Awesome Conference, Awesome Leaders, Awesome Advocacy Opportunities. |
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Last weekend, we wrapped up our first and, while successful and enjoyable, hopefully last virtual annual conference. A word of wisdom: Planning and executing a virtual event is far more strenuous than the real deal.
I am incredibly grateful to our speakers and their wonderful presentations. Dr. Scott Hickey gave his last annual President's Update (link below), and I was especially impressed by our Resident Rapid Fire Talks. Virginia's academic programs are generating top-tier talent in emergency medicine.
We also installed a new VACEP president, Cameron Olderog, MD, FACEP. The U.S. Army vet and Inova emergency physician is the first woman to hold the role since 2012 and, while we haven't checked the records, can likely say she's the first (or at a minimum, one of few) to also maintain a cattle/pig/chicken farm in Northern Virginia. Oh, and she and husband Chris have three kids. Get to know her here. Cameron is...kind of a badass.
Completing the leadership updates for the 2021-2022 year, Drs. Randall Myers and Jesse Spangler have been elected the Board of Directors. Dr. Jon D’Souza has stepped down from his position on the Board to accept a new job in Maryland (we'll miss you!). To fill his seat, the Board elected Dr. Courtney Zydron. The Board also elected Dr. Todd Parker (formerly Secretary-Treasurer) to President-Elect and Dr. Trisha Anest to Secretary-Treasurer. The Board also voted to elect Past-President, Scott Hickey, to a fourth term to last while Dr. Olderog is President.
This time last year was quite different. We were doing many of the same things — advocating during General Assembly, welcoming new leadership, and finalizing our follow up on the conference. But at the same time, I was tracking news of a coronavirus outbreak in China (and planning a soon-to-be-cancelled spring trip to Japan). While this last year has been intense, it has shown our strength as an organization. I look forward to what the next 12 months will bring!
– Sarah Marshall
VACEP Executive Director
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Frontline EM Advocacy opportunities
As the General Assembly session comes to a close, we are continuing our work on the Medicaid budget amendment and planning for future work on scope of practice, the MedMal cap, and a naloxone workgroup, among other issues.
Opportunities to be involved in emergency medicine advocacy continue to increase. In particular, there will be new state workgroups with significant EM involvement starting this summer. As we share them with this group, please let us know if you or one of your colleagues would be a good fit.
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Get On Our Level: The 2021 President's Update |
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It's been quite a year in emergency medicine in Virginia — both in the ED and out of it. Our 2021 President's Update will, in a half hour, bring you up to speed on where we are today, and where we’re headed. It was delivered by Scott Hickey, our now Immediate Past-President, as last weekend's Virtual CME Conference.
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"Be a leader in your work, and in your lives."
An Inspiring CME Keynote of Emergency Physician Leadership
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In what Dr. John Burton noted is "an entirely different tack" for a keynote address, the Chair of the Department of Emergency Medicine at Carilion Clinic reflected on the qualities of some of history's most notable leaders during difficult, trying journeys. It is an awesome, timely message that offers viewers and listeners insight on the skills necessary to sustain one through challenges. While the message will resonate with emergency physicians and healthcare leaders, it should appeal to all who want to learn from historic leaders Dr. Burton profiles: explorer Ernest Shackleton, abolitionist Harriet Tubman, Army vet Richard Winters, and statesman Winston Churchill.
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Honoring Present and Future
Emergency Medicine Leaders
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Also at VACEP '21, we honored three Emergency Physician members for their contributions to emergency medicine in Virginia. Brief write-ups are below, but you can learn more about their involvement from the President's Update; the video link at the button is queued up to the awards section. |
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(If video doesn't auto-start at the awards section, fast forward to 17:20) |
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J. Michael Joyce, MD
John P. McDade Research Award | Post-Graduate Category
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Dr. Joyce received the award for his work surrounding the virtual teaching/tele-proctoring of resuscitative transesophageal echocardiography at the VCU School of Medicine. View his abstract on the subject here.
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Joran Sequeira, MD, FACEP
Rising Star Award
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Engaged from the get-go after four years with VACEP, Dr. Sequeira got involved through the first Leadership and Advocacy (L&A) Fellowship. She has become an advocate for mental health issues, serving on a number of state work groups, and regularly jumps in as a spokeswoman for VACEP. Dr. Sequeira is an incredible asset and a role model for other young emergency physicians. She will continue to rise as a leader in emergency medicine both in Virginia and across the country. |
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William “Doug” Browder, MD, FACEP
Medical Director of the Year Award
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As medical director for Sentara Leigh’s emergency department in Norfolk, Dr. Browder transformed the department into one of the top-performers in the country. He has demonstrated incredible success in patient throughput and projects such as optimizing the admission process. "It is no question that he is not only deserving, but is also a role model for other medical directors," his nominators wrote.
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Speaking of Dr. Sequeira, she authored an op-ed that ran this month in the Daily Press (Tidewater area): Fix state Medicaid reimbursement policy to address inequality. The piece is meant to bring to light the damaging ER Utilization program and encourage lawmakers to end the policy (more on this policy below). Writes VACEP's Rising Star:
As we confront the legacy of racial inequity and attendant health disparities, it’s antithetical for Virginia to espouse equity and then codify policy that may perpetuate it by potentially limiting Medicaid patients’ access to emergency care. Now is the wrong time to do this when public reliance on social safety net programs such as Medicaid is rising — alongside the need for fully staffed emergency departments to meet patient needs — during the pandemic.
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You Came, You Saw, You CME'd. |
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Thanks to all who joined us for the 2021 Annual CME Conference. For attendees, video recordings and slide deck PDFs are available under each section in the virtual event platform. The content, including the videos and the Exhibit Hall, will be available until Wednesday, March 3, 2021. Please take one more virtual walk through our Exhibit Hall to thank our sponsors for their support!
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The Latest from the General Assembly Frontline. |
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The virtual session of the oldest continuous law-making body in the Western Hemisphere (that'd be the General Assembly, est. 1619) concludes on March 1 (Monday). As you know, we have been tracking multiple issues that can impact — and indeed, are currently impacting — emergency medicine in Virginia. Here are critical bills we monitored. Thanks to the many members who responded to our "Action Alerts" and sent messages to lawmakers advocating or opposing certain bills. The work continues, but for now:
ER Utilization Budget Item
The General Assembly declined to act and did NOT remove the offending language in the budget. Background: In July 2020, Virginia implemented the Medicaid ER Utilization program, penalizing emergency physicians and hospitals by automatically downcoding any condition found on a list of 790 Medicaid claims. More on the issue here, along with a video overview from the Virginia Hospital & Healthcare Association. Originally, we proposed a replacement solution to the program. While VACEP and our allies continue to favor the full elimination of the ED utilization penalties, in the final days of the 2021 General Assembly, we asked Virginia lawmakers for a suspension of the program due to the COVID-19 pandemic.
Medical Malpractice Cap Elimination | SB1107
The bill, passed by indefinitely and therefore dead for the year, would have eliminated Virginia’s medical malpractice cap. Caps dictate the maximum amount that a patient, family, and their attorney can recover in a medical malpractice lawsuit. Caps make medical malpractice insurance affordable and ensure access to quality patient care. However, it should be noted that there is a clear feeling in the General Assembly that this issue needs to be revisited, despite us being only eight years into a 20-year deal with the trial lawyers. This issue will be studied in the interim, and we expect to see legislation again in 2022.
Scope of Practice/Nurse Practitioners | HB1737
We opposed a bill (which passed) that will reduce from five to two the number of years of full-time clinical experience a nurse practitioner must have to be eligible to practice without a written or electronic practice agreement. We were able to attach a sunset clause to the bill, which means without further action from the legislature, on July 1, 2022, the clinical requirement will revert back to five years. This gives the Department of Health Professions time to finalize their three-year report on NP independent practice that is due in November. We expect we will have to fight this issue again in the 2022 session.
Scope of Practice/Certified Nurse Midwives | HB1817
After being placed into conference to work out differences between the House and Senate, a bill is likely to pass that will allow Certified Nurse Midwives (CNMs) to deliver babies in all settings, including the home, with 1,000 supervised hours after graduating from a CNM program and obtaining a practice license. Adding 1,000 hours was the compromise reached by legislators. However, we were disappointed a re-enactment clause wasn’t kept, which required the bill to pass again in 2022 before it becomes law. Language around a DHP study was also not kept.
Naturopath licensures |HB2272
The bill, dead for the year, would have licensed naturopaths in Virginia and allowed them to practice outside their education and training. We opposed.
Naloxone and opioid use workgroup amendment|HB2300
We supported a bill after it was amended to make it permissive and not mandatory. The bill passed, and requires hospitals to include language in their protocols about options physicians can employ when discharging a patient after an opioid overdose. The bill also creates a workgroup to examine best practices in the emergency department for treating and discharging individuals experiencing an opioid-related emergency, such as an overdose. We'll have more to share soon, and will be in need of members to serve on the workgroup.
When these bills were introduced, VACEP opposed because they would have added an arbitrary 90-day submission for claims. However, we were able to defeat two of the bills, and they will instead be sent to the Health Insurance Reform Commission to be studied in the interim. The one bill that passed, SB1289, was stripped of the language we opposed and now only includes anti-discriminatory language.
Special thanks to VACEP lobbyist Aimee Perron-Seibert for her hard work (and hundreds of hours on Zoom and watching virtual meetings), along with these recaps.
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VACEP advocates on behalf of you and your emergency department colleagues on issues that matter. Each year, we ask all members to "Give an Hour" ($150), or more, to help us support candidates who support us. Give now to the Emergency Medicine Political Action Committee (EM-PAC/VA). |
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Get Involved With VACEP's 10 Under 10
We've outlined 10 Things you can do in 10 minutes to get more involved with VACEP and ACEP. Technically, one of the things takes a half hour, but who's counting, really?
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A quick 11th? Dana Ramirez, MD is a pediatric emergency medicine physician at Children's Hospital of The King's Daughters in Norfolk. She and others at CHKD are seeing significant mental health effects on children secondary to the pandemic and to being out of school. Dr. Ramirez, a member of the school re-opening task force for the Virginia Chapter of the American Academy of Pediatrics, is gathering anonymous information from emergency physicians across the state to learn what they are seeing in pediatric patients.
The survey takes 5 minutes or less. Help a doc out!
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Who should conduct Temporary Detention Order evaluations in VA? A VACEP-supported report is published. |
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Under orders from the General Assembly, a Workgroup within the Department of Behavioral Health and Developmental Services (DBHDS) reviewed the current process for conducting temporary detention order (TDO) evaluations and developed a comprehensive plan to expand those who may conduct them. The final report, authored in part by members of VACEP, was published in January.
Among the recommendations, Emergency Physicians are outlined as qualified professionals who should conduct TDO screenings.
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Special thanks to VACEP’s Bruce Lo, MD, MBA, FACEP; Jared Goldberg, MD, FACEP; Jonathan D’Souza, MD, MBA, FACEP; and lobbyist Aimee Perron-Seibert for serving on the TDO Evaluator Workgroup. |
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Get ACEP's Wellness Resources |
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The COVID-19 crisis is uniquely exhausting. It’s vital to prioritize your own mental health — and this is an especially vulnerable time of year in an extremely stressful environment. Take advantage of these resources whenever you need them:
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Did you know your ACEP membership comes with three free counseling or coaching sessions available through phone, text or online chat? And for a small extra fee, you can add on financial and/or legal assistance.
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The Physician Wellness Hub can help you find the right support, whether you’d like to talk with a peer or a professional counselor.
It’s a great time to gently check in with your friends, family and colleagues. Worried about saying the wrong thing? Read these peer support basics.
Want to remind your team about on-site support options? Create a mental health care access map. Already have one? Resend the map so your coworkers know how to find support during the challenging weeks ahead.
ACEP hosted two Theater of War performances in 2020 and recently partnered with the Infectious Disease Society of America on a podcast discussing how these performances can help EM physicians process the unprecedented hardships of working in the ED during a pandemic. Learn more.
Litigation Resources
Most physicians will be sued during their career, and the experience – or even just the prospect of being sued – can be very stressful. On top of that reality, COVID-19 presents new concerns that could make it even more complicated. These resources are here to help.
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VACEP Fellowship Opens Soon |
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Applications open soon for the 2021-2022 Leadership & Advocacy Fellowship. Be thinking about good candidates for the next cohort and share the application information when it goes live next month.
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Also, ACEP’s Leadership & Advocacy Conference (LAC) has been rescheduled for July 25-27, 2021. Please share this link with your colleagues and encourage them to register. |
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VACEP Lit Review: CDC Update to Sexually Transmitted Infection (STI) Treatment |
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Here's your case: A 25 year-old-male presents with yellowish discharge from his penis for the past three days. It is associated with a burning pain with urination. He has no testicular pain, abdominal pain, fever, rash, or vomiting. He is sexually active with three partners in the last three months, and he occasionally employs barrier protection. You suspect a sexually transmitted infection, and the patient prefers empiric antibiotic treatment in the ED, while awaiting results of his urine nucleic acid amplification testing for gonorrhea and chlamydia.
What medications do you administer?
UVA Health System emergency physician and affiliated med school associate professor Joshua Easter will help you answer based on new guidelines from the CDC.
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Most salient to us as emergency physicians is that the CDC now recommends administering ceftriaxone 500 mg IM for uncomplicated urogenital, anorectal, and pharyngeal gonorrhea. In addition, if chlamydia infection has not been excluded, they recommend administering doxycycline 100 mg PO for 7 days. These represent changes from the prior standard of administering 250 mg IM ceftriaxone for gonococcus and 1 g PO azithromycin or doxycycline 100 mg PO for 7 days for chlamydia (CDC, 2015).
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VACEP members are invited to share their readings and reviews on the latest emergency medicine medical literature. If you read a study and have time to write a short, easy-to-digest review for your EM peers, we'd love to share it. Email us to get started.
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SAVE THE DATE
READ
Catch up on Regs and Eggs:
ABEM issued a statement in response to requests to eliminate the Oral Certification Exam. You can read the entire statement here.
New Resource: ACEP's Health IT Committee revamped the EHR page on the website to help you tackle common issues that cause frustration on the job.
Addressing ED Violence: Rep. Joe Courtney (D-CT) and a bipartisan group of co-sponsors just re-introduced legislation to address ED violence that ACEP has long supported. Read the ACEP and ENA joint statement applauding this bill. If you would like to publicly share a personal story about your experience with ED violence please reach out to Steve Arnoff at sarnoff@acep.org.
LISTEN
Calling all podcast fans - check out these new episodes:
WATCH
Watch the recap of the latest Capital 30 Minutes for updates on ED violence bill reintroduction, COVID relief, ACEP's meeting with OSHA about PPE and the latest on surprise billing implementation.
DOWNLOAD
Check out this Pediatric Education and Advocacy Kit (PEAK) developed by the Emergency Medical Services for Children Innovation and Improvement Center (EIIC). ACEP is a proud partner in this project.
DEADLINES
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Virginia College of Emergency Physicians | (804) 297-3170 | E-mail | Website
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