of health care.

In response to this crisis, and at the request of the Society of Academic Emergency Medicine, the Josiah Macy, Jr. Foundation appointed a planning committee to organize a conference that would examine the future of the medical specialty of Emergency Medicine.

The end product was seven recommendations regarding Emergency Medicine. The second recommendation emphasized the importance of sustaining Emergency Medicine residency positions to continue to address the shortage of qualified emergency physicians. The third recommendation addressed quality of care concerns in regards to physician and other staffing.

Recommendation 2: Federal, state, and local governmental organizations, including the Council on Graduate Medical Education, should ensure that the number of residency positions in Emergency Medicine is not reduced as planning for health care reform proceeds.

Recommendation 3: The society of Academic Emergency Medicine, the American College of Emergency Physicians, and the Joint Commission of Accreditation of Healthcare Organization should revise the classification of emergency departments. This classification should reflect the level of care available for emergency patients, and indicate whether or not the facilities are adequate and whether appropriately qualified and credentialed emergency physicians are available 24 hours a day. In addition, this classification of emergency departments should establish minimum qualifications for physicians, nurses, and other health professionals who provide services in emergency departments, with special attention to the qualifications of "moonlighters."