Market-based approaches to managing natural resources are becoming increasingly popular. In contrast to traditional command-and-control approaches, federal agencies are shifting to incentive-based structures where landowners are rewarded for activities that support vital ecosystem services such as clean water, clean air, healthy habitat, and biodiversity. Now, instead of tracking down and punishing those who do not comply with federal laws, government agencies are sitting at the same table with business managers to sign mutually beneficial land-management agreements. Consensus for this approach has solidified in the past few years; recently, the Millennium Ecosystem Assessment, an international effort by nearly 1,400 scientists to determine human impacts on the environment, expressed encouragement for market-based systems as one tool for “taking nature’s value into account” and achieving a more sustainable future (Millennium Ecosystem Assessment, Statement from the Board. Living Beyond Our Means: Natural Assets and Human Well-being. March 2005 (available at http://www.maweb. org/en/products.aspx). Market-based strategies enable landowners to buy and sell ‘credits’ for conserving ecological features such as wetlands, endangered species habitat, water-quality reduction (nutrients, oxygen, turbidity, etc.), carbon sequestration, and mercury reductions (specific to electric utilities). These credits that represent natural-resource values are banked for internal use or sold on the open market. In its most common application, a property owner agrees to preclude development on a sensitive tract of land in exchange for a cash payment. Under government-sanctioned guidelines, the property owner then collects payments from companies who need mitigation for impacting sensitive land elsewhere. EPRI Solutions has found that new niche markets have resulted in valuations of up to $125,000 per acre for land that supports rare plant and animal species (Fox, J. and Nino-Murcia 2005), up to $250,000 for an acre of wetland (Fox, personal communication), and over $25 for a ton of carbon in European markets (Carbon Finance Magazine). In this way, ecological resources are converted into financial assets, increasingly referred to as “eco-assets.” A summary of eco-asset types and their regulatory instruments is presented in Table 1.

Objectives:1. To determine how diverse are emergency departmental faculty nationally 2. To determine what modalities emergency medicine department faculty are utilizing to achieve diversity within their departments 3. To determine how effective those modalities have been in achieving diversity in emergency medicine departments

Background: There has been a growing amount of evidence that clinician bias, racism, inequality, stereotyping, and discrimination has indeed contributed to health inequities. These variables have been proven to have negative effects on patient care and health outcomes. Countless studies have shown that diversifying the physician workforce can produce better patient outcomes and decrease the number of health disparities. Patients are more likely to communicate a higher level of care satisfaction when treated by health professionals who share the same racial, ethnic, or cultural background as them. Although many health centers, hospitals, and divisions are determined to promote diversity among their faculty and staff, minority representation has made very little progress. This study aims to determine how diverse are Emergency Medicine departments nationwide, how is diversity being promoted, and how effective are those methods.

Methods: This is a national convenience sampling of 263 Emergency Medicine department heads including medical directors, section chiefs, and department chairs. A REDCap based questionnaire was developed and distributed to the listserv. Participation was tracked and weekly follow-up reminders were sent to participants. Interim analysis was conducted on participants. All statistical analyses were carried out in SAS 9.4. Fisher’s exact tests were used to assess the associations between variables.

Results: For the interim analysis, we look at the first 24 responses which consisted of 17 males (70.8%) and 7 (29.2%) females with aligning gender identity. Participants were white (91.7%), black (8.3%), and Hispanic/Latino (4.2%). Looking at suburban vs urban programs where 3 to 5, 6 to 10, and > 10 physicians of color were hired, suburban (0, 0, 0) vs urban (4, 3, 3) respectively; (p= 0.0483).

Conclusion: Upon assessing the first 24 respondents for this interim analysis, we can conclude that 66.7% of the participants classify as white males. While 66% of the leaders who were non-white hired 6 to 10 physicians of color, only 5% of white leaders hired 6 to 10 physicians of color. When asked how successful their efforts were to diversify their staff, 3 respondents reported that their efforts were very successful and 20 reported either partially or not very successful. There was an association between the type of location (suburban vs urban) and the number of physicians of color hired when looking at programs that hired 3 or more physicians of color.