Plotting the course of the next 50 years of EM

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Breaking down the highlights of the interim AMA HOD meeting.

Long ago, emergency medicine focused on its grand idea: developing the specialty, gaining academic and institutional recognition, developing residencies and fellowships, and kick-starting research programs. Fifty years later, the big question is what’s next?


Emergency Medicine is one of the top 10 in-demand specialties in the US (1). We are well poised to expand our influence outside of EM. There are many national issues and problems that affect our practice, but we cannot impact or solve them on our own. The next 50 years should give us an opportunity to ally strongly with all of our fellow physicians and work together for common goals of improving the health of the public. A rising tide lifts all ships.

Having the advocacy of institutions like the American Medical Association makes us a part of the bigger picture and allows us to work towards the bigger solution. If the AMA succeeds, we all succeed. It gave us great pride to see Steven Stack inaugurated as 170th president of the AMA—its youngest president ever, and the first emergency physician to achieve that rank.

How many EPs are AMA members? The rule is one delegate for every 1,000 members. ACEP has seven delegates, meaning that there are about 6,000 AMA members who designate ACEP as their organization. That’s about 16% of trained/boarded US emergency physicians.  AAEM has only observer status as it has not reached the 1,000 AMA-member thresholds.


Check out the following summary of the AMA House of Delegates November 2018 meeting. See how many issues ring true with you.

The AMA House of Delegates held its interim meeting at the Gaylord Convention Center in National Harbor, MD. There was the usual assortment of delegates, alternate delegates, interested non-delegates and supporting staff in attendance, including some very old and some relatively young and lots in between. Some were idealistic, some realistic and others very skeptical, but all seemed to have a passion to do the right thing. They were all there to consider some 109 resolutions and about 40 reports from various AMA Councils and the Board of Trustees.

Emergency Medicine was well represented with a strong Emergency Medicine Section Council and many other physicians and students who either are emergency physicians or on that path.

Several resolutions were passed that directly and indirectly impact the practice of Emergency Medicine:


  • Advocacy for Seamless Interface Between Physicians EHRs and Pharmacies and PDMPs. This advocates for the automatic provision of PDMP information for the prescribing physician as part of the EHR. This would go a long way toward easing the regulatory burden on physicians prescribing controlled medications and make the information more accurate and relevant.
  • The Council on Medical Education Report on the Competency of Senior Physicians is well worth a read, since Hospitals and Health Systems are increasingly creating barriers to older physicians continuing to practice. Since we all will be older soon enough if not already. This report aims to develop proactive standards for competency or quality performance while heading off calls for mandatory retirement ages or imposition of guidelines that are not evidence-based. (Note that the AMA has a lower membership rate for semi-retired physicians).
  • Developing Sustainable Solutions to Discharge of Chronically-Homeless Patients is an easily identifiable issue. Especially since California recently passed a law that requires discharge of homeless patients only to a safe and appropriate location—can you imagine? More to come on this in the future.
  • Eliminating Barriers to AED Use seeks to make AEDs more universally available and their use less restricted. Clearly this would benefit those patients of ours who suffer an out-of-hospital cardiac arrest.
  • Support for a National Registry for Advance Directives would provide a solution to an issue that many of us have experienced—the treatment of a patient in the ED from out of state who has altered mental status and is critically ill. Access to such a registry would provide very helpful information in guiding our treatment.
  • Increasing Patient Access to Sexual Assault Nurse Examiners strikes a chord with those of us who do not have such access. This would not only expedite the treatment of our patients who are sexually assaulted but also provide more consistent and thorough and compassionate care, while also standardizing evidence collection.
  • Mandatory Reporting seeks to oppose the mandated reporting of entire classes of patients and diagnoses unless there is compelling evidence that a serious public health or safety risk is present. EHR systems that automatically report these based on the diagnosis code could lessen this burden.

Other issues with enthusiastic discussion without formulation into specific resolutions include:

A board of trustees report on violence prevention. There were resolutions addressing the need to curb media coverage of mass shootings, more and better regulation of firearms in general and opposition to unregulated non-commercial firearm manufacturing such as 3-D printers.

The opioid epidemic generated a lot of discussion, especially MAT as an alternative. This topic is especially important for EDs that are now offering MAT.

With the rate of medical student and physician suicides continuing to rise, there is much interest in trying to better define the issue and its causes, as well as to provide some solutions now, such as a hotline. This whole issue will continue to percolate for the near future.


We in the Emergency Medicine Community need to remember that the AMA is still the largest and most effective advocacy organization for physicians. Individually we can choose not to join and participate, but we do so at our own peril because the AMA is still the dominant physician organization.

Please consider becoming a member, because representation is based on membership. The Emergency Medicine Section Council is becoming a respected, credible voice for Emergency Medicine in the AMA and the House of Medicine.


1) Becker’s Hospital Review E-Weekly, June 5, 2017


Dr. Carius is an alternate delegate to the AMA from Connecticut. He is also a past president of ACEP, and an executive editor for Emergency Physicians Monthly.

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