Imagine if the ABA acted like this...

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TheLoneWolf

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This was brought to my attention on another SDN forum. Much thanks to @drusso for pointing this out.

I highlighted the important parts

American Academy of Emergency Medicine

Updated Position Statement on Advanced Practice Providers
The American Academy of Emergency Medicine (AAEM) believes that emergency department patients should have timely and unencumbered access to the most appropriate care led by a board certified emergency physician (ABEM, AOBEM). We do not support the independent practice of Advanced Practice Providers (APPs)* and other non-physician clinicians.

Properly trained APPs may provide emergency medical care as members of an emergency department team and must be supervised by a physician who is board certified in emergency medicine.

As a member of the emergency department team an APP should not replace an emergency physician, but rather should engage in patient care in a supervised role in order to improve patient care efficiency without compromising safety.

The role of the APPs within the department must be defined by their clinical supervising physicians, who must know the training of each APP and be involved in the hiring and continued employment evaluations of each APP as part of the emergency department team, with the intent to insure that APPs are not put into patient care situations beyond their clinical training and experience.

Collaborating physicians must be permitted adequate time to be directly involved in supervision of care. They must not be required to supervise more APPs than is appropriate to provide safe patient care. Furthermore, supervision must not be in name only. Physicians are expected, and must be permitted, to be involved in meaningful and ongoing assessment of the APPs’ work.

Billing should reflect the involvement of the physician in the emergency visit. If the physician's name is used for billing purposes, the physician's involvement must add value to the patient visit.

A physician should not be required to cosign the chart, nor should his/her name be invoked with regard to any patient unless he/she has been actively involved in that patient’s care.

APPs should not supervise emergency medicine residents, nor should they interfere in the education or clinical opportunities for emergency medicine residents.

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.

*This designation includes, but is not limited to the following practitioners:

  • Acute Care Nurse Practitioner (ACNP)
  • Adult Nurse Practitioner (ANP)
  • Advanced Nurse Practitioner (APN)
  • Advanced Practice Registered Nurse (APRN)
  • Advanced Registered Nurse Practitioner (ARNP)
  • Certified Nurse Practitioner (CNP)
  • Clinical Nurse Specialist (CNS)
  • Certified Registered Nurse Practitioner (CRNP)
  • Doctor of Nursing Practice (DNP)
  • Doctor of Nursing Science (DNS, DNSc)
  • Doctor of Science (DSC)
  • Doctor of Science in Nursing (DSN)
  • Doctor of Pharmacy (PharmD)
  • Emergency Nurse Practitioner (ENP)
  • Family Nurse Practitioner (FNP)
  • Nurse Practitioner (NP)
  • Nurse Practitioner Certified (NPC)
  • Pediatric Clinical Nurse Specialist OR Psychiatric Clinical Nurse Specialist (PCNS)
  • Pediatric Nurse Practitioner (PNP)
  • Pediatric Nurse Practitioner - Acute Care (PNP-AC)
  • Women’s Health Nurse Practitioner (WHNP)
  • Advanced Physician Assistant (APA)
  • Advanced Physician Assistant Certified (APA-C)
  • Doctor of Medical Science (DMSc)
  • Physician Assistant (PA)
  • Physician Assistant Certified (PA-C)
  • Registered Physician Assistant (RPA)
  • Registered Physician Assistant Certified (RPA-C)
Approved 1/29/2019


Amazing slogan too. 'Champion of the Emergency Physician"

I had some experience with the PACs and administration and wondered why they cant have similar position statements. They could literally copy and paste this and just list CRNAs in the above list.

There are multiple parallels that exist between the mid level incursion in anaesthesia and ED.
In less than 2 pages, they have accomplished what our advocacy groups have supposedly championed for years though not bothered to put on paper a formal and clear position statement, distribute to their members and the public at large.
 
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that's an impressive list of "practitioners". I almost want to be a Doctor of Science. Sounds cool.
 
didnt mention CRNA. this is their chance! get a job in the ED!
On a side note, i'm amazed nurses dont have a CRNA equivalent in the EM world. CRNEM? Theres more money in ED to tap into than anesthesia. And since MDs work 40 hrs a week, CRNEM can probably get away with working 20 hr a week. or i guess NP and PAs are good enough for them, but they sure dont get paid like CRNAs
 
didnt mention CRNA. this is their chance! get a job in the ED!
On a side note, i'm amazed nurses dont have a CRNA equivalent in the EM world. CRNEM? Theres more money in ED to tap into than anesthesia. And since MDs work 40 hrs a week, CRNEM can probably get away with working 20 hr a week. or i guess NP and PAs are good enough for them, but they sure dont get paid like CRNAs

Nurse Practitioners and PAs with “EM Fellowship”
 
This was brought to my attention on another SDN forum. Much thanks to @drusso for pointing this out.

I highlighted the important parts

American Academy of Emergency Medicine

Updated Position Statement on Advanced Practice Providers
The American Academy of Emergency Medicine (AAEM) believes that emergency department patients should have timely and unencumbered access to the most appropriate care led by a board certified emergency physician (ABEM, AOBEM). We do not support the independent practice of Advanced Practice Providers (APPs)* and other non-physician clinicians.

Properly trained APPs may provide emergency medical care as members of an emergency department team and must be supervised by a physician who is board certified in emergency medicine.

As a member of the emergency department team an APP should not replace an emergency physician, but rather should engage in patient care in a supervised role in order to improve patient care efficiency without compromising safety.

The role of the APPs within the department must be defined by their clinical supervising physicians, who must know the training of each APP and be involved in the hiring and continued employment evaluations of each APP as part of the emergency department team, with the intent to insure that APPs are not put into patient care situations beyond their clinical training and experience.

Collaborating physicians must be permitted adequate time to be directly involved in supervision of care. They must not be required to supervise more APPs than is appropriate to provide safe patient care. Furthermore, supervision must not be in name only. Physicians are expected, and must be permitted, to be involved in meaningful and ongoing assessment of the APPs’ work.

Billing should reflect the involvement of the physician in the emergency visit. If the physician's name is used for billing purposes, the physician's involvement must add value to the patient visit.

A physician should not be required to cosign the chart, nor should his/her name be invoked with regard to any patient unless he/she has been actively involved in that patient’s care.

APPs should not supervise emergency medicine residents, nor should they interfere in the education or clinical opportunities for emergency medicine residents.

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.

*This designation includes, but is not limited to the following practitioners:

  • Acute Care Nurse Practitioner (ACNP)
  • Adult Nurse Practitioner (ANP)
  • Advanced Nurse Practitioner (APN)
  • Advanced Practice Registered Nurse (APRN)
  • Advanced Registered Nurse Practitioner (ARNP)
  • Certified Nurse Practitioner (CNP)
  • Clinical Nurse Specialist (CNS)
  • Certified Registered Nurse Practitioner (CRNP)
  • Doctor of Nursing Practice (DNP)
  • Doctor of Nursing Science (DNS, DNSc)
  • Doctor of Science (DSC)
  • Doctor of Science in Nursing (DSN)
  • Doctor of Pharmacy (PharmD)
  • Emergency Nurse Practitioner (ENP)
  • Family Nurse Practitioner (FNP)
  • Nurse Practitioner (NP)
  • Nurse Practitioner Certified (NPC)
  • Pediatric Clinical Nurse Specialist OR Psychiatric Clinical Nurse Specialist (PCNS)
  • Pediatric Nurse Practitioner (PNP)
  • Pediatric Nurse Practitioner - Acute Care (PNP-AC)
  • Women’s Health Nurse Practitioner (WHNP)
  • Advanced Physician Assistant (APA)
  • Advanced Physician Assistant Certified (APA-C)
  • Doctor of Medical Science (DMSc)
  • Physician Assistant (PA)
  • Physician Assistant Certified (PA-C)
  • Registered Physician Assistant (RPA)
  • Registered Physician Assistant Certified (RPA-C)
Approved 1/29/2019


Amazing slogan too. 'Champion of the Emergency Physician"

I had some experience with the PACs and administration and wondered why they cant have similar position statements. They could literally copy and paste this and just list CRNAs in the above list.

There are multiple parallels that exist between the mid level incursion in anaesthesia and ED.
In less than 2 pages, they have accomplished what our advocacy groups have supposedly championed for years though not bothered to put on paper a formal and clear position statement, distribute to their members and the public at large.

@TheLoneWolf Please make is go viral. This is about patient safety. Send it to your professional society. Doesn't matter if you practice in an OR, ER, ICU, PACU, IRF, SNF, ASC, or outpatient clinic there should only be one standard of physician supervision of all mid-level providers. Stick it in the face of decision-makers, department chairs, managing partners, CEO, CMO's, etc. This should light MD/DO's hair on fire. It's bigger than MOC. Make it go viral. "One Supervision Standard." #OneSupervisionStandard
 
I love this, it's fantastic. Almost too good to be true. My thoughts on midlevel creep is well documented elsewhere, so I won't rehash but in brief it's a growing/pressing problems in fields like EM and very well could be an issue in the next 10 years in CCM.

However (and that's a big however), when I read through the EM thread about this I was fairly surprised. I am sure @drusso or @Groove and speak to this better than me, but it seems like AAEM (American Academy of EM) is not the dominant society in the field - that belongs to ACEP (American College of Emergency Physicians), and it may not even be close. ACEP is your typical huge society sponsored by huge national organizations like TeamHealth and the like who utilize NP and PAs aggressively. There's some other language that's a little rough in AAEM's statements, like straight up admitting this is to protect current and future EM docs (rather than protecting patients), it's all covered pretty solidly here on the EM forums: AAEM Position on APPs

If this is a model to be followed, I would LOVE for something larger like the AMA to adopt language like this. Especially provider confusion and the emphasis on "doctor" being reserved in the clinical realm for physicians only - this is much more commonly a problem in other specialties, in particular primary care where everyone claims they are a doctor. Heck even PAs are pushing for an advanced practice degree known as "Doctor of Medical Science" or DMSc. The theory is that they will only do research, but in practice they want independent clinical responsibilities. I wish I could even make up something so ridiculous, but it's true... Doctor of Medical Science - ATSUhttps://www.atsu.edu/doctor-of-medical-science Doctor of Medical Science – University of Lynchburghttps://www.lynchburg.edu/...sciences/physician...medicine/doctor-of-medical-science/

Unfortunately, I doubt the AMA would ever do such a thing - they are much too busy being a political entity concentrating on Trump's presidency rather than on-the-ground physician issues. Head is way too far up in the sky, and I refuse to give them a dime of my money even if my practice will cover the dues.
 
The ABA wont do this!! It would ruffle too many feathers and get whoever wrote it terminated. They would NEVER get involved with something like this.

This is why I will NEVER give money to the PAC or ASA or join any of their organizations. And I encourage everyone reading this to UNJOIN or NOT JOIN the ASA ever until a position statement such as this is rendered. They are spineless souls and so is every chairman of anesthesia who doesnt support this statement, and invites CRNAS to participate jointly in the weekly conferences. ITS BS>
 
I love this, it's fantastic. Almost too good to be true. My thoughts on midlevel creep is well documented elsewhere, so I won't rehash but in brief it's a growing/pressing problems in fields like EM and very well could be an issue in the next 10 years in CCM.

However (and that's a big however), when I read through the EM thread about this I was fairly surprised. I am sure @drusso or @Groove and speak to this better than me, but it seems like AAEM (American Academy of EM) is not the dominant society in the field - that belongs to ACEP (American College of Emergency Physicians), and it may not even be close. ACEP is your typical huge society sponsored by huge national organizations like TeamHealth and the like who utilize NP and PAs aggressively. There's some other language that's a little rough in AAEM's statements, like straight up admitting this is to protect current and future EM docs (rather than protecting patients), it's all covered pretty solidly here on the EM forums: AAEM Position on APPs

If this is a model to be followed, I would LOVE for something larger like the AMA to adopt language like this. Especially provider confusion and the emphasis on "doctor" being reserved in the clinical realm for physicians only - this is much more commonly a problem in other specialties, in particular primary care where everyone claims they are a doctor. Heck even PAs are pushing for an advanced practice degree known as "Doctor of Medical Science" or DMSc. The theory is that they will only do research, but in practice they want independent clinical responsibilities. I wish I could even make up something so ridiculous, but it's true... Doctor of Medical Science - ATSUhttps://www.atsu.edu/doctor-of-medical-science Doctor of Medical Science – University of Lynchburghttps://www.lynchburg.edu/...sciences/physician...medicine/doctor-of-medical-science/

Unfortunately, I doubt the AMA would ever do such a thing - they are much too busy being a political entity concentrating on Trump's presidency rather than on-the-ground physician issues. Head is way too far up in the sky, and I refuse to give them a dime of my money even if my practice will cover the dues.

I’m EM and can comment.

ACEP is the primary national organization. It’s about a clean as a used car salesmen. The conference is littered with ads and paraphernalia from massive EM groups who are raping the field. Everyone knows it. It is certainly losing credibility in the field. They only care about money. They don’t even keep up the facade that they care about patients or doctors anymore.

SAEM is the academic society that basically only is research and academic related.

AAEM was a grassroots EM organization that popped up as ACEP clearly doesn’t represent us. They only allow BE/BC EM docs in. They are mission driven. They defend ER docs against bogus testimony and push for reform. They’re membership is probably 10-25% of ACEPs if I had to guess and have much less money. I’ve met the former president. They are the real deal.

As I’m typing this, I realize I need to donate to AAEM...

Sadly, one of the EM docs who has a megaphone/popular podcast who seems hyper insulated in NYC academia basically fully denounced this on Twitter.

Yea, I think I’m going to go spend some CME money on AAEM.

Good luck with the CRNA doctors...
 
If I received a position statement like this in my inbox from the ABA I would immediately assume I was getting spammed and upgrade my malware protection.

Spam from who? A new organization? Someone punking?

I have older partners who could careless about CRNA encroachment..... as far as they’re concerned, as long as they don’t have to sit in the room, they’re good with it. But they’re also the ones who would try to start every case and extubate every case; at the same time teach CRNA regionals. So I am not sure what their positions are.
 
I’m EM and can comment.

ACEP is the primary national organization. It’s about a clean as a used car salesmen. The conference is littered with ads and paraphernalia from massive EM groups who are raping the field. Everyone knows it. It is certainly losing credibility in the field. They only care about money. They don’t even keep up the facade that they care about patients or doctors anymore.

SAEM is the academic society that basically only is research and academic related.

AAEM was a grassroots EM organization that popped up as ACEP clearly doesn’t represent us. They only allow BE/BC EM docs in. They are mission driven. They defend ER docs against bogus testimony and push for reform. They’re membership is probably 10-25% of ACEPs if I had to guess and have much less money. I’ve met the former president. They are the real deal.

As I’m typing this, I realize I need to donate to AAEM...

Sadly, one of the EM docs who has a megaphone/popular podcast who seems hyper insulated in NYC academia basically fully denounced this on Twitter.

Yea, I think I’m going to go spend some CME money on AAEM.

Good luck with the CRNA doctors...
can you please out this clown who denounced this on twitter so i can lambast him over there.
\
SHoot, Ill donate money to the AAEM and Im not even an ER doc
My personal heroes are Wesby Fisher who is fighting the MOC fight for us and needs our support. PLease donate if you have the cash
Click here to support Practicing Physicians of America organized by Westby G. Fisher
Its better than donating to the ASA . They are actively making your life infinitely more difficult.
and Paul tierstein who is also fighting the MOC battle.

Now we need someone of clout to take on midlevels
 
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Someone post link to donate to AAEM. I'm almost an attending and this is a good cause for my money.
 
This is the clown. He also likes to shill Point of Care ultrasound courses for midlevels by looking at his recent tweets.




Sounds like a greedy FMG, trying to build a national EM management group and subsequently pander midlevel providers to hospitals so he can rake in the money while cutting out the docs.
 
Maybe people sitting in the ivory tower know something that I don’t. All are embracing midlevels hard.
 
Maybe people sitting in the ivory tower know something that I don’t. All are embracing midlevels hard.

the ivory tower types always hated the salaries that non academic earned compared to them.
there are professorships to be built by giving administrates and legislators the cover to expand scope.
 
the ivory tower types always hated the salaries that non academic earned compared to them.
there are professorships to be built by giving administrates and legislators the cover to expand scope.
Who's gonna take care of patients when they are in the lab/office?!?!
 
I’m EM and can comment.

ACEP is the primary national organization. It’s about a clean as a used car salesmen. The conference is littered with ads and paraphernalia from massive EM groups who are raping the field. Everyone knows it. It is certainly losing credibility in the field. They only care about money. They don’t even keep up the facade that they care about patients or doctors anymore.

SAEM is the academic society that basically only is research and academic related.

AAEM was a grassroots EM organization that popped up as ACEP clearly doesn’t represent us. They only allow BE/BC EM docs in. They are mission driven. They defend ER docs against bogus testimony and push for reform. They’re membership is probably 10-25% of ACEPs if I had to guess and have much less money. I’ve met the former president. They are the real deal.

As I’m typing this, I realize I need to donate to AAEM...

Sadly, one of the EM docs who has a megaphone/popular podcast who seems hyper insulated in NYC academia basically fully denounced this on Twitter.

Yea, I think I’m going to go spend some CME money on AAEM.

Good luck with the CRNA doctors...
The emcrit guy too? Or swami?

I lose track of who is selling out sometimes
 
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