Tom Scalea, chair of the research panel, spoke next. He observed that the two issues that repeatedly emerged in all four sessions were money and workforce challenges. Among the four panel topics, he said emergency care research is probably the area where the least progress has been made in the past 3 years. He summarized the three major points of the research panel discussion. First, the field needs a team of investigators who can be funded and sustained through their entire career (much of the research conducted now, he said, is done on the backs of faculty practice plans). Second, research questions that cross traditional academic boundaries need to be defined, and people need to cooperate in order to be able to execute research plans. The corollary to this, he said, is identifying a way to fund that research. Little clinical research on trauma care is funded, he noted, other than perhaps by the Department of Defense. Finally, people need to grapple with regulatory issues that hinder emergency care research.

Jon Krohmer, chair of the workforce panel, spoke third. He said the top take-home message from his panel was how pessimistic the discussion had been. The overall theme was that there are critical issues at the physician level, not just among the emergency physicians and trauma surgeons, but also the on-call specialists, critical care specialists, and other disciplines that are needed to support the emergency care system. The emergency nursing workforce also has significant challenges, particularly in recruiting and retaining sufficient numbers of nurses to care for patients appropriately. In addition, there are ongoing concerns with EMS personnel, particularly in terms of how they should fit into the broader emergency care system. Overall, he said, the system today is very stressed.

Krohmer noted that his panel had discussed alternative models of care that involve mid-level providers, physician assistants, and nurse practitioners. However, he said that right now health profession students are not offered enough education in emergency health care. This problem needs to be addressed. Certification or some other type of recognition should be established, he said.

Guy Clifton, chair of the fourth and final panel discussion oneconomics, said the combination of underpayment of public programs and growing numbers of the uninsured has produced a chronically underfunded system. He recalled trauma surgeon William Schwab’s statement that in Pennsylvania, the percentage of patients on which trauma hospitals lose money varies between 20 percent and 65 percent. Some hospitals are “operating on air.”

Clifton said his panel’s discussion highlighted longstanding distortions in the Medicare Resource-Based Relative Value Scale (RBRVS) system. This discussion raised interesting questions regarding where the money would come from to rebalance the system. In a zero-sum situation, would transfer payments have to come from other specialties such as neurosurgery and



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