The cat is out of the bag. In wake of the most dramatic residency match in the history of emergency medicine, it is no secret that our specialty is struggling. We are losing the fight, and medical students have wisely recognized this. Extreme ownership, a term coined by a Navy SEAL, is the concept that you are responsible for everything in your world. The buck stops with you.
Everyone likes to blame private equity, and surely, they do seem like a Lernaean Hydra monster. But EM could use a healthy dose of extreme ownership. Regarding the impending EP surplus, academic centers and nonprofit health systems alike contributed by creating new programs or increasing their cohorts.
Other programs that have implemented nonphysician provider (NPP) “fellowships” are merely training our replacements. EM residents are pitted in fierce competition against an ever-expanding number of “providers,” watering down precious learning opportunities.
The Accreditation Council for Graduate Medical Education and the Residency Review Committee have allowed unchecked proliferation of programs that have no business becoming accredited. Medical directors who influence EP staffing and ratios for NPPs have become lackadaisical. State medical boards are asleep at the wheel, allowing for NPP scope creep with no oversight or medicolegal consequences. Everyone has heard stories of democratic group leaders who sold their practices to make a fortune while abandoning the masses.
Any EP can advocate at the hospital, local, state, and even national level. We all have a role to play. It's time to look in the mirror and take extreme ownership in this evolving crisis.
Clayton Korson, MD