Fall 2020 Newsletter

In This Issue


President's Message

The past year has seen challenges on many levels that we have never experienced. COVID-19 has permeated every aspect of our lives, from our personal day-to-day endeavors to our profession. Who does not have or know of a child that is on virtual schooling? How many relatives have we not visited over holidays and family events in hopes of quelling the SARS spread? And we all have read or know of emergency physicians whose practice has been seriously altered. The loss of compensation notwithstanding, many of us have self-quarantined or tried to live “remotely” even within our homes. Increased depression, domestic violence, and substance abuse have taken a further toll. COVID-19 collateral damage some have called it. Part of that damage was the unfortunate cancellation of our FLAAEM Scientific Assembly this past May.

It is times like these that our professional organizations can offer guidance. It is times like these, when some emergency physicians are mere pawns on the financial chessboard, when AAEM will step up to continue protecting the principles we all deeply value: the right for access to quality emergency care provided by a qualified emergency physician in an unencumbered clinical practice. It is these times when Florida emergency physicians need to band and network together more closely than ever. With all the new challenges, it’s difficult for physicians to monitor the multitudinous changes. It seems like we are living on shifting sands. As a member of FLAAEM, physicians can know that their best interests and the interests of their patients are always our highest priority. We at FLAAEM work to be a part of the vanguard as the Champion of the Emergency Physician on the state level. But none of this can be accomplished without your continued support. Your membership is vital in letting FLAAEM know where the serious issues are – for if it affects one emergency physician, it can affect any emergency physician.

So thank you from the board for your endeavors. Please continue your stay with FLAAEM. Encourage your emergency colleagues to join FLAAEM for we are all stronger and more effective with increased membership.

For now, we at FLAAEM wish you and your families a safe but renewed hope for the Holidays.

Sincerely,

Ramon Pabalan, MD FAAEM
President, FLAAEM

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Message from the Editor

Dear FLAAEM members,

Our Fall 2020 edition of the Florida Chapter Division of AAEM (FLAAEM) newsletter comes at an interesting time for emergency medicine. We are being challenged in our specialty on many fronts. There are many things happening for the first time ever in my 25-year career in emergency medicine.

COVID-19 has contributed to the largest decreases in emergency medicine (EM) volumes that I have ever encountered. Most emergency departments around the country saw 40% decline in volume according to the CDC. This has led to numerous staffing issues and financial hardships for many.

Senior residents throughout Florida are reporting difficulty finding jobs. This is definitely a first in my career and should ring alarm bells to our members about how important it is to take stands to protect our future. The number of EM applicants continues to increase. In 2012, there were 2,935 applicants. In 2020, there were 3,640 applicants. The number of programs continues to increase. Today there are 221 EM programs in the United States. In 2014, there were 1,786 EM positions available and in 2018, that number increased to 2,278 available EM positions.

CMS is about to instill the largest pay cut in our history as a profession. This will no doubt have repercussions on our ability to provide for our families. It is startling that at a time when we are at the frontlines risking our lives fighting a pandemic, CMS wants to cut our reimbursement.

This on top of the weakening of our ability to negotiate with insurance companies with the Surprise Medical Billing legislation. The insurance companies stand to make huge profit at our expense by putting the patients in the middle of our negotiations with insurers for fair reimbursement. The insurance companies have painted physicians in a very negative light and we have lost the support of public opinion. This legislation passed as being a part of the new COVID-19 bill that was recently passed.

On a brighter note, we have an opportunity to finally have due process for our staff privileges.

The bipartisan bill (HR 6910) is asking that the U.S. Secretary of Health and Human Services issue regulations to ensure due process for emergency physicians. This is vital for the future of emergency physicians. We are on the cusp of losing our ability to advocate for our patients.

Having emergency physicians under the thumb of hospital administrators does a grave disservice to the community at large. Again, please call your representative and ask them to support HR 6910.

As 2020 winds down, we are blessed with hope as we line up for our COVID-19 immunizations. The fear and turmoil the pandemic has instilled in the emergency medicine community is unprecedented in my lifetime. Praying this is the beginning of the end!

Happy Holidays everyone and prayers for the promises 2021 may bring!

Editor Mark Foppe, DO FAAEM FACOEP
Board of Directors, FLAAEM
Newsletter Editor

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FLAAEM Board Votes to Restart Educational Meetings in 2021

The FLAAEM Board of Directors has voted to hold a virtual Town Hall Meeting this spring on Saturday, March 20, 2021. The format will be similar to our national town hall meeting and will allow members to hear what is currently happening in emergency medicine in Florida as well as give members the opportunity to share their experiences of our current practice environment and any other issues concerning the membership.

The board also voted to hold an in-person 9th FLAAEM Scientific Assembly in October or early November 2021 (dates to be determined). We are planning to return to the Fontainebleau Miami Beach. Dates and details to be announced soon.

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9th Annual FLAAEM Scientific Assembly

October/November 2021

Registration rates:

  • Non Member: $125-Attendings; $75-Not Certified Physician/Allied Health; FREE-Resident/Student
  • FLAAEM & AAEM members with refundable deposit: $100 Attendings; $50 Residents; $25 Students

More information coming soon.

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27th Annual AAEM Scientific Assembly

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FLAAEM Board of Directors Call to Action

During this time of restricted face-to-face meeting the FLAAEM Board of Directors encourages the membership to reach out to the FLAAEM Board of Directors with questions or concerns at info@flaaem.org.

For a roster of board members, please click here.

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Board of Directors Meeting Update – November 2020

2021 FLAAEM Board of Directors Election

Nominations Open Mid-March 2021

Open board positions in 2021:

  • President
  • Vice President
  • Secretary-Treasurer
  • Resident Member Representatives (3 positions) North, Central and South Florida
  • Medical Student Representative

Self- nominations are encouraged.

FLAAEM is seeking passionate physicians to further the causes of emergency medicine and physicians in Florida.

Please consider running yourself or nominate a member who you think is energetic and has the right stuff to work with us.

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Dr. Vicki Norton Elected to the National AAEM Board of Directors

Congratulations to Dr. Norton (Immediate-Past President of FLAAEM) on her election to the national AAEM Board of Directors. FLAAEM is proud to continue its representation on the national level and glad to support Vicki Norton, MD FAAEM during her term as a At-Large Director on the AAEM Board of Directors.

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Member Benefits

FOMA - Discounted Rate of $25 for Prescribing Controlled Substances Course

The Florida Osteopathic Medical Association (FOMA) is providing FLAAEM members a $25 rate (regularly $75) for their two (2) hour online “Prescribing Controlled Substances” course. Fulfills the opioid prescribing requirement for all Florida physicians. Log-in to your member account to retrieve the discount code.

Free* Annual Scientific Assembly - 9th Annual Scientific Assembly: October/November 2021

Registration opens March 2021.

*With a refundable deposit

Dress A Med - 20% Discount on scrubs/uniforms

FLAAEM is pleased to announce our latest partner in our member discount program. Dress A Med provides quality scrubs and medical uniforms. FLAAEM members receive a 20% discount sitewide.
Visit the FLAAEM member center to retrieve the code.

Advanced Medical Certification - 35% Discount on online ACLS & PALS

FLAAEM has aligned with Advanced Medical Certification (AMC), the premier online certification and recertification course provider for health care professionals offering 100% online courses for certification and recertification in ACLS, PALS, BLS and CPR.
Visit the FLAAEM member center to retrieve the code.

American Seminar Institute - 15% Discount on custom travel CME

American Seminar Institute (ASI) offers portable and accredited continuing education courses. You can take your individual course at home or anywhere in the world. Complete your continuing education when it fits into your schedule. Multiple specialty areas and topics are available.
Visit the FLAAEM member center to retrieve the code.

FLAAEM Advocacy and Legislation Reform

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Recent News, Updates, and Articles

FSU College of Medicine - Sarasota Emergency Medicine Residency Program Update

Greetings from Sarasota!

Our intern class is all settled in and they already are making us proud. We have held multiple SIM labs such as pericardiocentesis, chest tube, airway lab, and central lines. Our interns are also becoming extremely proficient in the use of ultrasound, especially after having extensive training during their orientation month.

We are continuing to expand our connections within the hospital system. Currently, our ultrasound director, Dr. Ashley Grant is working on creating an ED ultrasound rotation for medical students. We have had residents sit on multiple committee meetings at the hospital as well. One of our rotations in the PGY-2 year includes an administrative month, which aims to educate on various facets of the emergency department not taught during medical school such as billing, ED flow, and working with the ED staff to come up with plans for unexpected circumstances. We’re very proud of our own Dr. Josh Lehman for his first publication! Our PGY-2 class has been steadily working on their research projects for the year.

Our wellness event this past month consisted of a beach clean-up which was a lot of fun to get outside and help the community. We’re looking forward to the rest of the year, and especially looking forward to 2021!

Courtney Kirkland, DO, PGY-2

 

Update for Brandon Regional Hospital - Emergency Medicine Residency Program

There are many exciting happenings occurring at Brandon Regional Hospital's Emergency Medicine residency program. This is the first year that we have a full complement of three full classes of residents and we welcome the new PGY -1 class of 15 residents!

There are numerous graduating seniors who have successfully matched into fellowship programs: three have matched into ultrasound fellowships (UPenn, UF Jacksonville, and Boston Medical College), one has matched into a critical care/ emergency medicine fellowship (UPitt), and one has matched into a simulation and patient safety fellowship (Georgetown U)!

Two of our senior residents, Dr. Ricki Brown-Forestiere and Dr. Andrew Glickman have signed to stay on at Brandon Regional Hospital as attending physicians and they are very excited for the opportunity to work at their home institution at the completion of their residency training.

Throughout the past six months, we have added numerous core faculty that are all fellowship trained. We are very excited and grateful to have Dr. Priscilla Cruz (International Medicine trained), Dr. Martin Kim (Simulation fellowship trained), Dr. Amanda Webb-McAdams (Research fellowship trained), and we are excited for the arrival of Dr. Rafael Colon (Hyperbaric Medicine fellowship trained).

The residents have put out many publications in the past 3-4 months with the assistance of our Ultrasound fellowship trained core faculty Dr. Eric Kalivoda, Dr. Gabriel Cabrera and our research director Dr. Amanda Webb-McAdams.

We are very committed at the BRH Emergency Medicine Residency program to caring for COVID-19 patients. The residency has continued to grow and excel even in these trying and stressful times.

We are very excited for the future and continued strides our program makes every day by caring for patients located within Hillsborough County.

Andrew Glickman, DO MS- PGY3

 

USF Emergency Medicine Program Updates

This year USF launched a new website, usfemergencymedicine.org, and an educational blog that provides a glimpse into our training program. The website is not the only thing new at USF this year! Dr. Ryan McKenna, our Simulation Director, established a Simulation Fellowship and we are pleased announce our inaugural fellow, Dr. Nicole Abdo. Sim Fellows will train at the Center for Advanced Medical Learning and Simulation (CAMLS), an unparalleled state-of-the-art simulation center. Dr. John Elkes matched into our EMS Program and Dr. Judith Oriental-Pierre, from UConn, will join us as our Ultrasound Fellow. We are also proud to partner with USF to offer a multi-disciplinary Global Health Fellowship next year. Dr. Jasmine Patterson, Director of our Pediatric Emergency Department, has joined our Core Faculty. Dr. Patterson has recently worked with our department to incorporate a longitudinal pediatric component to our residency curriculum.

Our Research Department continues to expand even during the COVID-19 pandemic. Our established research infrastructure has allowed us to continue enrolling patients into clinical trials and to operationalize COVID-19 research within and outside the hospital walls. Specifically, our research assistants and advanced practitioners have played a huge role in linking eligible patients to COVID-19 research studies and then administering study drug and completing visits at a COVID-19 participant research center. Our research group continues to lead the southeast in ED-INNOVATION enrollments since October 2020. ED-INNOVATION is an NIH funded grant to improve patient care for opioid use disorder in the ED. We have also become part of another important NIH funded, Operation Warp Speed study, ACTIV-4, which places patients with COVID-19 on anticoagulation after ED discharge. Our department has helped our hospital system make use of our research infrastructure to treat patients with monoclonal antibodies both as research and as part of recent FDA EUAs. While much of the focus has been on monoclonal antibody treatment options, Dr. Okonkwo initiated a trial in November that examines the effect of an anti-viral medication on patients with mild/moderate COVID-19 after ED discharge.

We are also excited to welcome our first Post-Doc fellow, Bernice McCoy, who will defend her PhD in anthropology in December 2020. We are committed to partnering with our social medicine programs under the leadership of PhD candidate Heather Henderson and the support of the USF Department of Anthropology. Our newest major initiative will be the launch of the Syringe Services Program operated with the USF Tampa Bay Street Medicine program. That initiative will ramp up harm reduction efforts while also focusing on decreasing HIV and HCV transmission in our community. Additionally, our department continues to lead the surrounding area in the treatment of opioid use disorder (MOUD) and opioid withdrawal syndrome with ED initiated buprenorphine, onsite MOUD specialists, and referral programs.

Like all programs, COVID has forced our department to adjust in many ways. We are proud of the efforts we have made at TGH to protect our patients, residents, and staff. In October, our hospital launched the Global Emerging Disease Institute (GEDI) to further facilitate interdisciplinary COVID-19 care. Our ED serves as the hub of pivoting patients with COVID-19 to the right care at the right time - whether that be a monoclonal Ab infusion, a research study investigating new treatments, or other supportive care options within or outside the ED. We are also excited to have been one of the five sites chosen to receive vaccines in the first wave after EUA is granted by the FDA! 

2020 has been a year like no other! We are grateful to be a part of the USF Family and wish all the EM community a happy and healthy New Year!

 

Orange Park Medical Center Residency Update

The last few months have been a time of extraordinary growth for our program. Not only did we expand as a residency, by welcoming our second class into the ED, we are also in the process of literally expanding our hospital as we near the completion of a three-story addition to increase our available inpatient bed space. We have also begun rotating our residents at a third ER for our program at Normandy Park ER, giving our residents another environment to learn and train. In the research realm, we are working towards multiple industry grants as well as continuing our multi-disciplinary research in collaboration with our dermatology residency. Our second-year class has begun putting in the groundwork on some other exciting projects involving our local EMS agency and point-of-care ultrasound.

Other academic updates include our program competing in our first FCEP case presentation competition. Dr. McKeny and I came home empty handed, but our program live-streamed all the presentations, learned a ton, and became even more eager for a chance at the title next year. Similarly to all programs, we’ve tried to adapt to the times. We’ve been offering a “virtual rotation,” allowing medical students to stream into our Thursday conference and get more involved with our residents each week. Dr. Fry and Dr. Descallar have led this initiative to assist medical students struggling to arrange rotations due to COVID-19 – an additional opportunity to stay involved in the EM community.

We have also begun working with our partner medical school, Mercer College of Medicine, and will be hosting a simulation day at their campus giving medical students a chance to have some hands-on scanning time learning basic bedside ultrasound skills with our ultrasound guru Dr. Euwema. And, to take a break from it all, we are getting together as a program with all our residents and family members to go to a socially-distanced Jacksonville Jaguars game together, where we will see our very own Dr. Deaton on the sidelines as the airway physician for the Jaguars. Our residency has also encouraged adventurous elective rotations to get away including a wilderness medicine elective recently completed by Dr. VanderVelde and Dr. Lofran involving them rappelling from large downtown buildings with our local EMS and search and rescue colleagues. In summary, it’s been a rather exciting year of growth at Orange Park Medical Center.

 

Greetings from Miami

It has been an interesting six months in Miami. We have welcomed our class of 2023. They are another fantastic class who come from all over the country, bringing a breadth of diversity, experiences, and insight. Their onboarding occurred during our second peak of COVID-19 in South Florida. We hit out apex at the end of July but managed it well as a community, hospital system, and residency.

Faculty and residents from the University of Miami/Jackson Health System were excited to attend, participate, and present at this year’s Symposium by the Sea, virtual edition. We were amazed by our residents, Dr. Joshua Goldstein and Dr. Andrea Alvarado who competed in the clinical pathology competition. Dr. Goldstein won the award for the best presenter, and Dr. Alvarado won for best discussant, and we were selected as the best overall team. Dr. Naomi Newton won an award for her HIV research at the poster competition as well. Congratulations to them for their hard work and well-deserved victory.

We are over halfway with our first virtual recruitment season and are excited to say things have been running quite smoothly. We have already met an amazing group of applicants and can’t wait to welcome our new Class of 2024. We have held socials virtually and other events such as a women in emergency medicine gathering to discuss the topic of “imposter syndrome.”

One of the newest additions to our residency has been the development of our Social Emergency Medicine curriculum. Led by our PGY-1 Naomi Newton, the project aims to increase community outreach, enhance access to care, and tackle social justice topics. We are excited for all the opportunities this will bring to improving our Miami-Dade community.

By far the most exciting news of 2020 is that we began vaccinations at Jackson Memorial Hospital on December 15. We are hopeful and looking forward to post COVID-19 life. Stay safe everyone, and thank you for all that you do.

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Case Presentation

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