AAEM Position on APPs

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Here's the email text that AAEM sent:

We Hear Your Concerns About the Role of APPs

The AAEM leadership has, with increasing frequency, heard concerns from its membership about the evolving use of advanced practice providers (nurse practitioners and physician assistants - APPs)* in our emergency departments. The use of APPs in our emergency departments is not new. There is a long history of including APPs as an integral part of the emergency department team.
The concerns brought to the Academy's attention highlight that the use of APPs is increasing, that they are being used in clinical scenarios that may be beyond their capabilities, that APPs are viewed as a less expensive alternative to a board certified emergency physician, and that APPs are seeking the independent practice of emergency medicine. These concerns affect all AAEM members and AAEM/RSA members as they advance into EM careers.

Task Force Formed & Position Statement Created

For the last year a task force convened by the AAEM board of directors has explored these issues. While there is still work to be accomplished by this task force, they have reviewed the available literature, the current training requirements of APPs as compared to emergency physicians, and the current utilization practices. The board has decided to adopt a new position statement on the use of APPs in the emergency department. The statement below stresses the importance of an emergency physician-led team approach to care that may utilize APPs in a supervised fashion. AAEM's position statement is a pro-active step to protect employment opportunities for board certified emergency physicians and upcoming residents & students.

Allied Health Membership Dissolved

Additionally, the AAEM board of directors has decided to dissolve the allied health membership in AAEM as of January 1, 2019. The Academy is an organization of emergency physicians that exists to serve emergency patients and physicians. The Academy feels that this is a pivotal time in our evolving specialty. We have established and defined this specialty and we believe strongly that patients presenting to an emergency department expect and deserve to be evaluated and treated by a team that is led by a physician specialist in emergency medicine. All patients should have unencumbered access to that physician if desired by the patient or dictated by the clinical setting. The use of inadequately supervised APPs to staff emergency departments is as big a threat to our specialty as the use of non ABEM/AOBEM physicians. The first principle in our mission statement echoes this sentiment and continues to be a guiding force for AAEM as an organization.

Champion of the Emergency Physician

AAEM will continue to provide outstanding educational opportunities for APPs and a discounted rate for attendance at the AAEM Scientific Assembly and other educational offerings. These actions are not a statement against the great value of the properly supervised use of APPs in the emergency department, but a statement against the possibility of APPs being utilized to replace board certified emergency physicians.
AAEM and AAEM/RSA will continue to tirelessly advocate for you and for our speciality.

Sincerely,
AAEM Board of Directors
[email protected]
 
AAEM's position statement is a pro-active step to protect employment opportunities for board certified emergency physicians and upcoming residents & students.
Great statement, but I hope they have to good sense to never say this out loud again. That's just asking for trouble (always frame it as a patient safety issue, which admittedly is what the OP's link does).
 
Members don't see this ad :)
Great statement, but I hope they have to good sense to never say this out loud again. That's just asking for trouble (always frame it as a patient safety issue, which admittedly is what the OP's link does).

Why? Being constantly scared of offending anyone is the reason this crap proliferates so much.
 
Why? Being constantly scared of offending anyone is the reason this crap proliferates so much.
Because a statement like that makes the whole thing seem self-serving.

No one outside of EM (maybe medicine as a whole if we're being generous) cares if EPs have jobs. Everyone else cares that if they end up in the ED they get good care. That's the part you go after. Talk about how the best care comes from an EP-led team. Talk about how EPs get 3+ years of training that is entirely designed to make them the best at working in the ED. Contrast that with APPs who might get 1-2 months of ED time in their training. Compared total hours of training.

You don't say that this entire campaign is to make sure that current and future EPs have jobs.
 
This isn’t anything personal towards APPs but I love the fact that AAEM grew a set of steel balls to take a position that maximizes protection for physicians. Way to go guys. Damn, almost made me want to quit my ACEP membership and go all AAEM. (Currently have both.)

I can’t imagine what the nursing organizations are going to say when they get wind of this one. Get ready for the gnashing of teeth and screeching.
 
Everyone should drop ACEP and join AAEM.
If AAEM is dissolving it’s membership for allies health, they will need the money to make these changes happen
I’m not EM at all. But I have been posting here hoping to inspire all of you to take back medicine. We are stronger together!
 
AAEM has been on the right side of this issue since day 1, and pretty much every single issue that pertains to EM physicians, since they aren't owned by TeamHealth coughACEPcough.

ACEP would NEVER have the balls to say something like this:
"Every practitioner in an ED has a duty to clearly inform the patient of his/her training and qualifications to provide emergency care. In the interest of transparency, APPs and other non-physician clinicians should not be called ‘doctor’ in the clinical setting."

While all of my money will be going to AAEM, there's no question that they lack the same political clout that ACEP has. This is primarily due to lack of membership. Instead of giving your money away to ACEP who is clearly selling all of us out, I would give all my money to AAEM for this position statement alone.
 
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As an SDG guy I’m a big fan of AAEM, but I’ll actually be the lone pro ACEP voice. For me, AAEM is kind of like the libertarian party. I love most of what they have to say, but voting libertarian doesn’t enact change since they lack the clout to influence most of the issues. Luckily we don’t have just one vote. I like the idea of belonging to both. I can get involved with ACEP to help enact meaningful change in the system (fight insurance companies, influence laws, etc). I can also belong to AAEM in the hopes that some day they achieve critical mass to gain a seat at the table.
 
FAAEM here.

Eligible for FACEP this year and trying to decide if worth it. I align far more with AAEM, of course. Curious if others feel as @Hercules does since it's a salient point.
 
They will be getting my money based on this policy statement alone.
 
Members don't see this ad :)
This isn’t anything personal towards APPs but I love the fact that AAEM grew a set of steel balls to take a position that maximizes protection for physicians. Way to go guys. Damn, almost made me want to quit my ACEP membership and go all AAEM. (Currently have both.)

I can’t imagine what the nursing organizations are going to say when they get wind of this one. Get ready for the gnashing of teeth and screeching.

I quit ACEP recently because of this very issue, and the fact that ACEP is run by CMG overlords.
 
This isn’t anything personal towards APPs but I love the fact that AAEM grew a set of steel balls to take a position that maximizes protection for physicians. Way to go guys. Damn, almost made me want to quit my ACEP membership and go all AAEM. (Currently have both.)

I can’t imagine what the nursing organizations are going to say when they get wind of this one. Get ready for the gnashing of teeth and screeching.

It's crazy to me that, in the current climate, putting out this common-sense statement is considered having "steel balls." NP lobbying is way too powerful.
 
We live in a politically correct age in medicine.

If you tell a nurse that they did something wrong that negatively affected a patient outcome, you will be reported to a nursing supervisor and having to take an online anger management module.

If you call an NP a "midlevel provider" that is apparently offensive and no longer considered acceptable, they have to be called "Advanced Practice Providers" which in a way makes them sound even more capable/competent than they are.

If you are a male surgeon, you can't wear a scrub hat, you have to wear a bouffant because it makes you look less like a physician and "more part of the team"

One of my friends form medical school is working at a hospital where they were told they would no longer refer to a portable workstation as "COWs" (computer on wheels) since a nurse overheard that term and found it offensive and thought people were making fun of her. They are now called "WOWs" (workstation on wheels) which exudes a more positive connotation.

If you are a physician, you are now lumped into the term "provider" so that you are essentially an equivalent member of the team as the NP who took an online class and wears a white coat with more initials embroidered on it than you.

This is the world we live in, people. This is what things have come to. The erosion of what it means to be a physician is really, frankly, no joke. It is now harder than ever to become a physician, you have to take on more debt than ever, and the fund of knowledge/medical legal risk is higher than ever before, yet physicians are being pushed down to the bottom of the ladder because groups like ACEP do not sufficiently advocate for their interests.

Thank God AAEM has the courage to at least show something that resembles "steel balls".
 
Because a statement like that makes the whole thing seem self-serving.

No one outside of EM (maybe medicine as a whole if we're being generous) cares if EPs have jobs. Everyone else cares that if they end up in the ED they get good care. That's the part you go after. Talk about how the best care comes from an EP-led team. Talk about how EPs get 3+ years of training that is entirely designed to make them the best at working in the ED. Contrast that with APPs who might get 1-2 months of ED time in their training. Compared total hours of training.

You don't say that this entire campaign is to make sure that current and future EPs have jobs.
Ah, but it's not a public relations piece. It's the professional society with a stated mission to stick up for us sticking up for us. For us.
 
Join AAEM, quit ACEP.

Singed,
Wilco World MD, FAAEM
Didn't renew ACEP after residency.
Renewed AAEM and donated what ACEP would have cost to AAEM PAC from my CME. Will continue this indefinitely.

TooMuchResearch, MD, FAAEM, EffACEP
 
Ah, but it's not a public relations piece. It's the professional society with a stated mission to stick up for us sticking up for us. For us.

Well if all we want is good feels and rahrahrah, go for it. If we actually want a job with salaries high enough to pay off student loans, physicians need to start figuring out that public relations is the entire game. The corporations sure don't care about our concerns and the politicians will only care if the public cares. You have mid-levels telling John Q. Public (who is making <$40k a yea), that they care more, have more time, cost less, and are just as good if not better than physicians. Physicians should be saying medicine is hard, physicians have made significant personal sacrifices to do it well, and there are no shortcuts. Instead we come clomping in whining about how "we only make $250k/yr now instead of $350k/yr and oh why do all you dinguses come into the ED with things that are clearly not emergencies and why do I have to care if you're happy with your care". And don't get me wrong, those are legitimate complaints which ultimately affect the quality of healthcare but the argument requires a level of nuance that isn't realistically going to lead to any change.
 
an organization becomes stronger by having more $$$. And this can only happen by having many members join and donate to their PAC....that's how it happens. If everyone joins AAEM and gives the finger to ACEP-it will become the dominant voice. And if they are too liberal for you then get involved in their leadership, get a seat at the table and change that liberal tone.
 
Clearly, but it's now been published for all to see...

VA Hopeful Dr is correct. As much as I am about stickin' it to the man and standing up, we essentially need to market ourselves better and patient safety should be the number one selling point. We can't say that we're going to be advocating for physicians only just for the sake of it because corporate medicine will leave us in the dust if they can turn a better profit and start moving to mid levels. Unfortunately, we are just a means to an end and just peons at this point (especially EM docs, less so specialists) and will be replaced as soon as corporations will have it. Patient outcomes and safety should be what we're aiming for because we're more experienced and experience gives us the leg up. At this point if we don't have a better marketing strategy then we will get replaced for a cheaper option as soon as they can do it and it's already eroding away.

This is an extremely cynical post but I think it's reality. In the end the enemy is corporate medicine because their goal is money. So how can we translate our skills into making them more money? By showing patients that they're safer in our hands. Until we change what's funding us then we're stuck with this ****ty battle and threat of being replaced.
 
VA Hopeful Dr is correct. As much as I am about stickin' it to the man and standing up, we essentially need to market ourselves better and patient safety should be the number one selling point. We can't say that we're going to be advocating for physicians only just for the sake of it because corporate medicine will leave us in the dust if they can turn a better profit and start moving to mid levels. Unfortunately, we are just a means to an end and just peons at this point (especially EM docs, less so specialists) and will be replaced as soon as corporations will have it. Patient outcomes and safety should be what we're aiming for because we're more experienced and experience gives us the leg up. At this point if we don't have a better marketing strategy then we will get replaced for a cheaper option as soon as they can do it and it's already eroding away.

This is an extremely cynical post but I think it's reality. In the end the enemy is corporate medicine because their goal is money. So how can we translate our skills into making them more money? By showing patients that they're safer in our hands. Until we change what's funding us then we're stuck with this ****ty battle and threat of being replaced.
How do you show people that they're safer in your hands if none of your professional organizations (*ahem* ACEP) will stand up for this issue. Pretty sure ACEP funded a NP "residency". That's like shot in the gut for what you are proposing.
 
How do you show people that they're safer in your hands if none of your professional organizations (*ahem* ACEP) will stand up for this issue. Pretty sure ACEP funded a NP "residency". That's like shot in the gut for what you are proposing.

I completely agree with you. I think ACEP can go F themselves with that and I definitely agree with AAEM's statement but I don't think it went far enough and needs to advocate for us in a marketing aspect. I understand the term marketing is a crude term, but it's exactly what we need to do in this kind environment. For now the public knows that physicians are the standard of care and the top of the ladder, but corporate medicine and NP and PA advocacy/lobbying groups will slowly try to erode that publishing garbage studies of non-inferiority. Like someone above mentioned, we need to put money where our mouths are and fund the correct groups/PACs. The erosion is inevitable, but the loss of jobs, I believe, is not.

Yes, this seems like a "sky is falling" kind of post, but better to have it now and be aware of possible issues than it sneak up under our noses.
 
I completely agree with you. I think ACEP can go F themselves with that and I definitely agree with AAEM's statement but I don't think it went far enough and needs to advocate for us in a marketing aspect. I understand the term marketing is a crude term, but it's exactly what we need to do in this kind environment. For now the public knows that physicians are the standard of care and the top of the ladder, but corporate medicine and NP and PA advocacy/lobbying groups will slowly try to erode that publishing garbage studies of non-inferiority. Like someone above mentioned, we need to put money where our mouths are and fund the correct groups/PACs. The erosion is inevitable, but the loss of jobs, I believe, is not.

Yes, this seems like a "sky is falling" kind of post, but better to have it now and be aware of possible issues than it sneak up under our noses.
There are groups out there....they are smaller though. Pretty sure I can't cross-post and mention them.
 
VA Hopeful Dr is correct. As much as I am about stickin' it to the man and standing up, we essentially need to market ourselves better and patient safety should be the number one selling point. We can't say that we're going to be advocating for physicians only just for the sake of it because corporate medicine will leave us in the dust if they can turn a better profit and start moving to mid levels. Unfortunately, we are just a means to an end and just peons at this point (especially EM docs, less so specialists) and will be replaced as soon as corporations will have it. Patient outcomes and safety should be what we're aiming for because we're more experienced and experience gives us the leg up. At this point if we don't have a better marketing strategy then we will get replaced for a cheaper option as soon as they can do it and it's already eroding away.

This is an extremely cynical post but I think it's reality. In the end the enemy is corporate medicine because their goal is money. So how can we translate our skills into making them more money? By showing patients that they're safer in our hands. Until we change what's funding us then we're stuck with this ****ty battle and threat of being replaced.
That's what I was trying (poorly apparently) to get at.

I love that AAEM is advocating so strongly for y'all. But it has to be done right, with the main issue being a) patient safety with a closer second b) cost. The latter is tricky since physicians are more expensive than midlevels, but we work more efficiently as a general rule. Sure that NP ordering a barrage of tests on every patient looks good to the hospital bean counters... until that patient is self/no pay or Medicaid.
 
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It's great that AAEM put out this statement, but what happens now? Is AAEM lobbying against midlevel independent practice?
 
It's great that AAEM put out this statement, but what happens now? Is AAEM lobbying against midlevel independent practice?
They aren't actively encouraging it, which is better than most societies.
 
They aren't actively encouraging it, which is better than most societies.
Nurse Practitioners

"The nurse practitioner should not function as an independent health practitioner. The AAFP position is that the nurse practitioner should only function in an integrated practice arrangement under the direction and responsible supervision of a practicing, licensed physician. In no instance may duties be delegated to a nurse practitioner for which the supervising physician does not have the appropriate training, experience and demonstrated competence."
 
Nurse Practitioners

"The nurse practitioner should not function as an independent health practitioner. The AAFP position is that the nurse practitioner should only function in an integrated practice arrangement under the direction and responsible supervision of a practicing, licensed physician. In no instance may duties be delegated to a nurse practitioner for which the supervising physician does not have the appropriate training, experience and demonstrated competence."
AAFP has also been vocal on the issue and actively lobbying for the profession. I know that the AAFP is pretty good, along with the ASA (depending on who you ask). Some of our state medical societies are complicit, however.
 
AAFP has also been vocal on the issue and actively lobbying for the profession. I know that the AAFP is pretty good, along with the ASA (depending on who you ask). Some of our state medical societies are complicit, however.
That's part of the issue - this is entirely a state-level problem.
 
It's not the PAs calling themselves doctor, in almost all cases.
Wait for the next generation of PAs to start working. They are teaching the PA students at my school that PA school is medical school in 2.5 years.
 
They said this nonsense at the PA school where I was a resident, as well.
I never sat in on a PA class, but the attitude is so prevalent that they must get it from someone. Are they getting it from professors, peers, or online?
 
Graduating in a few months

can't wait to finish and join

after I pass my boards I guess
 
Each other. Then they get to the real world and realize how misguided that thinking is. At least the good ones do.
 
I think the CMGs are too greedy to do away with midlevels.
 
Graduating in a few months

can't wait to finish and join

after I pass my boards I guess

You actually can join AAEM as a student or a resident. You don’t need to be an attending.
 
Friends, ACEP published similar statements TWENTY YEARS AGO. Glad AAEM could catch up.
 
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