By Alexander M. Rosenau, DO, CPE, FACEP
As we come upon the halfway point of my Presidency, I’d like to offer ACEP members an update and share news about exciting things we’re working on for the coming months. For me, the past six months have been intense, as I’ve connected with individual members, groups, organizations and legislators in concert with our strong Board of Directors, expert staff and amazing volunteer physician members. Dialogue, conflict management for a better result, as well as bringing together the right folks for both the challenges at hand and those just over the horizon are daily activities. I’ve cherished every minute. Emergency physicians enjoy a tremendous relationship with each other, and I know we’ve done some things in the past six months to make our bond even stronger – and to appreciate our past even more. In all things emergency medicine, my mantra is “them is us and us is them,” meaning that the common bond we share is much stronger than the forces tugging at us in disparate directions. When you read this update, please know that I will continue to work hard for you over the next six months, and I welcome any feedback. I hope to see you at our Leadership and Advocacy Conference next month and ACEP14 this fall, and please don’t forget to say, “Hey.”
Report Card Garners Major Media Attention
Although we don’t like the results we saw from the release of the 2014 State-by-State Report Card on Emergency Medicine, an overall grade of D-Plus nationwide could have a positive impact on health care moving forward. Our Report Card fostered many a conversation with state legislators. Media outlets have pointed out what we already knew – that several states don’t have the resources and policies in place to support high-quality emergency care. Stories about the Report Card appeared in major newspapers, including The Washington Post, The Chicago Tribune, The New York Daily News, Forbes, The Huffington Post, The Los Angeles Times, San Francisco Chronicle, The Philadelphia Inquirer, Houston Chronicle and The Seattle Times, to name a few. Along with print stories, nearly 800 broadcast stories aired on news organizations including ABC’s World News Tonight with Diane Sawyer, MSNBC, CNN, Fox News’ Your World with Neil Cavuto, Fox Business News, CNBC’s Kudlow and Kramer, WNBC New York, and Telemundo as well as dozens of local television stations across the country. The estimated audience reach was 72.2 million people. Our dedicated spokespersons will continue to make sure the results of this study resonate nationwide. Keep up with the progress at www.emreportcard.org.
ACEP Working on Several Federal Advocacy Efforts
One of the most critical federal advocacy projects we’re currently working on is the support of H.R. 36/S.961, the “Health Care Safety Net Enhancement Act of 2013,” introduced by my 911 key contact, Rep. Charlie Dent (R-PA) in the House and Sen. Roy Blunt (R-MO) in the Senate. The bill provides medical liability relief for physicians providing care under the EMTALA mandate. The House bill continues to gain support and reached nearly 70 co-sponsors last month. Our advocacy team is working diligently on SGR repeal in concert with a number of allies. Although the CBO rated an SGR fix the most affordable ever, Congress failed to settle the offset funding issue and we didn’t get the permanent fix. The previous work of our Washington office in collaboration with our specialty and AMA allies assured prevention of a seriously damaging 24 percent cut in Medicare reimbursements for one year; also extending dozens of other expiring health care-related provisions. ACEP will continue to work with the AMA and other medical specialty societies to encourage members of Congress to take action this year on the permanent repeal of the SGR. We’ve also been working very closely with the Emergency Medicine Action Fund (EMAF) to address regulatory reform under the Affordable Care Act, including areas related to quality measures reporting and reimbursement.
ACEP Now Launched
When the calendar flipped to 2014, ACEP turned its monthly publication up a notch. We wanted to blend the needs of our membership with an edgy editorial vision related more closely to the world we work in. Beginning with a round-table discussion cover story and a compelling piece on breaking down racial barriers in the ED, the new-look ACEP Now hit mailboxes in mid-January and began receiving rave reviews from ACEP members. I hope you like the direction of our new medical editor-in-chief Kevin Klauer, DO, EJD, FACEP, and our new publishing partner, Wiley Press. The new ACEP Now is not only bigger, it features more incisive opinions, “you are there” real articles regarding our decision making and advice from some of emergency medicine’s most renowned physicians. The news from ACEP and events related to the College will always be a part of the magazine, so none of that has changed. What has changed is the attention to detail and open dialogue when opinions differ on controversial issues. If you haven’t seen ACEP Now lately, grab a copy soon. Your feedback is welcome at www.acepnow.com .
Strategic Plan Taking Shape
In leading the annual Board retreat in December, top-level goals and objectives for the college from now until 2017 were debated, prioritized and built for impact. Goal 1: Care transitions and reform of the health care delivery system continue at full gallup. Goal 2 received particular attention with the formation of the Membership Engagement Task Force, the Membership Bylaws Task Force and the Residency Visit Task Force. Your fellow member leaders of these groups, their Board of Director Liaisons, and assigned top level staff are poised for success in member engagement and satisfaction. Here’s an overview of the Strategic Plan:
Goal 1 – Reform and Improve the Delivery System for Emergency Care
- Objective A – Identify, support, and promote delivery models that provide effective and efficient emergency medical and acute care in different environments.
- Objective B – Promote quality and patient safety, including development and validation of quality measures.
- Objective C – Pursue strategies for ensuring fair payment and practice sustainability.
- Objective D – Pursue solutions for workforce issues that ensure access to high quality emergency care.
- Objective E – Advocate for meaningful liability reform at the state and federal levels.
- Objective F – Communicate the value of emergency medicine as an important component of the health care system.
Goal 2 – Enhance Membership Value and Member Engagement
- Objective A – Increase total membership and transitioning resident retention.
- Objective B – Provide robust educational offerings, including novel delivery methods.
- Objective C – Support member well-being.
- Objective D – Ensure adequate infrastructure to support growth.
Building Bridges and Strengthening Relationships
My other mantra is to connect ACEP with others who share our passion for quality health care. If we build bridges and enhance our synergy with other health care organizations, we benefit and so do our patients. We’re currently working to provide input to ABEM for recognition of Clinical Ultrasound for subspecialty certification. This will improve education, continue to allow Ultrasound use for patient care by all members meeting ACEP guidelines and validate point of care as a reimbursable item. This contributes to our value. Our relationship with CORD continues to grow, as does our joint work with CORD and SAEM in GME matters. EMRA has a new executive director and our relationship with EMRA could not be stronger. We’re proud to announce the recent ACEP/SEMPA Advanced Practice Provider Academy drew rave reviews and more than 300 physician assistant and nurse attendees. I participated as our two organizations penned a new five-year management service contract in New Orleans last month. I directed a new task force be formed to reach out to identify opportunities for collaboration with the Society of Hospitalist Medicine. When it comes to building bridges, there are many organizations whose activities, benchmarks and plans have relevance to us. That is just one reason our executive director, Dean Wilkerson, has been such an asset to our organization for the past decade. We meet by phone at least weekly, communicate via email most days. Your Board members are out and about on a national scale gathering information, forming relationships and honing the judgment that all of you expect your elected leaders to use. I personally appreciate their diplomacy and expert work.
Two Clinical Policies Reviewed
ACEP reviewed two Clinical Policies recently. In response to the Council- and ACEP Board–adopted Amended Resolution 32(13), the “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department” is being reviewed. The Clinical Policies Committee, as per council, accepted comments until March 24. Findings and any recommendations regarding the policy will be reported to the ACEP Board in June. Also, per the resolution, future clinical policies will include a 60-day comment period before finalization. A Clinical Policies Subcommittee of ACEP completed a draft clinical guideline in late March, “Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients with Suspected Acute Non-Traumatic Thoracic Aortic Dissection.” It’s open for comments until May 28, 2014. To view the draft policy and comment form, go to http://www.acep.org/content.aspx?ekfrm=96266. For questions, please contact Rhonda Whitson at email@example.com.
Quality Measures and Reimbursement
ACEP has accepted donated emergency medicine quality measures from other organizations, and we’re developing our own for member benefit (both for CMS incentive and avoidance of CMS penalty). These steps, in addition to our continuing education on reimbursement and coding, add value to your bottom line and salary. We’ve had several recent articles, webinars and a spring conference devoted to Reimbursement and Coding, helping you prepare for reimbursement issues, the eventuality of ICD-10 and PQRS benefits in concert with ABEM.
ACEP’s Official Mobile App Improved
The official ACEP mobile app, an essential resource for members and other emergency care providers, received an upgrade early in 2013 to make navigation easier and to improve the design. The next phase of upgrades is currently being implemented. This includes the addition of several links to education resources from ACEP’s bookstore, audio recordings from the monthly Education on Demand newsletter and a section where emergency medicine news published in ACEP Now can be found. You can also find a secure Member Directory, a personalized Member Guide that reflects your chapter and sections, an events calendar and ACEP’s clinical policies. If you don’t have ACEP’s app on your phone, download it today for iPhone or Android devices.
EMF Continues Endowment Push
Since October, EMF has launched a new logo and continues the momentum of the ACEP $1 million match to bring the endowment to maturity with a corpus of $2.5 million. To help achieve this goal, for every dollar contributed to EMF before June 30, EMF will match it with a contribution of 50 cents toward the endowment. EMF has a new board and a new Strategic Plan. It’s Goals and Objectives are to:
- Goal 1 – Position EMF as the principal sponsor of scientifically rigorous research and education to to improve the care of the acutely ill and injured and policy research that aligns with emergency care priorities
- Goal 2: Increase EMF’s capacity to engage more people in emergency medicine research and award more grants
- Goal 3 – Position EMF as the premier 501(c)(3) emergency medicine foundation
- Goal 4 – Increase EMF revenue to fund more research grants and education projects
Please go to www.emfoundation.org, and make EMF your charity of choice.
Annals Added to eCME Options
In collaboration with ACEP’s online education program, articles from the Annals of Emergency Medicine are being offered as a CME component. As of April 2014, there were 13 Annals-based articles available to members. ACEP looks forward to seeing this educational offering become a robust element of ACEP’s overall online education program. Learn more at www.acep.org/ecme.
Concurrent with the inauguration of the eCME program, Annals announced that it would continue its relationship with long-time publisher, Elsevier. The five-year contract runs through December 2018, and provides a solid and stable financial basis for journal revenues. The contract provides a generous editorial office stipend along with a guaranteed minimum royalty, enabling Annals to contribute substantially toward the overall financial success of the College.
ACEP Continues to Add Value, Enhance Image
The continued strength of our specialty requires us to do some heavy lifting in areas such as keeping prudent layperson as a recognized part of the ACA, working toward an SGR fix and changing perception about the cost of emergency care. Working together, we will make progress. As a result, our place in the House of Medicine will be enhanced. And we’re building strong connections with others while providing service to our chapters as they protect the interests of our members. Chapter efforts in Washington state and most recently in Virginia underscore the need for our teamwork. We believe that Steve Stack will become the AMA’s first ever Emergency Physician President. We have a real chance for the AMA to continue its re-invigoration with a clear view of EM’s contribution to the house of medicine because of his upcoming service. If you have any membership dollars available in your professional budget, I hope you consider making this year one in which you might become an AMA member to bolster our ACEP delegation at the AMA. There are certain things that are more do-able when we have a strong delegation within the AMA, whether advancing our cause within the house of medicine or in our negotiations at the RUC.
Spring Conferences in Full Swing, LAC Coming Up
ACEP’s busy spring conference lineup began in February with the Reimbursement and Coding Conferences in New Orleans. With the upcoming changes in coding and the implementation of the Affordable Care Act, payment topics have become even more popular and necessary. More than 200 emergency physicians participated in the February 2014 conference. Your next chance to brush up on your knowledge in this area is March 2015 when the R/C Conferences move to Las Vegas.
The 2014 Advanced Pediatric Emergency Medicine Assembly was held in New York City in March and drew more than 550 four-day registrants. This is the highest number in four years.
ACEP’s newest offering, the Advanced Practice Provider (APP) Academy, recently wrapped up. More than 300 attendees received a crash course in emergency department essentials. Held in conjunction with SEMPA, this conference is vital for emergency department providers who might be new to the ED or need help in certain areas. The demand for this conference was high and feedback positive, so ACEP and SEMPA have decided to hold a second installment of Phase I in August. The conference has also been renamed Emergency Medicine Academy.
ACEP’s Leadership and Advocacy Conference will be May 18-21 in Washington, D.C. If you’ve never been to this conference, you’re missing one of the best three days of education and networking available. Thought-provoking, inspiring and challenging sessions by nationally recognized speakers and key decision makers will provide you the inside information and skills you need to maximize your impact as an emergency medicine leader and advocate. Invited Speakers for the Conference include: U.S. Sen. Ron Wyden (D-OR); U.S. Rep. Andy Barr (R-KY); Amy Walter, Political Analyst for the Cook Political Report; Patrick Conway, MD, Deputy Administrator for Innovation & Quality & CMS Chief Medical Officer. Please plan to come to Washington, D.C., next month to network with ACEP leaders and advocate for your specialty.
Please remember the elevator speech when you run into your hospital leaders and legislators:
We are 4% of the physician workforce seeing 28% of all acute care visits. We are the doctors of first contact, unscheduled, federally mandated care regardless of financial status. We are over 32,000 ACEP members seeing 130 million patient visits, 24/7/365 for about 4% of the national healthcare dollar. Our customers include primary care docs who send their patients to us for complex medical diagnostic work-ups. We are the portal of entry for 75% of all hospital admissions. We are the hub of the enterprise, and are working toward being masters of transitions of care. We are not only expected to be the admittors, but also the admitting avoidance service through our work in care coordination. And we do this in a room, in a hallway, in ‘copters and ambulances during disasters large and small every shift of every single day.
Thanks for the Past Six Months
I started my EM practice in the 1980s, and there are many reasons I value membership and the friends I’ve made over the years. I can pick up a phone and dial a colleague anywhere for advice. Like all families and all democratic groups filled with the riches of a knowledge-based constituency, we will have disagreements and some conflict. It’s all for a better result and a strong organization, as long as we stick together. The knowledge I’ve gained in reimbursement and coding and practice management has paid me back every dollar I ever contributed to ACEP, EMF and NEMPAC. The education I’ve received at conferences has made my practice better and improved the care of my patients. I was proud to join ACEP then, and I’m proud to be its President today. ACEP is growing. ACEP is dynamic. ACEP gives you a good return on your dues investment dollars. Your partners, your colleagues are the members of the committees, task forces, sections, Board, Council, and technical expert panels that create our future. Let’s connect. See you at LAC and ACEP14.
Alexander M. Rosenau, DO, CPE, FACEP
President, American College of Emergency Physicians
Apologies for the delay, but here it is, better than ever! Highlights:
-Advance directives and EMS cardiac arrests in Oregon: do they agree?
-Organ donation after cardiac arrest? Ethical and practical issues
-Is outpatient ED care profitable?
-Reimbursement effect of the ACA
-A Standardized Mortality Rate for EM
-Bells Palsy in the ED: how often do we have it right?
-Does it matter which thrombolytic or dose, for ischemic stroke?
And much more…. Email anytime at firstname.lastname@example.org.
What other jobs allow you to stay up all night long, party with crazy people, and get paid for it?
That’s what I like to say every New Year’s Eve. New Year’s Eve is my favorite shift, and it’s because of the people.
They are what keep me going in this career: the people, the crazy people, and I don’t mean just the patients.
Docs, nurses and techs all have to be a little bit loony to enjoy this job as well. It is the best job in the world! I come to work not knowing exactly what I will be doing, and even while working we never know what’s going to happen next.
Time-bombs are lurking in the humdrum of the daily routine. Our job is to identify them and defuse them. This keeps us on our toes, and this keeps me intrigued. When I can solve a medical puzzle, I am intellectually rewarded. When I can help someone I am gratified. When I can make a child smile I am happy. I can’t figure everything out or everybody out but I can sure have fun trying! This is why I continue my career of emergency medicine.
Why did I make it my career in the first place?
It looked exciting, isn’t that why we all chose it?
Please register for the next Quality Improvement & Patient Safety (QIPS) “All Section Webinar,” which will feature a presentation from ACEP leaders Dennis Beck, MD, FACEP & Rick Newell, MD, FACEP on the 2014 Updates to the CMS Physician Quality Reporting System (PQRS) and the Physician Value-Based Payment Modifier (VBM) with input from Mike Granovsky, MD, FACEP.
This webinar will take place 11:00 a.m. EDT on Tuesday, April 1.
- Learn about CMS new requirements for the 2014 PQRS incentive and the 2016 payment adjustment and the PQRS measure set as follows. The penalty for failure to report PQRS has increased from 1.5% to 2%, and non-reporters will also be penalized with an additional 2% penalty for the new Value-Based Modifier.
- Learn which measures to report in order to earn the PQRS Incentives CMS requires eligible professionals to report 9 Measures Across 3 NQS Domains via the claims-based or registry reporting mechanisms
- Understand the Measures Applicability Validation (MAV) process, which will allow CMS to determine whether an eligible professional should have reported quality data codes for additional measures.
Please register here or click on the link below and be sure to add the event to your calendar after registering.
Tuesday, April 1 at 11:00 a.m. ET
Dial in Number: 1-877-366-0711
Participant Code: 14253069
Sorry for the late notice, but the March audio summary is up. Highlights:
-Gestalt in the ED for diagnosing PE and ACS: we’re overdoing it
-Radiation exposure among zero and near-zero risk patients: we’re overdoing that too
-Editorial: Should patients pay when asking for unnecessary testing?
-Topical anesthesia for mouth ulcers in kids: a RCT
-EHRs in the ED: associated with more imaging, medication, and testing of all kinds
-Health Info Exchanges: need to be better
-Central line infection prevention: tougher than it sounds
Email any time, and thanks for listening as always,
By: Seth R. Gemme, MD
The ACEP Clinical Policies Committee regularly reviews guidelines published by other organizations and professional societies. Periodically, new guidelines are identified on topics with particular relevance to the clinical practice of emergency medicine. This article highlights recommendations for the education, recognition, and management of concussions, published by the American Academy of Neurology in June, 2013.
Concussions have become a popular topic of concern in the media and with the public over the last several years as many amateur and professional athletes have had career ending head injuries. According to the Centers for Disease Control and Prevention, concussion visits to the emergency department have increased, likely as a result of the increased awareness. Thus there is a need for a better understanding of the neurocognitive pathology and risks associated with a concussion.
In June of 2013, the American Academy of Neurology (AAN) published a guideline focusing on the risk factors of concussion, clinical features associated with worse outcome, and management. They graded the literature since 1955 using a modified version of the GRADE working group process and made recommendations using a modified Delphi process.
Various risk factors were investigated. There was not enough evidence that age made a difference in risk of concussion. With regards to gender, men make up the majority of concussions, likely due to more men playing contact sports, with the greatest risk in American football and Australian rugby. Females were found to be at higher risk if participating in soccer or basketball versus other sports. There is no evidence that mouth guards protect athletes from concussion in any sport. In American football, there is no evidence regarding superiority of one type of football helmet in preventing concussion. Other factors associated with greater risk include a BMI of greater than 27 or training for less than three hours per week. In addition, it is likely that there is an increased risk for repeat concussion within 10 days of the initial concussion.
Clinical features associated with severe or prolonged early postconcussion impairments include a history of prior concussion, early post-traumatic headache, fatigue or fogginess at the time of diagnosis, early amnesia, altered mental status or disorientation, or younger age. Increasing concussion exposure is a risk factor for chronic neurobehavioral impairment in a broad range of professional contact sports but evidence is insufficient in amateur sports of whether or not prior concussion exposure increases chronic cognitive impairment.
The AAN recommends that school-based professionals, athletes, and parents be educated by a designated licensed health care provider (LHCP) about concussions in general and associated risks. A LHCP is one who has acquired skills and knowledge relevant to the evaluation and management of sport concussions and is practicing within his or her scope of practice. This can be either a sideline or clinical LHCP. AAN also recommends that assessment tools be used by the sideline LHCP and those results be made available to the clinical LHCP. One sideline tool discussed is the Standardized Assessment of Concussion which can be administered in 6-minutes and assesses orientation, immediate memory, concentration and delayed recall. Other sideline tools discussed include the Post-Concussion Symptom Scale and the Graded Symptom Checklist which also may be administered in a short time interval and identify concussion.
Two important grade B recommendations are that team personnel should immediately remove any athlete from play with a suspected concussion and that the athlete not be allowed to return until evaluated by the LHCP. It is also recommended that no player should return to play until a LHCP has deemed the concussion to be resolved after being off all medications. A graded process for return of play is recommended with consideration given for formal neurocognitive testing. This makes it essential that patients with a concussion who are discharged from the ED follow up with a LHCP in the outpatient setting.
Per this guideline, in the diagnosis of a concussion, head CT scan is not indicated unless other more serious complications are possible. Factors they deemed as risks in their recommendation include loss of consciousness, post-traumatic amnesia, persistence of a GCS<15, focal neurologic deficit, clinical skull fracture, or clinical deterioration. The guideline does not go into any more detail with regards to imaging.
As an athlete gets older and enters more competitive sports, there is a high level of pressure to get back to play. With continued awareness programs and through this guideline, physicians, parents, coaches, and athletes may be able to reduce risk of recurrent concussions and help prevent long-term neurobehavioral impairment.
Summary of evidence-based guideline update: Evaluation and management of concussion in sports. Neurology. June 11, 2013;80(24):2250-2257.
Dr. Gemme is a resident in emergency medicine at Alpert Medical School of Brown University, and is the 2013-2014 EMRA Representative to the ACEP Clinical Policies Committee.
By Francis L. Counselman, M.D., CPE, FACEP
In the August 2013 issue of ACEP News, the various pathways available to current and future emergency medicine residency graduates to achieve Critical Care Medicine (CCM) certification through fellowship training were reviewed. In this issue, the options available to ABEM diplomates who completed a Critical Care Medicine fellowship prior to the establishment of the current pathways will be discussed.
First, there is no “practice only” pathway for Critical Care Medicine. All CCM certification requires successful completion of ACGME-accredited CCM fellowship training, and practice of Critical Care Medicine. Secondly, there is no “grandfather” pathway available through the American Board of Surgery (ABS) for Surgical Critical Care. This decision by ABS was made for internal policy consistency, and there are no exceptions. Finally, like all “grandfather” pathways, there is a time-limited window during which one can apply for certification. Please make yourself aware of these dates.
American Board of Internal
Medicine (ABIM) Critical Care Medicine
For Internal Medicine-Critical Care Medicine (IM-CCM), the “grandfather” pathway requires both the completion of a 24-month CCM fellowship and the practice of Critical Care Medicine. This pathway is scheduled to close on June 30, 2016. For the 24-month CCM fellowship to count, it must meet one of the following criteria: a) an ACGME-accredited IM-CCM fellowship completed prior to September 21, 2011; b) an unaccredited IM-CCM fellowship that subsequently became ACGME-accredited on or before December 31, 1992; or c) an ACGME-accredited fellowship in another critical care specialty (i.e., Surgical CCM, Anesthesiology CCM).
The second component, the practice portion, is a little more complicated. The EM applicant must have met the practice criteria as of the date on which the application is submitted to ABEM. For at least three years, not necessarily contiguous, of the five years prior to submitting the application (including the 12 months immediately prior to submission), the applicant must have met one of the following criteria: a) 40% of post-training clinical practice time in the practice of CCM; or b) 25% of total post-training professional time in the practice of CCM.
Finally, for those ABEM diplomates who completed an ACGME-accredited IM-CCM fellowship in the recent past (i.e., between September 21, 2008, and September 20, 2011) criteria can be met if, during 60% of the time between completing fellowship training and applying for certification, the applicant completed one of the following: a) 40% of post-training clinical practice in the practice of CCM or; b) 25% of total post-training professional time in the practice of CCM. For example, if an applicant completed fellowship training on June 30, 2011, and applied for certification on July 1, 2013, 60% of the time (i.e., 24 months) would be 14.4 months. So, during that 14.4-month period between completion of fellowship training and application submission, the applicant must meet either the 40% or 25% criterion, as described above.
Physicians whose total practice exceeds 40 hours per week may use 40 hours as the denominator for the “40%” or “25%” calculations for either of the above scenarios.
American Board of Anesthesiology (ABA)
Critical Care Medicine (ACCM)
ABEM diplomates seeking certification through the “grandfather” pathway must have completed both an ACGME-accredited ACCM fellowship program (one or two years in length) and the CCM practice component by the time of application submission, and no later than June 30, 2018; this is the final date of the last application period within the grandfather pathway. The ACCM fellowship training must have been started prior to July 1, 2013. In order for the fellowship program to count, it must have been ACGME-accredited at the time of the applicant’s training; it does not count if the fellowship subsequently became accredited.
For the practice component, during the two years immediately preceding the application submission, the applicant must have completed one of the following: a) 40% of post-training clinical practice time in the practice of CCM, or; b) 25% of total post-training professional time in the practice of CCM. For either calculation, if total practice time exceeds 40 hours per week, 40 hours may be used as the denominator for the “40%” or “25%” calculation.
For both the IM-CCM and ACCM eligibility criteria, the “practice of CCM” is strictly defined. An acceptable practice must occur in a designated critical care unit. Caring for critically ill patients in the ED does not count toward the practice component. For more detail on what constitutes the practice of CCM, please visit the ABEM website at www.abem.org
For all CCM subspecialty pathways, the ABEM diplomate must: meet the requirements of the ABEM Maintenance of Certifications (MOC) program at the time of application and throughout the certification process; be in compliance with the ABEM Policy on Medical Licensure; and provide information about someone who can independently verify the physician’s clinical competence in CCM, successful completion of ACGME-accredited CCM fellowship training, and the physician’s practice of CCM. No opportunities for CCM certification existed just two years ago for emergency physicians, but we now have three pathways going forward, including two grandfather pathways. It is a very exciting time for emergency physicians interested in Critical Care Medicine. The opportunities that now exist are the direct result of the hard work, persistence, and energy of many of our colleagues. To all involved, “Thank you!”
Dr. Counselman is Chairman of the Department of Emergency Medicine at Eastern Virginia Medical School, and President-elect of ABEM.
Here’s a link to the first article in this two-part series
Why I will be an Emergency Medicine Physician
By Joey Leary – LECOM- Bradenton Class of 2014
Living in rural Haiti before medical school was my introduction to the field of emergency medicine. Having studied the religion, politics, and culture of the country as an undergraduate anthropology student, my move to the city of Leogane, Haiti in order to volunteer for the University of Notre Dame’s public health initiative to eradicate lymphatic filariasis had context. Further, Dr. Paul Farmer MD, acclaimed anthropologist and physician, had uprooted to this same region years ago. I intended to use my gap-year in a meaningful way which might later give me strength and perspective during my anticipated life as a physician. Today, four years later, it is with this attitude that I reflect upon the 2010 earthquake, and am thankful for my role in one of the most extraordinary tragedies of the century. In the absence of a functioning hospital or any doctors, I was looked to as a physician. The frustration and impotence I felt that day as a first responder has guided me toward a career in emergency medicine.
When the sun came up on Jan 13th, twelve hours after the first earthquake which immediately killed one hundred thousand and would be responsible for the deaths of one hundred and fifty thousand more, I considered how to be most useful. I was exhausted after a sleepless night of walking and hitchhiking the twenty miles from Port au Prince to Leogane, the city which turned out to be closest to the quake’s epicenter. Once back, searching through a partially collapsed Hospital St. Croix looking for friends and trying to call home occupied my time, not sleep. With the destruction of the town’s only hospital, locals began laying the wounded and dead in a field in front of a nursing school, hoping for any sort of expertise. I decided that distributing water and ibuprofen from my first aid kit to a field filled with compound fractures, head injuries, deep lacerations, and amputations, to name a few of the horrific injuries, was the most practical and useful thing for me. When I met an American nurse practitioner, Michelle Sare – founder of Nurses for Nurses International, and was asked to amputate a finger and start splinting arms and legs, my perception amongst the wounded changed. Family members begged me frantically to do something as their loved ones slowly died from internal bleeding, respiratory failure, and renal failure. That day was remarkable in every sense of the word.
Two months of rotations in Memorial Hospital’s level one trauma center in South Bend, Indiana as a third year medical student confirmed my suspicion that emergency care is for me. I couldn’t help but marvel whenever I would see a patient with an injury similar to one I saw in Haiti. The pride that I take in knowing how to treat these acute injuries when confronted a second time is immense. I feel like a wizard when I am able to relieve pain with several well calculated thrusts, a splint, or some well-placed lidocaine. I hope to have more of these skills at my disposal so there will not be a crisis that I am unqualified to respond to.
The most valuable opportunities that have come my way; a chance to volunteer in Haiti, a chance to study dengue fever in the amazon, a chance to work as a camp counselor in Colorado, have always been a result of my enthusiasm and hard work. These qualities, in addition to my unique motivation born out of natural disaster, give me reason to believe that I would make a great emergency physician. Regardless of the matching service’s determination, the moment I step off the plane in Port au Prince this June after graduation, I will be an emergency medicine doctor.
This month’s Annals audio, a look at the national report card on EM, is now posted and available. Highlights:
-The American College of Emergency Physicians has released their comprehensive national and state-by-state report cards on the status of emergency medicine in the United States. We do a brief summary and review.
-The new College clinical policy on procedural sedation and analgesia.
ALIVE – AGAIN
By Bruce D Janiak, MD, FACEP
A 40-something female came into our ED with some confusion, low BP, and tachycardia. EKG and labs were normal, but she continued to deteriorate despite appropriate treatments. The cardiology fellow was with me when she arrested, and despite ACLS protocol, we were unsuccessful in our resuscitative efforts. She was pronounced dead.
As the cardiology fellow and I were discussing her case outside of the room, the monitor began to show a spontaneous rhythm. She regained a pulse and BP and was admitted. Later that day she arrested again and after unsuccessful efforts was pronounced dead (again)!
Then she revisited her Lazerus process and spontaneously recovered.
Some two weeks later she came to the ED to see me saying “Dr Janiak, thanks for your efforts. I could hear you guys talking about me during the whole resuscitative process”
(Yes, this really happened!)