Posts Tagged advocacy
Did you hear? “The ER physicians and hospitals have been abusing their privileges as providers of ER services for years,” according to the Chief Medical Officer for the Washington State Medicaid Program.
These are the statements that make involvement in organized medicine and participation in leadership at all levels critical. But where do we acquire the skills to combat these misperceptions and outlandish statements?
In May every year, there is a one of a kind event in Washington, DC called the ACEP Leadership and Advocacy Conference. It is an intimate conference with about 500 attendees, representing leaders in emergency medicine from across the country.
The conference focuses on principles of leadership, current issues in advocacy, media training, and practical everyday leadership challenges that will confront leaders in every state. It is also an excellent opportunity to network with colleagues from across the country.
When I first attended 5 years ago, I went as a member of the EMRA Chair’s Challenge and the incoming Legislative Advisor for EMRA – a neophyte to organized medicine by all accounts. It was an eye-opening experience to be talking with the leaders of our specialty. These were the people and faces that went with the legendary names I read about in Annals and ACEP News. Now I was talking with them, learning from their experiences and stories, and finding out how varied the opportunities were in emergency medicine.
From chairs of departments, leaders of advocacy groups such as the AARP, AMA delegates, speakers of the council, and so many others, I had the chance to see and live the history of our specialty. Then on the final day of the conference, we put it all together and walked up to Capitol Hill as hundreds of physicians representing our millions of patients to share our stories with elected officials and change the face of medicine.
This year it is my privilege to share with you my experience in Washington State, having put these skills into action on the local level. When I joined the Washington ACEP Board of Directors, I never imagined I would use so much of what I learned at LAC. From media training skills in doing press interviews and the gotcha journalism warnings, to relationships I have leaned on for statistical assistance in fighting misleading information, and the practice of speaking with legislators – these are all invaluable skills.
If you have the slightest of desire to join the leadership of emergency medicine in your hospital as a facility medical director, at the state level in an ACEP Chapter, nationally on a committee, or be involved in one of the hundreds of other ways possible, I encourage you to attend ACEP’s Leadership and Advocacy Conference in May. It is the conference that I walk away from every year re-invigorated and ready to take on the challenges of caring for our patients in the halls of our department, but also and more challenging often, the halls of the Legislature. You will not regret coming to DC, but you might just regret missing it!
Let’s face it. I’m an old dude. I have only been practicing emergency medicine for 16 years but I have 5 years of post graduate training and went to medical school late in life. Sooo…when it comes to this” techie” stuff I am in my infancy. My 12 year-old and certainly 20-year old have me beat. However, as painful as this may be, I decided to “step-up to bat” when I received a note from ACEP asking if I might be interested in blogging.
Don’t get me wrong, I have a few computers and they are not like my first, a Tandy, from Radio Shack that cost me more than three computers in today’s world and it worked on “floppy disks, but now I am really dating myself. Look, everyone needs to try new technology. I remember my first hand held calculator that I received for college – it weighed about one pound, cost about $100 and could add, subtract, and do square roots!
Now I even have a Blackberry so perhaps I’m not that much of a novice with technical gadgets but I refuse to switch my carrier to AT&T for an i-Phone (although it does look like fun). And, I even have Twitter, but use it anonymously, since I really don’t think people who don’t know me are that interested in what I’m doing every minute of my life.
As a faculty member in an emergency medicine residency, I was convinced to actually join Facebook. Perhaps, it was done out of pseudo-peer pressure, but it has added to the camaraderie in the Emergency Department and has reduced stress levels amongst the staff.
Well enough said about the technical aspects of blogging other than the time commitment to blog. As a start, I will try and commit to a weekly entry since I have to still work my shifts, teach, take care of administrative issues, and of course be a “real person” outside the ED. It does scare me looking at all the gizmo’s on this website that the reader doesn’t see like icons for You Tube, insert points for cameras, video, google, Spike….Perhaps I’m out of my league but time will tell!
Oh yeah…one more thing…why was I asked to blog anyway? Since I have been involved in federal and state governmental affairs with both ACEP and my state chapter, it was suggested that physicians may want to hear a member’s perspective on advocacy. I will be the first to acknowledge that I am no expert; there are far smarter people out there than me, but hopefully my opinions and observations may motivate others to become more involved in this process.
For now, please forgive me as I get oriented to the site and all the bells and whistles on this side of the keyboard…and thank God for spellchecker…Wow and I kept it under 500 words…awesome.
The Senate began debate Nov. 30th on its version of health care reform legislation. Opening statements came from Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KY). The debate is expected to heat up as the parties offer alternating amendments. Rumor on the Hill is that Reid will conduct much of the work for consensus on the bill in the privacy of his office. According to American Health Line (11/30/09) four moderate members of the Democratic Party have been requested to attend private meetings to discuss the public option – Sens. Mary Landrieu (D-LA), Joseph Lieberman (I-CT), Blanche Lincoln (D-AR), and Ben Nelson (D-NE).
Of interest to emergency physicians is an amendment proposed by Sen. Charles Schumer (D-NY) that would add 2,000 residency positions to the current cohort of 100,000. Although it is unclear from the amendment which specialties would benefit from the additional training positions, physicians have conveyed their concern to lawmakers that health reform legislation will increase the demand for medical care.
Separating reality from rhetoric is always a major task in Washington D.C., and the debate over health care in America has only made that task more difficult. What IS apparent, however, is that the White House has decided to weigh-in with its own public relations campaign.
Check out this video featuring Vice President Joe Biden and the presidents of the American Association of Family Physicians and the American Nurses Association. You tell me…..reality or rhetoric?
- HIV, Early Recognition, and Rapid Testing from EMedicine.
- The Emergency Medicine Clinics of North America has a great review article from 2008: HIV Infection and Complications in Emergency Medicine.
- Needle-stick Guidelines from EMedicine
- Many people don’t know this, but there is an algorithm for treating people with “non-occupational” (usually sexual) recent exposures to HIV, and post-exposure regimens from this great CDC paper. If it’s less than 72 hours and a significant exposure, treat! You could prevent HIV infection in someone. (According to one study I’m just quickly skimming where they followed 700+ people after exposure treated for 1 month, 1% became HIV+ at 12 weeks (no placebo control).
- It appears as if the rise in HIV infections is slowing in the world. USA HIV/AIDS stats. If you want some shocking, scary statistics, look no further than the US City/State HIV/AIDS data. I thought we had it bad in New York — call me ignorant, but I never knew how terribly the South is effected: the highest rates of AIDS diagnoses are in Miami, New Orleans, and Baton Rouge? And that Washington DC has a percentage of AIDS patients 5 times larger than #2 on the list (New York)? (And the Virgin Islands actually has a higher percentage than New York.)
- Update: My fantastic attending just pointed me to a great, free educational tool to learn about post-exposure prophylaxis of all varieties: The CEI Widget, from the Clinical Education Initiative from New York State walks you through everything. (Thanks,
Last night the U.S. House of Representatives passed a health reform bill, H.R. 3962. Emergency physicians are divided in their thoughts about the consequences of this legislation, as is the house of medicine and the country in general. However, there are many aspects of the bill that are positive for emergency patients and for emergency physicians.
Some of these include:
- Inclusion of emergency services as part of an essential health benefits package
- Statutory authorization of ECCC (Emergency Care Coordination Center) and ECCC Council of Emergency Medicine
- Health and Human services annual report to Congress on ECCC activities, with focus on emergency department crowding, boarding and delays in ED care following presentation
- Emergency care/trauma regionalization pilot project grants
- Trauma stabilization grants
- Health and Human Services incentive payments to states that establish medical liability reforms (Certificate of Merit/early offer)
- Health and Human Services demo project to reimburse private psychiatric hospitals that provide EMTALA services to Medicaid beneficiaries
The American College of Emergency Physicians has worked diligently to represent emergency physicians and emergency patients throughout this volatile process. As the process continues toward final legislation, ACEP will continue to focus on the needs of emergency patients, future emergency patients, and the physicians who care for them.
It’s been my experience that conferences are often like great big pep rallies, except usually the night or day following the pep rally the big game happens. Keeping motivation and spreading it tends to be more difficult when it comes to motivating people towards advocacy. I decided that this time I would be prepared for my trip back home. I loaded up with copies of the EMRA Advocacy Handbook, and filled my head with information before departing D.C., but it seems that I wasn’t as prepared as I should have been.
Once home, I found that by and large the residents that I spoke to could largely be grouped into one of two classes: 1) Those who wish that the knew more about health policy and health care legislation, but didn’t know where to find it, or 2) Those who were glad that I enjoyed “that stuff”, but it wasn’t for them.
The first group, I’m sure all of us reading this blog are familiar with; If it isn’t us now, it was us at some point in our careers. What I found funny was that I found more interest in the latter group. Many of them because I knew well enough to know that the DID have a stance on health policy. Most were surprised when they learned that many of the things that interested them not only “counted” as advocacy, but were discussed at the conference. Whether the interest was EMS diversion, patient literacy, or on call coverage, each person had an advocacy interest; Most of them thought that their interest fell outside of the lines.
Additionally, many complained that too often in residency we get so caught up in treating the patient, doing paperwork and making rounds that we neglect the non-clinical aspects of medicine. Just as how EM was left out of the EMTALA talks years ago, this goes on in hospital administration today. The sentiment seemed to be “we don’t know how, we don’t have time, so we don’t.” This made me reflect on my biggest fault. I an terribly guilty of the “If I Don’t Do It, No One Will” mentality. It dawned upon me that there are many people who are ready to step up and fill in the big roles; including the resident level. However as residents we are new to the field and what many of us need is someone who will show us the way. Admittedly, one of my strengths is in seeking out new opportunities; however, because if my aforementioned fault I often kept them to myself. As my residency continues it is my goal to pass those opporunities on to others for the betterment of myself, my peers and our collective careers.
Every episode of Scrubs has an overall theme summed up with a moralistic ending and a great song to drive the message home. Most, if not all, of the characters come to the same grand realization at the end. The episode “My Best Moment” J.D. (the lead character) was put in charge of telling a group of medical students what it was to be a doctor; instead, he reminisced over his greatest moments and challenged his staff to relive theirs. In many ways, the L & A conference had this feeling for me.
It’s been 8 years since I was last on Capitol Hill. I have made a few odd trips to DC for one reason or another since then, but not to the Capitol building, not with an agenda, and never with so much energy and enthusiasm. My first trip was as a congressional intern for Dr. John Cooksey. He was the representative for the 5th district of Louisiana and an Optholmologist in Monroe (my hometown…of sorts). Few people that I had ever met commanded such respect and in the community, and his ability to be both a congressman and a doctor were legendary. Dr. Cooksey was a believer that to use the title of “Doctor” you needed to actually see patients and did so 3 days a week when the congress was in session (more when it wasn’t).
This trip to D.C. and meeting up with old colleagues now serving as staffers reminded me of those good times. “My Best Moments”, however, will be the times sitting around with my new physician colleagues trading stories on our starting points, our most difficult and most rewarding patients. The talks about the best (and worst) of being a doctor. Now, the most gratifying moment of the trip was the opportunity to share all of these stories with our representatives who were eager to hear first hand stories of the true “life in the ER”. They were exceptionally receptive to our ideas.
Unfortunately for me, of Louisiana’s 3 physician representatives, I was only able to meet with 1 (don’t fret, members of the LA-ACEP chapter met with them all). Dr. Cassidy (Congressman for the 6th district) embodied the best of what I remember about Dr. Cooksey. Considering himself to be first a physician, he told us all that if he could not properly treat his patients he would not stay in D.C. He also understood the lack of input by physicians into the current health care debate and felt a calling to speak on behalf of both physicians AND patients. That through his time working on policy he could ensure better care for a greater number of patients. Admittedly, only a small portion of our time was discussing the bills being presented; he majority of our time was spent discussing the needs of our patients and our desires to serve. It gave you a sense of relief to meet a representative who cared so much.
So…the end of that episode of Scrubs. Everyone recognized the great things that had come before, and that better things could come if they were to build upon that experience. Oh, and the song at the end of the episode…”Joy to the World” by The Butties. Fitting, indeed.
Next Installment: My Take Home Message…
Today we have heard a variety of opinions from close observers of, and one participant in, the early phases of development of health care reform legislation.
The participant was Neera Tanden. Ms. Tanden was a senior vice president for Academic Affairs at the Center for American Progress before being appointed Hillary Clinton’s policy director for the 2008 presidential campaign. Then, late last June, she was recruited to become Director of Domestic Policy for the Obama campaign. She is now the point person on health reform for the Department of Health and Human Services in the Obama Administration. After making relatively brief remarks as the luncheon speaker at ACEP’s Leadership & Advocacy Conference, she invited questions.
Most of the questioners focused on enlarging her understanding of the emergency medicine perspective on reform of the health care system. She did her best to assure us that our concerns were not unfamiliar to policy wonks in the Administration and among the leaders and staffers of key Congressional committees. And she was forthright in asserting that the Administration has learned from the errors made during past, unsuccessful, efforts at comprehensive reform. One member of the audience (can you guess who it might have been?) asked if there is reason for us to believe that the president’s “clear path” toward universal coverage does not represent more ineffective incrementalism on a “long and winding road” (apologies to Paul McCartney). Ms. Tanden was certainly the most optimistic of the speakers who addressed us today, asserting that President Obama did not come to the White House to accomplish small things, that his approach to reform will be bold and aggressive, and that it will be weeks to months, rather than years, before we are firmly on that clear – and short – path toward the goal of covering every American.
An earlier speaker had pegged the likelihood of enacting substantial health care reform legislation this year at no better than 50-50. Let us hope that Ms. Tanden’s optimism proves to be well founded. As Mr. Obama has said repeatedly, the cost of inaction is unacceptable, and doing nothing is simply not an option.
This morning we heard a great “call to arms,” as it were, by our fearless leader, Dr. Nick Jouriles. He discussed something we’ve been hearing about for the past year.
There does need to be change. The problem is no one is really in agreement on how that change should occur.
Who wins these nauseatingly long and verbose arguments?
No one. And least of all, the patient. The one we started this whole med school and residency thing for anyway.
Because ultimately, that’s what it should come down to: our patients. That’s what we’re here in DC doing – advocating for our patients and for our specialty.
Now, granted, we’re here for our patients. But what really talks in the Beltway is money. It’s all about the Benjamins here. As AC/DC once said: Money talks.
In today’s economic climate, everyone is spending less and expecting more. But if you haven’t donated to NEMPAC yet, because you’re saving for that rainy day, let me tell you something, honey. It’s pouring outside. It’s raining on our patients and the emergency department is the umbrella that covers everyone. We’re it people. A storm is a-comin’ and the umbrella is about to flip inside out and carry us away.
As Dr. Jouriles says, it’s time to give a shi(f)t. Only one Benjamin for us residents, and 10 for attendings. Let me hear the money talk.