Board Meeting Minutes

American Academy of Emergency Medicine
Minutes of Board of Directors Conference Call Meeting
September 20, 2000

IN ATTENDANCE: Robert McNamara, MD; Joseph Wood, MD; Drew Fenton, MD; Howard Blumstein, MD; Antoine Kazzi, MD; Christopher Minas, MD; Margaret O'Leary, MD; Tom Scaletta, MD; Tobey Williams, MD; Leslie Zun, MD. Staff: Eric Lanke and Kay Whalen.

I. President's Report

Dr. McNamara thanked everyone for participating in the call and noted that he had been at SUNY-downstate earlier in the day to speak to the residents there. He also announced that the resident recruitment mailing would be mailed this week.

II. EuSEM Joint Meeting Proposal

Dr. McNamara reminded the Board that during the last Board call, AAEM's joint sponsorship for a September, 2001 meeting with the European Society of EM in Stresa, Italy, had been discussed. Since that call, the EuSEM Board approved moving forward with this meeting. The AAEM Executive Committee had also discussed this meeting during its last conference call. However, due to the financial implications of this meeting, the full AAEM Board of Directors needs to approve joint sponsorship of this meeting.

Dr. Wood moved and Dr. Scaletta seconded that AAEM jointly sponsor a September, 2001 meeting in Stresa, Italy with the EuSEM.

Dr. Kazzi reported that he had been working on this joint proposal with the EuSEM for some time. The last meeting held by the EuSEM attracted 600 delegates. Therefore, the Joint AAEM/EuSEM Planning Committee is confident that the Stresa meeting will attract at least 400 delegates. If the Congress earns a net profit, AAEM will be entitled to 50% of that profit. Dr. McNamara noted that the expenses that AAEM would initially be responsible for include American speaker travel and honoraria and American promotion. He also noted that Ed Panacek, MD, was serving as an AAEM representative to the Joint Committee.

Dr. Williams asked if residents would be granted a discounted registration fee. Dr. Kazzi replied that the Joint Committee had already discussed this and planned to offer a discounted registration fee to residents.

After discussion on the topics that would be presented at the meeting, Dr. McNamara asked for a vote on the earlier motion. MOTION PASSED UNANIMOUSLY.

III. FSMB Consensus Proposal

Dr. McNamara reminded the Board that Dr. Kazzi had arranged for a meeting in May with representatives from AAEM, CORD, SAEM and the Medical Board of California to discuss the FSMB's stance on resident moonlighting.

Subsequent to the meeting, a final summary document was drafted. This summary document has already been endorsed by SAEM and the Medical Board of California.

Dr. Minas asked how this summary document differed from AAEM's current position statement on this issue. Dr. McNamara replied that this summary simply strengthens the AAEM position statement by creating a dependent licensure status that would enable residents to function as physician extenders.

Dr. Kazzi moved and Dr. Fenton seconded that the following summary report be endorsed by AAEM:

I. FSMB recommends "3. All applicants for licensure should have satisfactorily completed a minimum of three years of postgraduate training in an ACGME- or AOA-approved postgraduate training program, including completion of PGY3 level training prior to full and unrestricted licensure."

With regard to the FSMB recommendation to restrict full licensure to physicians that have completed 3 years of post-graduate training, we were in agreement that such a recommendation would raise the medical standards provided when care is delivered. We all agreed that the current practice of moonlighting subjected patients to care delivered by physicians who have less than optimal training.

We all acknowledged that a shortage for board-certified emergency physicians persists at this point, particularly in rural and underserved areas.

We therefore proposed the following addition to the FSMB recommendation: The FSMB should support the establishment of a "dependent practice of medicine" license by state boards" that "physicians in-training" could secure after successfully completing one year of residency training in a US -accredited allopathic or osteopathic program (ACGME or AOA).

• The dependent practice license would be time-limited. "Physicians in-training" is defined as maintaining current, satisfactory enrollment in an ACGME or AOA approved residency training program.

• Such a dependent practice would be restricted in scope to clinical activities consistent with those that the resident is performing in the course of their residency training program and the scope of practice for that clinical specialty.

• On-site supervision of the resident physician that is working under the dependent practice of medicine license is required.

Such supervision should be 1) continuous, 2) onsite, and 3) provided by fully licensed physicians who are board-certified/prepared in the resident's own field of training.

• Board certification or preparation of the supervising physician must be provided by a certifying body recognized by the American Board of Medical Specialties or the American Osteopathic Board of Specialties.

• Such a dependent practice of medicine would be equivalent to extending eligibility for a "Physician Extender" status to residents who are in good standing in their training program.

• Such dependent practice licensure would require annual renewal.

• Physician groups and institutions that contract or employ physicians who are practicing under a dependent practice license would share the legal liability for the quality of care provided by the residents working for them. They would assume the responsibility of clearly defining the supervision mechanism for the dependent practitioner. This mechanism should not vary substantially from that provided in the resident's training program.

II. FSMB recommends "2. All physicians enrolled in postgraduate training programs shall be subject to medical board regulation and oversight through a mechanism that requires the physician to obtain a training permit or limited license expressly designed for such purpose. This mechanism shall also require that program directors report annually to the medical board on all individuals enrolled in their respective programs."

We believe this recommendation requiring program directors to annually report details of each residents' education process to be counterproductive. All represented EM organizations are strongly opposed to this requirement. We proposed modifying that 1998 FSMB position by shifting the responsibility and timing of the reporting of residents and the permit renewals from the program director to the Graduate Medical Education Office (GME) of their medical institution.

The proposed revision is: All physicians enrolled in postgraduate training programs shall be subject to medical board regulation and oversight through a mechanism that requires the physician to obtain a training permit or limited license expressly designed for such purpose. This mechanism shall also require that the graduate medical offices of training institutions report annually to the medical board any serious disciplinary action taken against a resident such as termination. However, remediation programs and probationary actions are best handled internally within the training institution so that deficiencies in performance are openly addressed rather than overlooked or inadequately addressed for fear of ruining the resident's future career. Mandated reporting of such activities would create an environment in which residents attempted to hide or cover up educational mistakes or deficiencies, rather than proactively seeking assistance through the residency.

III. FSMB recommends "1. All applicants for postgraduate training shall have satisfactorily completed Steps 1 and 2 of the United States Medical Licensing Examination (USMLE) or Parts 1 and 2 of the certifying examination administered by the National Board of Osteopathic Medical Examiners (NBOME) prior to acceptance into a postgraduate training program."

EM organizations found no strong objection to this recommendation. Concerns were expressed that a small minority of applicants who could potentially pass the USMLE before the beginning of their training would be discriminated against during the selection process of the match.

Conclusion:

The AAEM, CORD and SAEM appreciate the efforts of the FSMB as it strives to provide patients with the most optimal level of protection and the highest standards that are available and achievable at this point in time.

We hope that the FSMB could formally adopt these modifications to their 1998 recommendations. We then could all begin working together to implement them via the legislative and regulatory processes they would each require.

MOTION PASSED UNANIMOUSLY.

IV. Purchase of ABEM Mailing List

Dr. McNamara then drew the Board's attention to the last item on the agenda. As many on the Board knew, ABEM has a policy of releasing its mailing list only to those organizations that are sponsoring organizations of ABEM. However, ABEM does allow for other organizations to purchase this list from the company that maintains it if ABEM grants a special exemption. AAEM has been granted such an exemption.

Ms. Whalen has been in contact with the company that maintains this list and has found that the cost for purchasing this list of 16,746 names is $10,884. The list can then be used for 12 months.

After discussion, Dr. Wood moved and Dr. Williams seconded that AAEM purchase the ABEM mailing list. MOTION PASSED UNANIMOUSLY.

V. New Business

Dr. McNamara informed the Board that the Executive Committee had selected Daniel F. Danzl, MD, as the recipient of this year's David K. Wagner Award.

There being no further business, the conference call meeting was adjourned.

Respectfully submitted,

Kay Whalen
Organizational Director