Position Statements

New AAEM Board of Directors Passes New Position Statements

The AAEM Board of Directors passed the following position statements during the February 22, 2001, Board meeting.

Position statements were passed on:

• Unions

• Physician Credentialing

• Emergency Physician-to-patient ED Staffing Ratios

• Emergency Nurse-to-patient ED Staffing Ratios

• Non-discrimination of Practice Track Emergency Physicians (amended)

Unions in Emergency Medicine
AAEM recognizes the right of emergency physicians to organize into collective bargaining units under the auspices of the National Labor Relations Board. AAEM acknowledges the presence of certain practice issues, such as economic exploitation and termination without cause, that may prompt the formation of unions in Emergency Medicine. We support AAEM members who form unions to improve patient care and their work environments. However, AAEM believes emergency physicians should preferably seek ownership of their practice by pursuing relief through existing laws and regulations including those prohibiting fee-splitting and, where applicable, the corporate practice of medicine. AAEM will provide assistance to emergency physicians who seek such ownership.

In addition, AAEM president Dr. Robert McNamara has appointed Dr. John Calomeni to chair a task force to further examine the issue of unions in Emergency Medicine. AAEM members interested in serving on this task force should contact Dr. Calomeni by email at jcalomeni@austin.rr.com

Emergency Physician Credentialing
Whereas higher care quality, improved patient safety, and decreased medical legal risk can be directly linked to qualified Emergency Medicine specialists; and

Whereas emergency physicians should be involved in the process by which they are credentialed; and

Whereas AAEM has become the lead organization in promoting the practice of Emergency Medicine only by qualified practitioners;

Therefore be it resolved that AAEM asserts that health care organizations obtain, verify, and document the following information when credentialing emergency physicians for practice in emergency departments:

1. Documentation of ABEM or AOBEM board status and, for those not yet ABEM or AOBEM certified, completion of an ACGME or AOA-approved postgraduate training program in Emergency Medicine.

2. Lifetime medical licensure history.

3. Health care related employment/appointment history (including terminations, challenges or decisions pending, and voluntary resignations/relinquishments).

4. Past 12 months' clinical activity (approximate number of patients treated and clinical setting).

5. Previous 10-year malpractice history (including claims, suits, and settlements).

6. Sanctions by licensing or regulatory agencies.

7. Lifetime criminal record.

8. Signed professional references (attesting to adequacy of clinical knowledge, technical skills, judgment, communication skills, overall professional performance, and adherence to rules and bylaws) by emergency physicians who have observed the applicant first-hand.

AAEM already recognizes that ABEM or AOBEM certification provides training superior to that provided in ACLS and ATLS courses and, as such, those credentials should not be required of board-certified emergency physicians.

Emergency Physician-to-Patient ED Staffing Ratios
Whereas the volume of ED visits continues to rise and now exceeds 100 million in the United States annually; and

Whereas the scope of Emergency Medicine requires a high intensity of service for many conditions, especially during the first hour of treatment; and

Whereas emergency medicine involves patient evaluation, interval assessments, complex decision-making, time-intensive procedures, care coordination with primary care and consulting physicians, chart documentation, aftercare education, and inter-facility transfers; and

Whereas emergency patient work-ups are getting more involved due to admission prevention strategies of managed care organizations; and

Whereas emergency physicians provide a vital role in medical error reduction in one of the highest risk areas (according to the Institute of Medicine);

Therefore be it resolved that AAEM asserts that, as a guideline for comprehensive, moderate acuity emergency departments, the emergency physician staffing ratio should be based on the rate of patient influx such that the rate of 2.5 patients per physician per hour is not exceeded.

Emergency Nurse-to-Patient ED Staffing Ratios
Whereas the volume of ED visits continues to rise and now exceeds 100 million in the United States annually; and

Whereas the scope of Emergency Medicine requires a high intensity of service for many conditions, especially during the first hour of treatment; and

Whereas emergency nursing involves patient evaluation, interval assessments, medication administration, procedure assistance, point-of-care testing, chart documentation, and aftercare education; and

Whereas emergency patient work-ups are getting more involved due to admission prevention strategies of managed care organizations; and

Whereas emergency nurses provide a vital role in medical error reduction in one of the highest risk areas (according to the Institute of Medicine); and

Whereas a reduced regular staffing pool results in the use of inexperienced nurses during crisis periods (e.g., influenza season);

Therefore be it resolved that AAEM asserts that, as a guideline for comprehensive, moderate acuity emergency departments, the minimum emergency nurse-to-patient staffing ratio should be 1:3 or based on the rate of patient influx such that the rate of 1.25 patients per nurse per hour is not exceeded. In addition, dedicated triage and charge nurses are necessary in higher volume departments.

AAEM Board Clarifies Stance on Non-Discrimination of Practice Track EPs
At the February 22, 2001, Board meeting the AAEM Board of Directors passed an amendment to its existing position statement on the non-discrimination of practice track emergency physicians, clarifying its reasons for taking that stance. The revised position statement reads:

AAEM asserts that board certification through ABEM or AOBEM is recognized as the standard that establishes competence in the diagnosis and management of conditions in Emergency Medicine.

The restriction of employment or access to fellowship training programs for board-certified emergency physicians based upon a requirement of prior Emergency Medicine residency training is improper. AAEM asserts that equality of status between residency trained and practice track physicians is established by board certification, and equity of both educational and professional opportunities should follow.

This is to recognize the fact that there is a period of time in the early formation of every specialty where no formal residencies exist, and that it was therefore appropriate to create a time-limited practice track for the founders of the specialty to become board certified. Currently and for the future, in the interest of patient welfare, accredited Emergency Medicine residency training is the only acceptable pathway to ABEM/AOBEM certification.

Bylaws

Change Will Require Maintenance of Board Certification
At the February 22, 2001, Board meeting the AAEM Board of Directors passed an amendment to the AAEM bylaws to require that Board members maintain their board certification status throughout the length of their terms of office. From this point forward, any Board member who allows his/her board certification status to expire will automatically be retired from the Board.