AAEM Takes a Stand on the Role of APPs in ED
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 specialty.
AAEM Board of Directors
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)