The lovely and unique Honolulu Convention Center was the scene for the annual gathering of the American Medical Association House of Delegates 2012 Interim Meeting. This meeting was dedicated primarily to the discussion of advocacy issues. Although getting to Honolulu can be a stressful activity, especially for those on the East Coast on the heels of Hurricane Sandy, there was good attendance by every sector of medicine. Emergency physicians were well represented by ACEP’s five delegates and five alternate delegates and by AAEM’s representative. There were also some 60 additional emergency physicians and medical students involved in a range of sections, from state societies to residents and fellows to organized medical staffs. It was encouraging to see young emergency physicians and residents and medical students interested in emergency medicine taking activist and leadership roles in the AMA.

The meeting brought discussion on a wide range of topics. There was a potpourri of resolutions considered, 55 in all, plus some 28 well-researched and informative board and council reports. Issues discussed and approved that might be of interest to the emergency physician community included the following:

01 A board report on the principles for physician employment, which included a discussion of employment relationships, including contracting, conflicts of interest, peer review and evaluations, payment agreements, and medical staff membership, important considerations for employed emergency physicians, which may increasingly be the norm in the future.

02 A board report on violence in medical and non-medical environments, including the ED, which espouses violence prevention measures, condemns violence against physicians, and reaffirms AMA support for state legislative efforts directed against violence in the workplace.

03 A resolution seeking a more uniform approach to assessing patients for controlled substances for pain relief. As most EPs are very aware, we are frequently placed in the untenable position of having to refuse chronic pain patients requested narcotic analgesics without there being clear standards to back up our decisions. Creating safe harbors would be a step in the right direction.

04 A resolution seeking incentivized use of integrated electronic patient care reports for prehospital providers, which would be of great benefit to emergency physicians caring for patients arriving by EMS. One of the greatest annoyances in emergency medicine is the lack of timely accessibility of EMS information after the patient has been delivered to the ED.

05 A resolution seeking a study to identify and evaluate appropriate metrics for use by hospital-based specialties within the Value Based Payment Modifier (VBPM) initiative. This will likely impact emergency physician practices by identifying appropriate performance quality measures.

06 A resolution seeking harm reduction strategies for patients at risk of opioid overdose, including appropriate education of at-risk patients and their caregivers and risk mitigation methods and appropriate treatments for patients at risk for opioid overdose.

07 A council report on national drug shortages addressed the current status and complexities of shortage monitoring. This drug shortage problem will likely increase without additional government regulation or a change in financial incentives to produce these drugs.

08 A resolution to educate children and adults to never use medications prescribed for other individuals, the source of many intentional and inadvertent drug overdoses.

09 A resolution to support entry into ACGME accredited residency and fellowship programs from either ACGME-accredited programs or AOA-accredited programs, which has great potential for opening up allopathic fellowship training to osteopathic residency graduates.

I have said it before and I will say it again: We in the emergency medicine community need to remember that the AMA is still the largest and most visible and effective advocacy organization for physicians, whether we like it or not. Individually we can choose not to join and participate, but we do so at our own peril. Please consider becoming a member, because representation is based on membership.

Michael Carius, MD
AMA Delegate from Connecticut


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