Packed Agendas and a Call for Your Opinions

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The resolutions you submit to the Representative Council guide our conversations and empower us to advocate on your behalf. Spring deadline: March 9!

The EMRA Representative Council Meeting held in conjunction with ACEP Scientific Assembly each fall is typically busy and exciting. The entire house of emergency medicine descended upon our nation’s capital from Oct. 25-Nov. 1, and while the educational sessions took center stage, your EMRA Board of Directors and residency program representatives were hard at work making great use of that time.

Representative Council

The Representative Council (RepCo) meeting featured a jam-packed schedule that extended into the afternoon. We heard from partner organizations, including the American College of Emergency Physicians, American Board of Emergency Medicine, and Council of Emergency Medicine Residency Directors. We elected 5 new officers to our Board of Directors. We also discussed and voted on 7 resolutions that made changes to the EMRA Bylaws and Policy Compendium. These resolutions help the Board of Directors set our agenda by identifying the topics you, the members of our organization, feel are important for us to work on in the coming year.

The changes to our Bylaws focused on two things: improving the clarity of our language and simplifying the way we change our Bylaws in the future. Five of these resolutions were passed at our meeting, and the current Bylaws and Policy Compendium are updated online at www.emra.org/leadership/Governing-Documents.

We also passed a new resolution dealing with the critical issue of climate change. There is a wealth of research underway to assess the health effects of climate change, and the RepCo wants EMRA to be a part of that. The program representatives voted to support these ongoing research efforts and to make sure our members are informed of the results in an effort to increase education about this important issue.

ACEP Representative Council

Your Board of Directors not only enacts the work of our representative council, it also represents you within ACEP’s Council. This body guides the agenda for ACEP for the coming years, and EMRA has 8 seats out of the 440 in the room to make sure your voice is heard. From speaking on the floor about paid parental leave and fairer and more transparent drug pricing for our patients to speaking against a narrowed definition of scholarly activity, we make sure the ACEP Council knows what the future leaders in emergency medicine want our specialty to look like. But while the issues we address are based upon what is in our Policy Compendium, not everything the ACEP Council considers is something on which we have policy.

One of the resolutions the ACEP Council passed in October relates to safe injection sites. There is evidence that these centers are associated with a decrease in opioid mortality1 and high-risk behavior in Canada2, but little research has been done on the efficacy of these sites in the U.S. ACEP discussed a resolution to work with the AMA on piloting these sites in America. The EMRA Board decided to support the resolution — but that decision was made without insight into the will of EMRA members because there is no policy related to opioid treatment, addiction, or abuse in the EMRA Policy Compendium. Should we be researching these safe injection sites for the potential benefits they may present to our patients, or are these sites a tacit approval of illegal substance use and something we as physicians should not be participating in? What about other harm reduction strategies like needle exchange programs? What do you think we, as emergency medicine physicians, should be advocating for?

There was also considerable debate on Maintenance of Certification (MOC). Recently the state medical societies that make up the American Medical Association have been working within their state legislatures to pass laws making it more difficult or illegal for insurance companies and hospitals to require board certification for reimbursement or hospital staff privileges. They argue that board certification and the subsequent MOC comes at a considerable cost to the individual, in both time to take the test or complete the requirements and cost paid to the board of medical specialties, and does not improve patient outcomes. However, if a hospital is forbidden by state law from considering someone’s board certification status when making hiring decisions, that could open to the door for physicians who are not board eligible or board certified in emergency medicine to start working in the emergency department. While some ACEP state chapters have been in support of the efforts of their partner medical societies, EMRA has not taken a stance on the issue of Maintenance of Certification. We have policy stating that board certification from ABEM and AOBEM is the only pathway to the independent practice of emergency medicine, but when MOC comes up for a vote within the AMA or ACEP, how do you want EMRA to vote? Do you support the idea of ABEM and AOBEM requiring Maintenance of Certification? Do you support certifying every 10 years, as is the standard now? What do you want to see an alternative to the high-stakes exam?

We want to hear from you!

Resolutions like those passed at our Representative Council and at ACEP’s Council define the goals and advocacy missions of our organization and our board of directors. There are a lot of issues that inspire strong viewpoints, from the speaker and vice-speaker, to the board of directors, to the representatives, to you the members of our organization. However, EMRA is not about what I think or what the board thinks; it’s about what you think. We need to hear from you! Reach out to us or your program reps when you run into a problem on shift that you think we can help you solve, or that you want us to help you find a way to solve. Find an issue that you are passionate about and craft a resolution on that topic. Don’t feel comfortable with the formal resolution process? Shoot me an email and we’ll build one together. Your council officers will work with you to make sure it captures your vision and helps to set the direction for our organization for years to come.

Members of our board serve within the American Medical Association’s Residents and Fellows Section and are involved in the AMA’s Emergency Medicine Caucus. We serve on tasks forces and working groups within ACEP, AAMC, ABEM, ACGME, and work closely with the leaders of CORD, SAEM, AAEM, ACOEP. The resolutions you submit to the Representative Council guide our conversations and empower us to advocate on your behalf. Reach out to us so we can influence emergency medicine and the house of medicine to fight for what is right for us, for our colleagues, and for our patients.

We need your ideas, your energy, and your passion. What do you want EMRA to do about the opioid epidemic, gun violence prevention, the provision of and payment for health care, and how we obtain and maintain insurance eligibility, board certification, and hospital privileges? Our Board of Directors works for you, and we need to know what you’re passionate about so we can represent you and advocate accordingly.

References

  1. Marshall BDL, Milloy MJ, Wood E, Montaner JSG, Kerr T. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011;377:1429–1437.
  2. Stoltz JA, Wood E, Small W, et al. Changes in injecting practices associated with the use of a medically supervised safer injection facility. J Public Health (Oxf). 2007;29(1):35-39.
Scott Pasichow, MD, MPH

Scott Pasichow, MD, MPH

Scott Pasichow is the 2017-2018 EMRA Vice-Speaker of the Council. He is an emergency medicine resident at Brown University in Providence, RI.
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