Health Policy Checkup
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ResidentOfficial Publication of the Emergency Medicine Residents’ Association February/March 2017 VOL 44 / ISSUE 1 Health Policy Checkup pg 8 Updates on Single Accreditation System pg 5 Inside Hurricane Matthew pg 16 We celebrate your achievements! Cheers to the recently matched medical students! Welcome to the specialty! We also celebrate current EM Residents on Resident’s Day, March 1st, 2017. We appreciate your hard work and dedication. • Opportunities for professional development and career advancement. Programs for residents, such as our Earn While You Learn Program. • A network of more than 14,000 EmCare affiliated clinicians • Rural or urban, low or high volume locations • More than 40 years of physician practice management experience • We are committed to your success and finding you the right fit! EmCare looks forward to supporting you throughout your career. Contact us today! Contact the Alliance and South Divisions at: 727.437.3052 or 727.507.2526 [email protected] Letter from the Editor Abby Cosgrove, MD Editor-in-Chief, EM Resident Washington University in St. Louis St. Louis, MO Dealey Plaza, site of Kennedy assassination couldn’t stop staring at the eerie photo off his left ring finger. The memories, even account for the needs of its residents, I had just taken from the 7th floor of to this day, are exhausting to relive. Maybe initially leaving them without any Ithe Texas School Book Depository, it wasn’t so different after all. dedicated educators, causing them to halt peering out over the intersection of Elm While we continue to suffer through their interview season and placing them at and Houston. I was standing in almost the tragedy, loss, and enormous grief within risk of losing their GME funding. exact location from where President John the walls of our own trauma bays today, Your EMRA Board of Directors was F. Kennedy had been assassinated on Nov. we are blessed with countless life-saving deeply distressed by this situation and 22, 1963. I could almost see the black car pharmaceuticals, medical devices, wrote an open letter expressing our speeding away to Parkland Hospital, Jackie and technologies that were completely concerns. Excerpts from this letter, along Kennedy, in her blood-stained pink suit, unheard of just 50 years ago. But we are with a Q&A with Summa’s new program crawling desperately over the back seat. also burdened by administrative and director, can be found on page 6 of this One visit to the Sixth Floor Museum systemic nuances that have attributed issue. This is not the first time EMRA has in Dallas this past December, and I to alarming rates of physician burnout gone to bat for the residents and medical was hooked. Hooked on the gruesome and fatigue. Surely Dr. Jones did not students it represents, and it certainly will Zapruder film, the conspiracy theories, encounter issues of intense overcrowding, not be the last. After all, advocating for your the fears and hopes played out by the boarding psychiatric patients, battles over needs is one of the three pillars upon which American people, and the steaming pot fair reimbursement rates, intense fears of this organization stands. of current affairs that boiled over into one litigation, or feelings of exploitation and Especially during the presidential of the most notorious crimes of the 20th loss of professional autonomy. transition, and at a time when the future century. It was all-consuming. As emergency medicine physicians of the American health care system is as Of course I couldn’t help but think in training, we spend every day trying unclear as ever, we will continue to fight about what the scene must have been like to master the knowledge and skillset for what is right and just. I would thus in Trauma Room 1 shortly after that fatal required to become excellent clinicians encourage you to become involved with shot. The account of the hospital operator capable of caring for any patient (or God EMRA’s advocacy initiatives (see p. 4, 9) frantically overhead paging any available forbid President of the United States) and to attend ACEP’s Leadership & doctor to the emergency room (to which who enters the doors of our emergency Advocacy Conference, March 12-15 in two general surgeons in the cafeteria department. But as in politics, every day Washington, D.C. decided to respond) is almost ludicrous we are also trying to learn within a practice After all... compared to the automatic trauma team environment that is increasingly driven by “It is not the critic who counts; not the man activations of present day, not to mention money, policy, and power. And sometimes who points out how the strong man stumbles, or the automatic presence of board-certified these two worlds collide. where the doer of deeds could have done them better. The credit belongs to the man who is emergency medicine physicians. It could This is exactly what happened to the actually in the arena, whose face is marred by not have been more different. the emergency medicine residents at dust and sweat and blood; who strives valiantly; Then I read an interview with Dr. Summa Akron City Hospital in Akron, who errs, who comes short again and again… Ronald Jones, a chief surgical resident at Ohio, this past January, who found who spends himself in a worthy cause; who at the time, who recounted the details of the out with 4 days’ notice that their entire the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at event he still remembers so vividly: the faculty and program director were being least fails while daring greatly, so that his place President’s lifeless stare, the restrictive replaced after a failed contract negotiation. shall never be with those cold and timid souls back brace they struggled to remove, the Unfortunately, this transition of contracts who neither know victory nor defeat.” wedding ring that Jackie Kennedy slipped led by hospital administrators did not Stay strong out there, my friends. February/March 2017 | EM Resident 1 TABLE OF CONTENTS EDITORIAL STAFF Categories EDITOR-IN-CHIEF Abby Cosgrove, MD COVER STORY Washington University in St. Louis PRESERVING THE SAFETY NET SECTION EDITORS 8 What is the CRITICAL CARE Maite Huis in ‘t Veld, MD True Cost of Michele Callahan, MD the Uninsured? University of Maryland As rumors grow, uncertainty ECG mounts about the future of Zachary S. Wilson, MD our country’s health care Icahn SOM at Mt. Sinai safety net, particularly for EMS the uninsured. Jeremy Lacocque, DO Midwestern University PRESIDENT’S MESSAGE HEALTH POLICY HEALTH POLICY Call to Action. The 21st Century Joshua Enyart, DO 4 10 Lehigh Valley Health Network Use Your Voice! Cures Act We, as EM residents, are the Big Pharma MEDICAL STUDENT future of emergency care in Handout Thomas Eales our country. or Drug Des Moines University Development Boon? PEDIATRICS LEADERSHIP REPORT Kaia Knutson, MD 5 The Single Kyra Reed, MD Indiana University Accreditation System CLINICAL — MENTAL HEALTH ULTRASOUND How It Is Di Coneybeare, MD 14 Assisted Outpatient Affecting AOA New York University/Bellevue Therapy for Residencies and Fellowships Psychiatric Patients EDITORIAL COMMITTEE Balancing Jennifer Beck-Esmay, MD Public Health New York University/Bellevue and Personal Freedom Marvinia Charles, MD Baylor Scott & White, Irving TX 6 Lucia Derks, MD University of Cincinnati DISASTER MEDICINE Aryeh Lapin, MD LEADER REPORT St. Luke’s-Roosevelt, New York 16 When Disaster Strikes Blending the Business of EM Resident (ISSN 2377-438X) is the bi-monthly Health Care magazine of the Emergency Medicine Residents’ with the Association (EMRA). The opinions herein are those of the authors and not of EMRA or any institutions, Practice of organizations, or federal agencies. EMRA encourages Medicine readers to inform themselves fully about all issues presented. EM Resident reserves the right to edit all material and does not guarantee publication. Crisis Management from © Copyright 2017 Emergency Medicine Residents’ Association Inside Hurricane Matthew UPCOMING EVENTS February 15 PEDIATRICS CLINICAL EMRA Committee & Division 20 Passport to Health 30 Fight Bites Vice-Chair Applications Due And Other EMRA Medical Student Council Human Bite Applications Due Injuries February 22 In-Training Exam NRMP Rank Order List deadline March 1 EMPOWER Emergency Medicine Residents’ 32 Sharing Our Appreciation Day March 3 Challenges of Caring for Stories Undocumented Children Bill Jaquis, MD, FACEP SIMWars Team Registration Deadline for in the Emergency Department Competition at SAEM Annual Meeting March 12–15 ACEP Leadership & Advocacy Conference CLINICAL/INFECTIOUS DISEASE RESIDENT EDITORIAL March 17 22 CNS Toxoplasmosis 33 Can I Take Your Order? Match Day Patient Satisfaction in EM April 3 Deadline for EMRA Resolutions @ SAEM April 27 CONSULT CORNER Chief Resident Symposium @ CORD 34 Radiology Academic Assembly “Consult Corner” is April 27–30 designed to help you CORD Academic Assembly, Nashville communicate effectively April 29–May 2 ULTRASOUND when seeking input from ABEM Spring Oral Certification Exam 24 Can’t Miss Killer other specialists. May 16–18 Essentials of Emergency Medicine, Las Vegas NEWS & NOTES May 16-19 36 Recognizing EMRA’s SAEM Annual Meeting, Orlando, Florida Leaders, #EMDocsRock, October 14–17 LAC, and more ABEM Fall Oral Certification Exam October 29–November 1 RESEARCH ACEP Scientific Assembly, The Role of Point-of-Care Ultrasound Washington, D.C. in Diagnosing Acute Aortic Dissection Rapid Research Review 38 November 6-11 An Initiative of the EMRA ABEM Qualifying Exam Research Committee TOXICOLOGY 26 Poisoned Pump VISUAL DIAGNOSIS Management 39 Diagnose this of Calcium Condition First Thursday of every month Channel Blocker Toxicity EMRA-Cast: ECG CHALLENGE GERIATRICS Listen at your 39 convenience 28 “I Feel Fine!” Approach to Abdominal Pain in the Geriatric Be sure to check EMResident.org Patient for exclusive online content! BOARD REVIEW Want to improve your CV? 41 Questions Write for EM Resident! Submit online at emresident.org.