Why I'm leaving ACEP

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"APP" - Advanced Practice Provider.
This is in the vernacular at my hospital. I’m still confused as to where physicians fall on this continuum (because we’re clearly not allowed to believe in two completely distinct scopes of practice)...are we super-advanced practice providers?

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I'm agreeing with you. If we arm everyone, then this will increase safety. The more guns, the better.

It's like you've never taken care of a drunk irrational person before!! How could this possibly help?!
 
I have 0 interest in the gun debate in this forum but I will say I think ACEP needs to stick to issues that impact our job.

The honest real issue with guns is neither side has an interest in an honest discussion and both push BS numbers. I think as educated people we should be upset that they wont fund research. I also think all those gun violence numbers need to be more honest about how many are suicides etc.

With regard to the first thing you say, I can see how gun violence and gun ownership, in and of themselves, can be construed as topics that are relevant to our line of work. My PCP asked me about guns in the home, which I assume is a screening question that, when answered affirmatively, is meant to provoke a discussion about appropriate safety measures, keeping guns away from the kids, etc. It was neatly tucked between questions about whether or not I wear my seatbelt and the like. Additionally, since we treat gunshot wounds, I find some discussion about firearms to be quite useful. What I don’t want from our professional societies is any sort of political statement on guns.

The second thing I quoted, I couldn’t agree more. The statistical arguments used for and against are supremely flawed. I have yet to hear a meaningful, objective argument in either direction, and I’ve listened to more arguments in this domain than I’d care to admit. They all consist of thinly-veiled, highly charged opinions being presented as facts.
 
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With regard to the first thing you say, I can see how gun violence and gun ownership, in and of themselves, can be construed as topics that are relevant to our line of work. My PCP asked me about guns in the home, which I assume is a screening question that, when answered affirmatively, is meant to provoke a discussion about appropriate safety measures, keeping guns away from the kids, etc. It was neatly tucked between questions about whether or not I wear my seatbelt and the like. Additionally, since we treat gunshot wounds, I find some discussion about firearms to be quite useful. What I don’t want from our professional societies is any sort of political statement on guns.

The second thing I quoted, I couldn’t agree more. The statistical arguments used for and against are supremely flawed. I have yet to hear a meaningful, objective argument in either direction, and I’ve listened to more arguments in this domain than I’d care to admit. They all consist of thinly-veiled, highly charged opinions being presented as facts.
SO should ACEP push a policy on Marijuana? Alcohol? Autonomous vehicles? Being that we work in an ED just about everything affects us. A reasonable thing would be to ask for more research since you know we are scientists.

Your PCP isnt an ED doc so its all different. Much like I dont think acep should have a policy on the ethics of cloning of humans. Potnetially those people can show up in the ED with their issues too. Same for gay marriage.. i could go on and on. Gay people will show up in the ED. Our job is to treat them with respect and deal with whatever brought them there.

I took care of a female to male transgender person recently. Significant bleeding post mastectomy and reconstruction. I dont need ACEP to be for or against this issue. Maybe im being foolish but i look at guns the same way. I dont care what the opinion of the ACEP leadership is on these issues.
 
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With regard to the first thing you say, I can see how gun violence and gun ownership, in and of themselves, can be construed as topics that are relevant to our line of work. My PCP asked me about guns in the home, which I assume is a screening question that, when answered affirmatively, is meant to provoke a discussion about appropriate safety measures, keeping guns away from the kids, etc. It was neatly tucked between questions about whether or not I wear my seatbelt and the like. Additionally, since we treat gunshot wounds, I find some discussion about firearms to be quite useful. What I don’t want from our professional societies is any sort of political statement on guns.

The second thing I quoted, I couldn’t agree more. The statistical arguments used for and against are supremely flawed. I have yet to hear a meaningful, objective argument in either direction, and I’ve listened to more arguments in this domain than I’d care to admit. They all consist of thinly-veiled, highly charged opinions being presented as facts.
Which tends to happen when one side successfully quashes funding to study the issue in an objective manner. While I don’t really have a dog in the ACEP should have a policy on guns fight, it’s difficult to rationally exclude guns as a matter of concern to public health.

There’s a middle ground between “guns scare me so nobody should ever have them for any reason” and “my AR is the only thing keeping the government from enslaving my family”. I think that American society would be safer and less divided if we could find that place. Unfortunately we’re not even allowed to ask questions that have testable hypotheses for risk of getting funding stripped.
 
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ACEP having any policy on guns doesn't help or hurt us. Yes, guns do effect our patient population, but ACEP having a stance won't change anything. I'd rather they stick to things they can influence which directly affect us in the ED. I don't want to hear moralizing from people on issues I don't care about. All this nonsense is just virtue signalling and it needs to stop.
 
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SO should ACEP push a policy on Marijuana? Alcohol?
Clearly you've never been to council. This **** comes up every year. ESPECIALLY the marijuana stuff. We spend hours talking about it. Powered alcohol was another.
Sigh.
 
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Clearly you've never been to council. This **** comes up every year. ESPECIALLY the marijuana stuff. We spend hours talking about it. Powered alcohol was another.
Sigh.
Right. I haven’t because I find them to be ******ed and have little value add. Much like I dont want them to discuss guns same for legalization of MJ or prohibition of alcohol.

Honestly, my opinion of ACEP is at an all time low. Of course I work for an SDG and moved 2k miles away from my last job to keep it that way.

Dare I say I believe in vaccines but I also dont want ACEP to have a policy on that. Let the AMA and AAP and the FP docs do it. I dont know why emergency doctors should have a policy on immunizations even though all my kids are immunized and I think people who dont immunize are ******ed but again its not an emergency medicine issue.

The fact that ACEP wastes its time on marijuana and guns is just more proof of their disconnect with their membership and mission.
 
ACEP Mission statement...

Our Mission and Vision. The American College of Emergency Physicians promotes the highest quality of emergency care and is the leading advocate for emergency physicians, their patients, and the public.

CMGs clearly violate this.. but ACEP doesn’t care. Immunizations, guns, abortion, marijuana and alcohol dont seem to fit the mission statement. You could loosely make the claim but its a stretch at best.
 
Which tends to happen when one side successfully quashes funding to study the issue in an objective manner. While I don’t really have a dog in the ACEP should have a policy on guns fight, it’s difficult to rationally exclude guns as a matter of concern to public health.

There’s a middle ground between “guns scare me so nobody should ever have them for any reason” and “my AR is the only thing keeping the government from enslaving my family”. I think that American society would be safer and less divided if we could find that place. Unfortunately we’re not even allowed to ask questions that have testable hypotheses for risk of getting funding stripped.
Fully agree
 
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It's a very valid question to ask, that if ACEP has pledged to stay out of politics, why did they wade into the gun control debate, and not other political issues that could be argued to intersect with Emergency Medicine?

Over 50,000 Americans OD on opiates yearly and die (more than from gun violence), many passing through EDs in the process. Why doesn't ACEP take a stronger stand, perhaps call for banning opiates for chronic pain, except for use in hospital or no more than 6 weeks after a surgery or fracture? Or does ACEP support the other extreme of complete drug legalization? Since ACEP taking political stances on gun laws, how can they possibly not stake a firm position on opiate laws, which is a more deadly crisis? Does ACEPs relative silence mean they condone current opiate policy which has lead to 50,000+ American's dying?

Patients come to EDs at times needing methotrexate or may request referral to a provider that does abortions. Why hasn't ACEP told their membership what to think on abortion?

Some states have legalized marijuana, others have not. Often times ED patients may use or be under the influence. Traffic deaths linked to marijuana legalization appear to be increasing in legal-weed state Colorado. Does ACEP's silence mean they condone current legalization of marijuana and if so, why aren't they as concerned about possible deaths from MJ-linked traffic deaths as gun deaths? Or are they against legal weed?

A pre-perbutal child, undergoing gender reassignment, comes into your ED with complications from that treatment? What say you, ACEP? Are you for it, or against?

ACEP?

ACEP?!



I...can't....h e a r . . . y o u u u u u u


Personally, I think ACEP and other similar organizations should stay out of politics. But I think it's a very legitimate question to ask, if our medical societies are going to weigh in on political issues that intersect with our specialties, then why don't they take a stand on all of them? And if they're not going to take a stand on all of them, why do they take a stand on any of them? Why do they pick favorites and ignore others? And when the refuse to take a stand on one issue, but not another, does that imply they condone the status quo on that issue?
 
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Some of the comments here seem to think that medical societies are supposed to perfectly fit the wants of each individual member. That is not how these institutions work; they work based on consensus. By the very nature of being a national organization lobbying congress for EM, ACEP is political. It’s policies reflect the views of the members involved. If you want to change it, show up. They can’t make statements in opposition to their policy. If you want to talk about their strategic partnerships with CMGs and corporate medicine, that has been done at a board level outside of policy and may be a worthwhile reason to hate on them if you disagree. However, to hate on their policy without actually understanding it is not productive.

If we are going to bash ACEP on their gun policy, I think it is only appropriate that we actually discuss the policy, not just what people think the policy is:

The American College of Emergency Physicians abhors the current level of intentional and accidental firearm injuries and finds that it poses a threat to the health and safety of the public.


ACEP supports legislative, regulatory, and public health efforts that:

· Encourage the change of societal norms that glorify a culture of violence to one of social civility;

· Investigate the effect of socioeconomic and other cultural risk factors on firearm injury and provide public and private funding for firearm safety and injury prevention research;

· Create a confidential national firearm injury research registry while encouraging states to establish a uniform approach to tracking and recording firearm related injuries;

· Promote access to effective, affordable, and sustainable mental health services;

· Protect the duty of physicians and encourage health care provider discussions with patients on firearm safety;

· Promote the development of technology that increases firearm safety;

· Support universal background checks for firearm transactions;

· Require the enforcement of existing laws and support new legislation that prevents high risk and prohibited individuals from obtaining firearms by any means;

· Restrict the sale and ownership of weapons, munitions, and large-capacity magazines that are designed for military or law enforcement use.

(Revised 2013, 2012, 2011; Reaffirmed 2007; Approved 2001)

Without getting into the merits of this policy each of the policies have specific word choices for a reason. In this instance, ACEP SUPPORTS this policy. That means that when asked or by the direction of the board based on the winds of politics, the organization will speak on the issue and offer its name towards those goals. This is why gun safety laws are not part of a strategic plan, as it is not core to EM and is subject to political whims, but is something they will comment on when appropriate.

ACEP has lots of policies on issues affecting our patients and the public (which is part of the mission statement of the organization if you don’t selectively read it) from alcohol/drugs to respectful treatment of all regardless of gender identity or expression. Just because there isn't a policy doesn't mean it hasn't been discussed; the intent may be covered by existing policy or there just may not be a consensus on what ACEP should do. As EM providers we have our own unique view on how these issues affect our practice and how they affect our patients when we see in the ED; ACEP is a way for the profession to have a collective voice on them when we decide it is appropriate.

Furthermore, just because there is a policy doesn’t mean the lobbyists are working 24/7 on that issue. The board decides the direction of the organization based on the political climate outside of specific directives from policy such as when the policy states that they will advocate for something. You can read everything here if you want: ACEP Policy Statements // ACEP
 
Why doesn't ACEP support more positions related to our actual business and salary?

One issue which I can bet close to 100% of ACEP members (excluding those with leadership positions in CMGs) would support is billing/salary transparency. ACEP should call on every organization which employs EPs to give monthly statements on amount billed in a member's name, amounts collected, and amounts actually paid out along with a percentage calculation. This should apply to every CMG, SDG, and hospital. Failure to do so would result in censure by ACEP and removal of their leaders from membership.

Of course they don't support this simple step which would improve our bargaining power, and reduce the ability of CMGs to take advantage of us.
 
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Why doesn't ACEP support more positions related to our actual business and salary?

One issue which I can bet close to 100% of ACEP members (excluding those with leadership positions in CMGs) would support is billing/salary transparency. ACEP should call on every organization which employs EPs to give monthly statements on amount billed in a member's name, amounts collected, and amounts actually paid out along with a percentage calculation. This should apply to every CMG, SDG, and hospital. Failure to do so would result in censure by ACEP and removal of their leaders from membership.

Of course they don't support this simple step which would improve our bargaining power, and reduce the ability of CMGs to take advantage of us.

Without discussing the merits of this proposal, you can test you presumption by actually proposing it.

Guidelines for Writing Resolutions // ACEP
 
Without discussing the merits of this proposal, you can test you presumption by actually proposing it.

Guidelines for Writing Resolutions // ACEP

I will submit it, but I can already tell where this will go. ACEP is paid for by TeamHealth/EmCare/USACS. They are not going to want to piss off the big donors with a policy like this.
 
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Associate Professor Philip Alpers from the University of Sydney said "the million guns destroyed after Port Arthur have been replaced with 1,026,000 new ones".

"By 2015 the arms trade had broken all previous records, and last financial year Australia ported 104,000 firearms".

It pains me that educated people just quote without actually giving a source for the quote. Without sourcing, one can say anything about anyone!

I found the quote you used, and I also see why you didn't provide the source, which itself would complicate your argument.

And, here's what FactCheck.org says:

Australian crime statistics show a marked decrease in homicides since the gun law change.

And:

Is this evidence that Australia’s laws reduced gun violence and homicides? In our 2009 story, we wrote that there was no consensus on that point.

For example, we wrote that a 2003 AIC study looked at rates of firearm-related deaths between 1991 and 2001 and found that some of the decline in firearm-related homicides (and suicides, as well) began before the 1996 law was enacted.

On the other hand, a 2006 analysis by scholars at the University of Sydney concluded that gun fatalities decreased more quickly after the gun law passed. “Australia’s 1996 gun law reforms were followed by more than a decade free of fatal mass shootings, and accelerated declines in firearm deaths, particularly suicides,” the authors of that study wrote.

In 2011, David Hemenway, director of the Harvard Injury Control Research Center, co-authored a paper that reviewed the available studies, as of 2011, on the effect of Australia’s buyback program on firearm deaths. He wrote that “many studies … found strong evidence for a beneficial effect of the law.”

Hemenway and his Harvard colleague and co-author, Mary Vriniotis, summarized the evidence in support of the theory that the buyback program saved lives:

“While 13 gun massacres (the killing of 4 or more people at one time) occurred in Australia in the 18 years before the NFA, resulting in more than one hundred deaths, in the 14 following years (and up to the present), there were no gun massacres.”
“In the seven years before the NFA (1989-1995), the average annual firearm suicide death rate per 100,000 was 2.6 (with a yearly range of 2.2 to 2.9); in the seven years after the buyback was fully implemented (1998-2004), the average annual firearm suicide rate was 1.1 (yearly range 0.8 to 1.4).”
“In the seven years before the NFA, the average annual firearm homicide rate per 100,000 was .43 (range .27 to .60) while for the seven years post NFA, the average annual firearm homicide rate was .25 (range .16 to .33).”
“[T]he drop in firearm deaths was largest among the type of firearms most affected by the buyback.”
The authors, however, noted that “no study has explained why gun deaths were falling, or why they might be expected to continue to fall.” That poses difficulty in trying to definitively determine the impact of the law, they write.

“Whether or not one wants to attribute the effects as being due to the law, everyone should be pleased with what happened in Australia after the NFA — the elimination of firearm massacres (at least up to the present) and an immediate, and continuing, reduction in firearm suicide and firearm homicide,” the authors write.

This is why medical organizations like ACEP should be doing scientific studies on this, instead of us just unscientifically quoting random people without proper citation.
 
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It pains me that educated people just quote without actually giving a source for the quote. Without sourcing, one can say anything about anyone!

I found the quote you used, and I also see why you didn't provide the source, which itself would complicate your argument.

And, here's what FactCheck.org says:



And:



This is why medical organizations like ACEP should be doing scientific studies on this, instead of us just unscientifically quoting random people without proper citation.
One of the interesting things I learned since this most recent shooting is that our overall homicide rate has actually decreased more than Australia's has in the same period (their's went down like 37% and ours went down around 43-45%).

Now obviously their gun homicide rate went down more than ours...
 
To take this a step further and much more direct to emergency medicine, most modern cars have full telemetry. Passenger restraint use, impact profiles, and the ability to risk model a given motor vehicle accident is available in near real time. This can be (and often is) transmitted in near real time without the overt knowledge of the vehicle's owner - think the GM "OnStar" system. This data would be invaluable for trauma services and allow for much more accurate classification of potential injuries prior to patient arrival. General Motors specifically does not disclose this information for privacy concerns as they do not want to be seen as a "snitch" regarding vehicle users lack of restraint use, speeding, or driving inputs that are suggestive of impairment.

From a patient safety perspective one could lobby for legislation that would allow for this information to be stored and transmitted but to remain non-discoverable and part of the medical record. ACEP? American College of Surgeons?
 
I couldn’t care less about their stance on firearms... their collusion with CMGs is a far more serious problem.


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From the title, that's what I thought this was going to be.


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