Winter 2020 Newsletter
The FLAAEM Board of Directors and the AAEM Work Force Committee have produced a letter which may be sent to your Florida Senator. FLAAEM strongly encourages our membership to contact their state senator and express their concern over SB 1676. The Florida Senate has advanced the Senate Bill 1676 (SB 1676) - legislation that would create a pathway for APRN independent practice. SB 1676 has passed out of subcommittee and is currently on the agenda-scheduled for the Appropriations Committee on Tuesday March 3, 2020, at 1:00pm. The following is a template that may be used as a letter to your State Senator.
I am a Florida physician. I oppose the proposed expansion of the scope of practice of non-physician practitioners (NPPs) via elimination of supervision requirements by SB 1676. I believe that ALL patients deserve physicians as the leaders of their healthcare teams in order to preserve high-quality care.
Physicians train for years in residency after achieving a 4 year doctorate degree in order to practice independently, and non-standardized, online NP programs with only 500 hours of clinical shadowing cannot duplicate this. Medical errors are abundant without adequate training, and without adequate supervision there will be no way to stop these errors from occurring. This devaluation of physician care will also cause the unintended consequence of more physicians leaving clinical medicine: some voluntarily (due to early retirement or alternative employment) and many others involuntarily (due to replacement by NPPs at places of employment).
I am gravely concerned about the far-reaching unintended negative consequences of SB 1676 on the public health and financial health of our state. As your constituent, I appreciate the opportunity to provide meaningful feedback. Please contact me if I can provide further input.
Write your Senator. To send your senator the above letter:
- Find your Senator at http://www.flsenate.gov/Senators/Find
- Click “Senators” tab, click onto your Senator, click “email this Senator,” and a form submission will pop-up.
- Select “Healthcare” as the topic.
- Copy & paste the above letter into form, add Senator’s name to the form email below, and your signature to the email below, complete the form, and send.
Ramon Pabalan, MD FAAEM
This past September I was fortunate to be able to attend the Mediterranean Emergency Medicine Conference (MEMC) in Dubrovnik, Croatia. It was the third time that I had attended an MEMC and once again it was a delight to experience the cultural and geographic diversity, not to mention the great topics in emergency medicine given by an equally varied speaker panel. One of my partners asked why I spent my hard earned CME resources and non-clinical time in a far-away location when I could obtain my necessary education much nearer to home, on the web. My answer was simple: it was an opportunity to understand medicine through a different lens in an equally different framework.
It’s easy to have the perspective that the emergency medicine we practice is the best in the world. We are leaders in research and innovation. We are looked upon by many countries as the very highest standard of care, the envy of the medicine. Or are we? For example, we’ve heard the statistics that we are nowhere near the best when it comes to infant mortality rates in spite of our large healthcare budget. The communities that have the highest percentage of functional centenarians live in very modest towns with relatively simple resources according to Dan Buettner from Blue Zones. Only one of those communities is within our country. Clearly, our paradigm of healthcare might be missing something and I wondered if I could glean some insight from our international colleagues, hence my trip abroad.
In the same vein, I begin to wonder about medicine closer to home. I learn a lot from our EM brethren, and not just about clinical medicine. The practice of medicine has become more than clocking shifts and moving patients through our departments. I know I am preaching to the choir when I say medicine is a business with the major players being government, insurers and the legal system. The influence of those of us in the trenches has eroded to the point where some systems view us as pawns to be shuffled across the financial and political game board. We know who some of those systems are. Or we should.
I make my case that this is one of the most powerful reasons that emergency physicians should band together more than ever. We need to reclaim our position in the healthcare arena. Membership in FLAAEM can help us speak more forcefully than a lone voice. Even now, we are battling the potential of non-physicians providing medical care without the supervision of a qualified physician. Florida’s HB607 will be decided soon. If it passes in one form or another, it will be a serious blow to the safety of our patients and significantly alter the course of our careers.
So I ask all emergency physicians to make a stand and join us, to reaffirm what it is to be a physician. More than ever our practice is in jeopardy but there could never be a more opportune moment to make a difference.
Dear FLAAEM members,
Welcome to the winter 2020 edition of the Florida AAEM newsletter. There are many issues presenting in this new decade in the state of Florida. FLAAEM is working hard to make sure our members are informed and represented. The foremost issue of note is House Bill 607, which is being sponsored by an emergency medicine physician Rep. Cary Pigman. The purpose of HB 607 is to give nurse practitioners and physician assistants independent practice rights without physician oversight.
The following is an excerpt from an interview with Rep. Cary Pigman who is an emergency medicine physician elected to the House of Representatives in the state of Florida.
Florida Politics: Representing a rural district, can you explain how the medical field is impacted where you live and what doctors in rural areas think of this issue?
Pigman: Most of the physicians in my district understand it, most are so busy doing what they are doing, they say it won’t impact them one bit. As an emergency room physician, I see a huge number of people who are sick and couldn’t get in to see primary care providers. To me, it’s about straight access to care. Many physicians who object most stringently, and today we had a retired Surgeon General who spoke, this will have zero effect on general surgery, urology, cardiology, all the specialty practice. Especially those with procedures, nurse practitioners and registered nurses won’t do that. But this is one of these scope-of-practice bills, and that’s a four-letter word in the state Legislature. Whenever we happen on an issue, it takes a long time to resolve. There’s always doom and gloom and terrible things that will happen. But after years we do it, and then nothing happens, or probably good things happen. This is just another case of that.
Editorial note: I live in the same county as Rep. Pigman and I can assure you I am very concerned that this will have significant impact on our practice. Rep. Pigman’s statement that this will have zero effect on “all the specialty practice” is blatantly untrue. Ironically, it is in Dr. Pigman’s own specialty where this will have a major impact. As emergency medicine visits have escalated over the last 10 years my experience to cope with the increased volume the CMGs have always chosen to “add a midlevel shift” or to “increase midlevel hours.” I am sure many of our members have had similar experiences. We can only expect to see a marked increase in this behavior from the CMGs if this Bill becomes law.
There will definitely be a shift to increase midlevel usage in the treatment of patients in emergency departments. Considering the marked difference in the training required to be an emergency medicine physician and a nurse practitioner/physician assistant. This is definitely not in the best interest of our patients.
One of the major arguments we hear is that NPs deliver healthcare much cheaper than MDs/DOs. Recent studies suggest that increased use of nurse practitioners may actually increase the cost of care, due to the tendency to overprescribe medications and unnecessary referrals to specialists and for diagnostic lab and imaging services.
While the supporters of independent practice like to say that 30 states allow full independent practice for nurse practitioners, that number is disingenuous because it includes states that require collaboration with a physician in order to prescribe some or all drugs, but not necessarily to make a diagnosis or otherwise initiate treatment. Even if you concede that the number is 30, it is important to look at those 30 states. The fact is that those states account for only 30 percent of the nation’s population.
A sample of the states that allow independent practice includes Alaska, Idaho, Montana, North Dakota, Vermont, and Wyoming. Larger, more populous states such as Texas, California, Michigan, and Massachusetts, and southern states such as Georgia, South Carolina, North Carolina, Tennessee, and Virginia all require physician supervision of nurse practitioners. Citing patient safety concerns, the state of New Jersey just rejected a bill to allow full independent practice for nurse practitioners. Of note is that despite multiple attempts, in the last five years, no state has enacted legislation granting nurse practitioners full, immediate independent practice. Florida should not be the one to change this statistic.
Editor Mark Foppe, DO FAAEM FACOEP
Board of Directors, FLAAEM
The Florida Patient Protection Coalition (FPPC) will highlight the difference in the education and training a physician receives compared to a nurse practitioner or physician assistant. Physicians receive more than 10,000 hours of clinical education and training. In contrast, advanced nursing degree programs only recommend 500 post-baccalaureate hours (about 12 weeks) of clinical training for Masters of Science in Nursing degree programs and 1,000 post-baccalaureate hours of clinical training for Doctorate of Nursing Practice degrees. Physicians complete three to seven years of residency training in a select surgical or medical specialty under experienced physician faculty supervision.
This coalition will also help counter the propaganda being disseminated by the nursing and physician assistant groups seeking to pass independent practice legislation. The FPPC believes that independent practice and team-based care take health care delivery in two very different directions. Independent practice further compartmentalizes and fragments health care delivery while team-based care fosters greater integration and coordination. Patients’ best interests are optimally served when they are treated in a physician-led, team-based model of care.
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The FLAAEM Board of Directors welcomes Patricia D. Panakos MD FAAEM to the FLAAEM Board of Directors! Dr. Panakos will fill the remainder of the term left vacant when Michael Dalley, DO FAAEM, was elected FLAAEM Secretary-Treasurer.
2020 FLAAEM Board of Directors Election
Nominations Open Mid-March 2020
- 4 At-Large Director Positions
- 1 Associate Member Representative Position
- 3 Resident Member Representative Positions (North, Central and South)
- 1 Student Member Representative Position
All full voting members may run for the At Large Director positions.
Any Associate member may run for the Associate Member Position.
Any Resident member may run for the Resident Member Representative Position of their area (North, Central or South).
Any Student member may run for the Student Member Representative position.
Self- nominations are encouraged.
FLAAEM is seeking passionate physicians to further the causes of emergency physicians.
Please consider running yourself or nominating a fellow chapter division member who you think is energetic and has the right stuff to work for the members of the FLAAEM.
The following is the candidate statement from FLAAEM’s Immediate Past President, Vicki Norton, MD FAAEM.
It is an honor to be nominated for the position of At-Large Board Member of AAEM. As an active member of AAEM for more than a decade, I am passionate about the ideals and values of our organization. I believe every emergency patient deserves to see a board certified specialist in Emergency Medicine and every physician deserves a fair, safe, and equitable practice setting. I will not sit by and allow outside interests threaten to take over our specialty. I want to work towards a safe environment for patients and physicians, due process for physicians, and the preservation of the independent doctor-patient relationship.
My first job out of residency, I signed on with a contract management group (CMG). They had recently acquired the ED contract at the hospital where I was originally offered a position with an independent group. If I declined the job at that time, I faced being unemployed and saddled with all my medical school debt and a new mortgage. And thus, began my exposure to corporate medicine. When I didn’t agree with blindly signing mid-level charts, I was threatened and labeled as a “disruptive physician.” When I saw a colleague fired without cause (but really because he was similarly "disruptive"), I had to silently cover his shifts. This experience validated all my concerns about corporate interference in medicine and became my call to action to do more for our profession.
As the past President of the Florida Chapter of AAEM, I have seen the effects of corporate medicine on my colleagues and patients in the state. Florida is often ground zero for questionable practices by CMGs. I have witnessed colleagues put the best interests of their patients first, only to get fired, be blacklisted, and be written off the schedule; shockingly, they were even accused of trying to interfere with the CMG’s contract. These “companies” do not care about patient safety or our medical licenses. Their only concern is profit and no one can threaten their bottom line. AAEM has long held that this type of interference in medicine should not be allowed.
AAEM’s values also include equitable conditions for physicians and I believe a part of this relates to gender equity, of which I am a strong proponent. As the Chair of the Women in EM (WiEM) committee for the previous two years, I have lead our efforts to advance women in Emergency Medicine and I am now overseeing the committee’s transition into a formal section of AAEM. I will continue to promote women in AAEM through award nominations, recognizing their achievements, and encouraging them to take leadership roles in their professional communities.
As physicians, our duty is to our patients: to be their advocates, to be their safety net for when they need it most. But who will protect us while we are in the trenches? I will. I will be your advocate and the advocate for Emergency Medicine physicians everywhere. I ask that you vote for me to join the AAEM Board.
AAEM Activities (past five years)
Florida Chapter Division of AAEM (FLAAEM) Board of Directors
Florida Chapter Division of AAEM (FLAAEM) Board President
Mediterranean Emergency Medicine Congress Speaker
Membership Committee Member
State Chapter Division Committee Member
Women in EM Committee/Section Chair
Women in EM Committee/Section Member
The following is the candidate statement from Bobby Kapur, MD MPH CPE FAAEM FIFEM, FLAAEM member.
I have the privilege of serving on the AAEM board for my second term, and it has been a humbling and eye-opening experience that has deepened my understanding and my profound respect for the enormous impact we have upon our local communities. During this time, I have worked with many friends and colleagues from the Academy around the country to expand high quality Emergency care, to address the unique needs of Emergency Physicians and to advocate for students, residents and fellows who are the future of our specialty. At our 26th Scientific Assembly, I am asking for your support to serve as the next President-Elect of AAEM. As ABEM celebrates its 40th anniversary, AAEM is firmly entrenched as the “Champion of the Emergency Physician” and the Champion for Emergency Medicine delivered by board certified Emergency Physicians.
With our specialty beginning its next decade, Emergency Medicine is entering a new stage, maybe a new era, in medicine. We no longer are the small voice in the halls of medicine that accompany being a young specialty. Emergency Physicians are now the leading voices, often the most poignant and articulate voices, in healthcare policy and broader social issues. We are at the forefront on the discussions of injury prevention, responsible firearm policies, diversity in medicine, the opioid crisis, HIV screening and treatment, global health, physician wellness, due process, meaningful reimbursement practices, and much more. This list exceeds 35,000 because it includes the spirit and passion of each board certified Emergency Physician. I share with my residents that if an issue has substance and importance in America then it is coming through our doors and people want to know from Emergency Physicians what are our views and what are the solutions. We have Emergency Physicians in local/state/national government positions, in healthcare executive offices and non-profit leadership roles, and, most importantly, in the front lines of medicine. We share a collective pride when we look around and take a moment to absorb the tremendous influence our specialty is having within our country. And this is the platform that serves as the basis of Emergency Medicine’s next stage. As AAEM’s President, I will continue dedicating my time and efforts to advance AAEM’s mission and to promote policies and practices that support Emergency Physicians who provide high quality care and support the Emergency Physicians themselves. I will work to strengthen and expand AAEM’s capacity to Champion the issues our members speak about and tackle each and every day.
I am proud of AAEM’s vast accomplishments and optimistic that our Academy will play an even greater role in the future to improve the lives of our patients and our colleagues. It is an honor to serve you on the AAEM Board, and I ask for your continued support as President-Elect.
AAEM Activities (past five years)
AAEM Board of Directors
AAEM Foundation Board of Directors
AAEM LEAD-EM Board of Directors
Academic Affairs Committee Member
Academic Affairs Committee Board Liaison
ACCME Subcommittee Board Liaison
Education Committee Board Liaison
India Chapter Division of AAEM (AAEMi) Board Liaison
Inter-American Emergency Medicine Congress Speaker
LMS Task Force Chair
Mediterranean Emergency Medicine Congress Pre-Congress Chair
Residency Visit Liaison
Residency Visit Speaker
Scientific Assembly Planning Subcomittee Board Liaison
Scientific Assembly Student Ambassador Liaison
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 - 8th Annual Scientific Assembly: May 10-11, 2019
Registration Now Open
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.
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.
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.
FLAAEM Advocacy and Legislation reform
Update from Adventura Medical Center
We have had three graduating residents accepted into fellowship programs for the upcoming 2020 academic year.
- Dr Jaskirat Gill matched into the Surgical Critical Care fellowship at University of Maryland/Shock Trauma
- Dr Frederick Chu into the Wilderness Medicine at George Washington University
- Dr Emerson Franke into EMS/Disaster Medicine at Barnabas Health NJ Beth Israel Medical Center.
- Dr Jessica Cook, core faculty and Simulation director at Aventura was also recently approved as an FACEP fellow.
Update from Brandon Medical Center
- Dr. Roli Kushwaha PGY2 presented at ACEP in Denver this past Fall on identifying and diagnosing perforated viscous via point of care ultrasound (POCUS) at bedside.
- Dr. Rachel Oliver, Dr. Caroline Shepard, Dr. Melissa Bacci, and Dr. Andrew Glickman all PGY2 residents have been selected to participate in the infamous EMRA Quiz Show to take place during CORD’s Scientific Assembly being held in Manhattan during this coming March.
- Dr. Rashmi Jadhav PGY2 was recently appointed to the CORD Fellowship for Wellness Leadership program. This national program focuses on developing leadership skills and implementing wellness and resilience concepts to a residency program and as a future attending.