Wednesday, August 13, 2014

Message from the President: Coalition for Quality Hospital Care

Dear members,

I wanted to update you on an escalating issue of concern to our members in California and nationwide. As many of you know, AAEM has voiced its strong opposition to Tenet Health's plan to replace emergency medicine, anesthesiology, and hospitalist groups at up to 11 hospitals in California with one out-of-state physician staffing company, using the profitable emergency medicine contracts to eliminate their anesthesiology and hospitalist subsidies (see my recent President's Message on the topic).

In addition, on July 11, I sent a letter to Tenet on behalf of our organization detailing our concerns (PDF). The letter states that AAEM believes Tenet's plan is "bad for Tenet, bad for its hospitals, bad for its physicians, bad for its patients, and likely runs afoul of federal fee-splitting laws and California's corporate practice of medicine laws." If Tenet moves forward with its plan, other hospital networks may be emboldened to take a similar approach in other parts of the country as well.

The leaders of several groups affected by the current scheme have contacted AAEM and asked for our assistance. I have spoken at length with many of these physicians; have sent letters outlining AAEM’s concerns to the relevant hospital leaders, hospital boards, and medical staffs. Recently, a coalition of concerned physicians, the Coalition for Quality Hospital Care, has been formed and has contacted us for assistance - the Coalition seeks to inform as many physicians as possible about this issue and generate more support against Tenet's plan. The Coalition is not asking for monetary contributions - but requests that AAEM members show their support by joining the coalition. The larger the group voicing concern, the greater chance we have to defeat Tenet's plan.

Time is running out for these physician groups. Tenet plans to meet with the chief executives of its California hospitals on August 31st to address this issue and then a decision is expected shortly thereafter. If you would like to show your concern about Tenet's plan, please take a moment and join the coalition at Thank you for your continued attention to this issue.

Mark Reiter MD MBA FAAEM
President, American Academy of Emergency Medicine

Wednesday, August 6, 2014

Fluids used in Fluid Resuscitation: "There's Nothing Normal About Normal Saline"

David Farcy, MD FAAEM FCCM, Chairman, Department of Emergency Medicine at Mount Sinai Medical in Miami Beach, Florida, speaks with Peter DeBlieux, MD FAAEM, Professor of Medicine at Louisiana State University Health & Science Center in New Orleans.

In this episode, Drs. Farcy and DeBlieux discuss the fluids used in fluid resuscitation including isotonic crystalloids and albumin.

Leave your comments below!

Monday, August 4, 2014

Top 5 Reasons to Review for Oral Boards with AAEM

1. Course format simulates, as closely as possible, the oral board certification exam.

2. One-on-one examiner to participant encounters — just like on exam day.

3. Same great course offered in six locations to reduce travel time and cost to participants.

4. Reasonably priced — lunch included each day for all course participants. Breakfast included each day for those who stay at the course site hotel

5. Practice both single AND multiple patient case encounters.
  • On ABEM exam day, you'll be tested on seven patient encounters: five single patient cases and two multiple patient cases.
  • Over the two days of the AAEM course you will participate in 12 single-case encounters and four multiple-case encounters. That's nine extra case encounters to help you feel confident! 

Thursday, July 24, 2014

We Asked and You Responded - And Then Some

View from the Podium

When we asked via Twitter and email for your input on the 2015 AAEM Scientific Assembly in Austin, Texas (scheduled for February 28–March 4), nearly 40 people responded and gave us more than 75 possible topics and speakers. Now it’s up to the Scientific Assembly Subcommittee to make the hard decisions: what tracks, what topics, what speakers?

Although I was in charge putting together the Scientific Assembly from 2001 through 2006, as AAEM surged to the forefront of education in emergency medicine, a lot has changed since then. New young educators from the third generation of emergency physicians have burst onto the education stage, demonstrating new ways of teaching and learning. The Free Open Access Medical Education (FOAMed) movement has quickly assumed a major role in the day-to-day — and sometimes hour-to-hour — education of emergency practitioners. Shorter didactic session times have become the norm. Adult learning principles such as “Flipping the Classroom” are now common.

Wednesday, July 9, 2014

Tenet Wants Emergency Physicians to Subsidize the Rest of the Hospital

Mark Reiter, MD MBA FAAEM
AAEM President

AAEM President’s Message: Tenet Wants Emergency Physicians to Subsidize the Rest of the Hospital

Tenet Health, one of the largest hospital networks in the country with 49 hospitals, recently put the contracts out for bid at 11 of its hospitals in California, to replace their emergency medicine (11), anesthesiology (11), and hospitalist (5) groups. Currently, most of the hospitalist contracts and some of the anesthesiology contracts include a subsidy from Tenet, while most of the emergency medicine contracts generate enough revenue through collected professional fees to be entirely self-supporting and quite profitable. According to some of the local groups involved, Tenet made it clear to the large contract management groups (CMGs) it is soliciting that it is looking for a no-subsidy arrangement for all 27 contracts (three specialties at 11 hospitals). Essentially, Tenet wants the profits from the emergency medicine contracts to cover its losses on the hospitalist and anesthesiology contracts. As only the largest CMGs can even hope to staff 27 new contracts at once, it looks like many local emergency medicine, anesthesiology, and hospitalist groups will be tossed out. This situation parallels the hospital-CMG joint ventures I wrote about a few months ago, since it is another attempt by hospitals — like CMGs — to feast on the professional fees of emergency physicians.

In the past, the quality of the care provided by a medical group was of paramount important to the hospital. But for Tenet Health, a for-profit hospital network, it appears that minimizing expenses and maximizing profit trumps everything else. Tenet earned a profit of $387 million in the first quarter of 2014. Perhaps by destroying the medical practices at 11 hospitals, Tenet will be able to cut its hospitalist and anesthesiology subsidies by a few million dollars in future quarters and make its investors happy. Of course, many of these groups have served their hospitals and their communities well for decades and built strong, productive relationships with their medical and nursing staffs. I’ve been told that many hospital CEOs are very supportive of their local medical groups, but the decision to put the contracts out for bid was made at Tenet’s headquarters in Dallas. Tenet’s corporate executives are not so easily swayed by simply providing excellent care — not when there is a chance to squeeze out more profit for investors and corporate officers.

Thursday, June 19, 2014

New Podcast: Health Information Exchanges

Health Information Exchanges
In this Policy Prescriptions® edition of the podcast, Cedric Dark, MD MPH, Assistant Professor of Medicine at the Emergency Medicine Residency Program at Baylor College of Medicine, speaks with Dr. Ellana Stinson, a practicing emergency physician in Boston, MA, and Dr. Jason Shapiro, Associate Professor and Chief of the Division of Informatics in the Department of Emergency Medicine at Mount Sinai Hospital. The discussion points include: a review of the article "Does Health Information Exchange Reduce Redundant Imaging?: Evidence from the ED," EMR versus HIEs, regional sizes and accessibility of HIEs.

Read Dr. Stinson's article on the Policy Prescriptions blog: "To scan or not to scan: Can health information exchanges help deter emergency departments from ordering unnecessary imaging tests?"

Leave your comments below!

Wednesday, June 4, 2014

Ultrasound Should be Integrated into Undergraduate Medical Education Curriculum

Photo Owned by Ashika Jain, MD
AAEM Clinical Practice Committee Statement
Ultrasound Should be Integrated into Undergraduate Medical Education Curriculum (5/30/2014)

 Visit the Clinical Practice Statement page on the AAEM website.

Chair: Steven Rosenbaum, MD FAAEM

Authors: Lisa D Mills, MD FAAEM
                Zachary Soucy, DO FAAEM

Reviewers: Ashley Bean, MD FAAEM
                   Jack Perkins, MD FAAEM

Reviewed and approved by the AAEM Board of Directors (5/30/2014).

Policy Statement:
It is the position of the American Academy of Emergency Medicine that ultrasound should be integrated into the core curriculum of undergraduate medical education.

Medical diagnostic ultrasound has been used by various specialties since the 1950s. Contemporary point of care ultrasound (POCUS) was first researched and utilized by emergency physicians in the mid 1980s. Emergency physicians have formally defined and pioneered POCUS over the past two decades. Research in a broad array of applications indicate improved patient care via procedural safety and success (11,13,17), improved diagnostic accuracy (20,21,22), decreased procedural pain (8), decrease time to critical interventions (11, 22), and decreased time to discharge (3). The practice of POCUS continues to grow. In the most recent decade there is an expanding role for POCUS across many specialties in medicine. As hospital wide ultrasound application has increased many healthcare institutions struggle to meet the growing educational needs of faculty and residents to obtain standardize ultrasound training. In addition, multiple specialties have POCUS fellowships and specialized POCUS training during other fellowships.