Updated Position Statement on Advanced Practice Providers

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)

Approved 1/29/2019

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